From the Guidelines
The patient should be evaluated immediately for the axillary abscess, despite having a scheduled surgical follow-up, to prevent potential complications and ensure proper management. The patient's age and the location of the abscess in the axilla are significant factors to consider, as these can increase the risk of complications and poor outcomes if not managed promptly and effectively 1.
Current Situation and Recommendations
The patient presents with a draining abscess in the left axilla and reports a significant amount of pus-like discharge, but denies any fever, fatigue, nausea, or vomiting. Given the patient's age (88 years) and the location of the abscess, it is crucial to monitor for any signs of systemic infection or worsening of the local infection, such as spreading redness, increased pain, fever above 100.4°F, or red streaking from the site 1.
Management Approach
While waiting for the surgical appointment, the patient should keep the area clean with gentle washing using mild soap and water, followed by applying a clean, dry dressing that should be changed whenever it becomes soiled. Over-the-counter pain medication such as acetaminophen 500-1000mg every 6 hours (not exceeding 3000mg daily) can help manage discomfort. However, it is essential to prioritize the evaluation and potential intervention by a healthcare professional to address the abscess directly.
Considerations for Antibiotic Therapy
The decision to use antibiotics should be based on the presence of systemic signs of infection or specific conditions that increase the risk of complications, such as the patient's age, location of the abscess, or signs of severe infection 1. The Infectious Diseases Society of America guidelines suggest that adjunctive systemic antimicrobial therapy may be beneficial in conjunction with incision and drainage for surgical site infections associated with a significant systemic response 1.
Key Points for Management
- Immediate evaluation by a healthcare professional is recommended.
- Keep the area clean and apply a clean, dry dressing.
- Monitor for signs of worsening infection or systemic symptoms.
- Consider over-the-counter pain medication for discomfort.
- Antibiotic therapy should be considered based on clinical judgment and guidelines.
Given the most recent and highest quality evidence, the approach should prioritize the patient's safety and the prevention of potential complications associated with the axillary abscess, especially considering the patient's age and the nature of the infection 1.
From the Research
Patient Presentation
The patient is an 88-year-old female presenting with a draining abscess in her left axilla, with a significant amount of pus discharged during a dressing change. She denies any fever, fatigue, nausea, or vomiting and has a follow-up appointment with surgery scheduled.
Relevant Studies
- The use of prophylactic antibiotics, such as cefazolin, has been shown to reduce the risk of surgical site infections (SSIs) in various surgical procedures 2, 3, 4.
- A study on the use of single-dose cefazolin for pre-operative prophylaxis in orthopaedic oncology found it to be safe and effective in reducing SSI rates 4.
- An overview of Cochrane Reviews on intraoperative interventions for preventing SSIs found high- or moderate-certainty evidence for the effectiveness of prophylactic intravenous antibiotics in reducing SSI risk in certain surgical procedures, such as caesarean sections and hernia repair 5.
- A prospective open-label study on the use of single-dose prophylactic ceftriaxone in laparoscopic cholecystectomy found significant serum and tissue concentrations of the antibiotic, with a low rate of SSI (2%) 6.
Key Findings
- Prophylactic antibiotics can reduce the risk of SSIs in surgical procedures.
- Single-dose cefazolin may be effective in reducing SSI rates in orthopaedic oncology.
- The timing of prophylactic intravenous antibiotics is important, with administration before incision shown to be effective in reducing SSI risk.
- Patient factors, such as age and diabetes, may increase the risk of SSI.
Potential Considerations
- The patient's age and potential underlying health conditions may increase her risk of SSI.
- The use of prophylactic antibiotics may be beneficial in reducing the risk of SSI in this patient.
- Further evaluation and management of the patient's abscess and overall health status are necessary to determine the best course of treatment.