When to Consult Infectious Disease for an Abscess
For most simple cutaneous abscesses, infectious disease consultation is not necessary—incision and drainage alone is the definitive treatment. 1 However, ID consultation should be obtained for specific high-risk scenarios outlined below.
Simple Cutaneous Abscesses: No ID Consultation Needed
Incision and drainage is the recommended treatment for carbuncles, abscesses, and large furuncles, and systemic antimicrobials are usually unnecessary unless fever or other evidence of systemic infection is present. 1
- Most simple abscesses can be safely managed in the ambulatory setting with I&D alone, without antibiotics or specialist consultation 2
- Antibiotics are only indicated as an adjunct to I&D when the patient has SIRS criteria (temperature >38°C or <36°C, tachycardia >90 bpm, tachypnea >24 breaths/min, or WBC >12,000 or <4,000 cells/µL) 1
- For patients requiring antibiotics, an agent active against MRSA should be used in those with carbuncles, markedly impaired host defenses, or SIRS 1
When ID Consultation IS Indicated
Deep or Complex Infections Requiring Specialist Input
Consult ID for moderate-to-severe diabetic foot infections, as these require surgical specialist consultation and often complex antimicrobial management. 1
- Diabetic foot infections with deep abscesses, compartment syndrome, or necrotizing soft tissue infections require urgent surgical intervention and ID consultation 1
- Multidrug-resistant organisms (MRSA, extended-spectrum β-lactamase producers, carbapenemase-producing organisms) are more common in patients with recent antibiotic exposure, prior hospitalization, or chronic care facility residence—these cases warrant ID consultation 1
Neuraxial or CNS Infections
For any suspected neuraxial infection (epidural abscess) or brain abscess, consult ID immediately at the first sign of serious infection. 1
- Brain abscesses require neurosurgical aspiration or excision as soon as possible, combined with 6-8 weeks of IV antimicrobials—ID consultation is strongly recommended for antimicrobial selection and duration decisions 1, 3, 4
- Empiric therapy for community-acquired brain abscess is a 3rd-generation cephalosporin plus metronidazole, but ID expertise is needed for culture-directed therapy and management of complications 1, 3, 4
Recurrent Abscesses
Recurrent abscesses should prompt ID consultation to evaluate for underlying causes and guide decolonization strategies. 1
- Culture recurrent abscesses and treat with a 5-10 day course of an antibiotic active against the isolated pathogen 1
- Consider a 5-day decolonization regimen (intranasal mupirocin twice daily, daily chlorhexidine washes, and decontamination of personal items) for recurrent S. aureus infections 1
Severely Immunocompromised Patients
Consult ID for abscesses in patients with malignancy on chemotherapy, neutropenia, or severe cell-mediated immunodeficiency. 1
- Blood cultures and tissue cultures should be obtained in these high-risk patients 1
- Empiric broad-spectrum coverage may be needed, and ID can guide appropriate antimicrobial selection 1
Common Pitfalls to Avoid
- Do not prescribe antibiotics for simple abscesses without I&D—drainage is the definitive treatment, and antibiotics alone are insufficient 1, 2
- Do not miss MRSA coverage when antibiotics are indicated—MRSA accounts for 80% of S. aureus isolates in operatively drained abscesses 5
- Do not delay surgical consultation for deep infections, diabetic foot infections, or suspected necrotizing fasciitis—these require urgent intervention 1
- Do not overlook anaerobic coverage in breast abscesses (especially in diabetics), trunk/extremity abscesses in IV drug users, or perirectal abscesses—anaerobes represent approximately 23% of abscess pathogens 5