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    Abses DM

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    Angel Makin
    1) Diabetes mellitus increases susceptibility to infections like cutaneous abscesses which are infected nodules containing pus that commonly form in the groin, buttocks, and extremities. 2) Common causes of abscesses include MRSA, Enterococcus species, and Gram-negative bacteria. Abscesses usually develop from folliculitis, furuncles, or carbuncles and can form at sites of trauma, foreign bodies, burns, or IV insertions. 3) Incision and drainage is the primary treatment for skin and soft tissue abscesses along with antibiotic therapy. Oral antibiotics are usually sufficient for uncomplicated cases while intravenous antibiotics may be needed for

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    Abses DM

    Uploaded by

    Angel Makin
    23 views19 pages
    1) Diabetes mellitus increases susceptibility to infections like cutaneous abscesses which are infected nodules containing pus that commonly form in the groin, buttocks, and extremities. 2) Common causes of abscesses include MRSA, Enterococcus species, and Gram-negative bacteria. Abscesses usually develop from folliculitis, furuncles, or carbuncles and can form at sites of trauma, foreign bodies, burns, or IV insertions. 3) Incision and drainage is the primary treatment for skin and soft tissue abscesses along with antibiotic therapy. Oral antibiotics are usually sufficient for uncomplicated cases while intravenous antibiotics may be needed for

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    1) Diabetes mellitus increases susceptibility to infections like cutaneous abscesses which are infected nodules containing pus that commonly form in the groin, buttocks, and extremities. 2) Common causes of abscesses include MRSA, Enterococcus species, and Gram-negative bacteria. Abscesses usually develop from folliculitis, furuncles, or carbuncles and can form at sites of trauma, foreign bodies, burns, or IV insertions. 3) Incision and drainage is the primary treatment for skin and soft tissue abscesses along with antibiotic therapy. Oral antibiotics are usually sufficient for uncomplicated cases while intravenous antibiotics may be needed for

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    23 views19 pages

    Abses DM

    Uploaded by

    Angel Makin
    1) Diabetes mellitus increases susceptibility to infections like cutaneous abscesses which are infected nodules containing pus that commonly form in the groin, buttocks, and extremities. 2) Common causes of abscesses include MRSA, Enterococcus species, and Gram-negative bacteria. Abscesses usually develop from folliculitis, furuncles, or carbuncles and can form at sites of trauma, foreign bodies, burns, or IV insertions. 3) Incision and drainage is the primary treatment for skin and soft tissue abscesses along with antibiotic therapy. Oral antibiotics are usually sufficient for uncomplicated cases while intravenous antibiotics may be needed for

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 19

    DIAGNOSIS

    MANAGEMENT
    ABSES DM
    RSUD ENDE
    Juli 2022
    Diabetes
    Mellitus

    Diabetes mellitus (DM) is a clinical syndrome associated with


    deficiency of insulin secretion or action.

    DM has been associated with reduced response of T cells,


    neutrophil function, and disorders of humoral immunity.
    Consequently, DM increases the susceptibility to infections
    Abbreviations: Rx (Treatment), Abx (Antibiotics), Asx (Asymptomatic), SSTI (Skin and soft tissue infections)
    Abscess

    Cutaneous abscess is an infected nodule containing pus that


    occur within the dermis and subcutaneous space. They occur
    anywhere on the body; however, common locations for an
    abscess to develop are the groin, buttocks, axillae, and
    extremities. 
    Etiology

    01 02
    community-acquired methicillin
    resistant Staphylococcus aureus  (MRSA) – 44% Foreign body response (splinter,
    Enretococcus sp. – 9% ruptured inclusion cyst, injection sites)
    Gram negative ; Pseudomonas aeroginosa – 11%, – sterile abscess
    E. coli 7,2%
    Patogenesis

    Abscesses usually occur in folliculocentric infections, i.e. folliculitis, furuncles, and carbuncles
    that develop into abscesses. Abscess can also occurs at the site of trauma, foreign body, burn, or
    insertion site intravenous catheter.

    Abscess occurs due to the body's defense reaction from tissues to prevent the spread of infection
    in the body. Infectious agents cause inflammation and infection of cells in the environment,
    causing the release of toxins.

    The toxin causes inflammatory cells, white blood cells to go to the site of inflammation or
    infection. An abscess wall is formed to prevent infection from spreading to the other body parts.
    However, the encapsulation prevents immune cells from attack the causative agent of infection in
    the abscess
    Diagnosis In most cases, a cutaneous abscess can be diagnosed
    clinically on the basis of physical examination alone. 

    Sign & Symptoms :


    Laboratory and Imaging Test :
    - Tender red nodule forms
    - In time (day-weeks) - Leukocytosis
    - Pus collects within central space - Hypoechoic fluid pocket on ultrasound
    - Fluctuance of the central portion of lesion - Isolation of S. aureus on culture confirm
    - Warmth the diagnosis
    - Can occur at sites of trauma, foreign bodies,
    burns, or site of insertion of iv chateters.
    - Fever
    Differential Diagnosis

    Sellulitis
    Furunkel/Carbunkel
    commonly involves the lower
    limbs and in most cases is Develops arround hair follicle
    unilateral. 
    No Fluctuance
    Management
    incision and drainage
    antibiotic therapy alone is not sufficient for
    treatment
    In cases of
    antibiotic small fluid
    collections,
    Antibiotic usage after incision and drainage is only conservative
    recommended if management
    - the lesion is severe or associated with sellulitis with
    - there are signs of systemic illness antibiotics, in
    - There are comorbid factors or immune suppression addition to the
    - The patient is very young or very old manual
    - If the abscess is in abody location that is difficult to expression of
    drain pus can be
    - There is associated septic phlebitis considered.
    - No response to inscision and drainage alone

    Comorbid control
    Incision & Drainage It is the primary treatment for skin and
    soft tissue abscesses

    Indications
    Most patients with an abscess
    Equipment
    Contraindications
    cleansing agent
    large and deep abscesses, a local injectable anesthetic agent
    the presence of a pulsatile mass at the site of infection, 5 to 10 mL syringe with 25 to 40 gauge needle,
    proximity to the vasculature and nervous structures, scalpel blade with a handle,
    curved hemostat, normal saline solution with large
    syringe/splash guard/bowl for irrigation,
    Preparation packing material (iodoform or plain gauze),
    Informed consent from the patient or the patient’s swabs for wound culture (if desired), scissors and tape
    legal guardian must be obtained before the for dressing the wound.
    procedure. Risks including bleeding, pain and
    possible scar formation should be relayed.
    The verification of tetanus immunization status is
    also an important step in preparation.
    Incision & Drainage

    Technique

    Holding the scalpel with a steady grip, an incision is made directly over the center of the
    abscess until pus is expressed.
    The incision should be made parallel to skin tension lines in order to prevent scar tissue
    formation.
    A curved hemostat can then be used for blunt dissection to further disrupt loculations within
    the infected cavity.
    Manual expression can be used to facilitate drainage as well.
    After the abscess is drained, the wound should be copiously irrigated with sterile normal
    saline solution.
    The next step is to cover the site with sterile dressing and tape.
    A follow-up visit is advised 2 to 3 days after the procedure for removal of the packing.
    Wounds are then left to close by secondary intention.
    Antibiotic

    Topical
     topical mupirocin is only recommended in mild cases

    Oral
     Patients with no signs of systemic toxicity and uncontrolled comorbidities can usually
    be managed with oral antibiotics as outpatients.

    a. Dicloxacillin 250–500 perday;


    b. Clindamycin 3x300–450 mg ;
    c. Doxycycline 2x100 mg ;
    d. Minocycline 2x50–100 mg;
    e. Trimethroprim-sulfamethoxazole (TMX-SMX) 2x160/800 mg peroral
    Antibiotic

    Intravena
    comorbid, immunosuppression
    rapidly progressive infection
    concern for deep space infection,
    high fevers and rigors, h
    aemodynamic instability
    suppurative wound requiring surgical drainage
    lack of systemic or local response to oral antibiotics,
    rising or unchanging C-reactive protein
    positive blood cultures
    inability to tolerate or absorb oral antibiotics.
    Conclusion

    Bacterial skin infections have a variety of presentations from


    localised, trivial infection to rapidly progressive infection with
    systemic toxicity and considerable mortality. It is important to be
    able to recognise and treat these infections in the community, and in
    cases of severe infection to refer the patient promptly for specialist
    care.
    Thank you

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