Skin abscesses can be due to one or multiple pathogens including skin flora as well as microorganisms from adjacent mucous membranes. Staphylococcal aureus monoinfections which may be either methicillin sensitive S. aureus (MSSA) or methicillin resistant S.aureus (MRSA) occur in up to 75 percent of abscesses.(1) When patients present with bacterial infection, a decision has to be made about the need for empirical antibiotic. Antibiotics are a valuable resource. Hence, to safeguard future effectiveness they should be used judiciously. To achieve this one must recognise the role of antibiotic stewardship which is used by institutions to optimise antibiotic prescribing.(2, 3) When recommending antimicrobials one must aim to obtain an accurate diagnosis of infection, appreciate the difference between empiric and definitive treatment, switch to narrow spectrum agents when safe to do so and use cost-effective oral agents where possible. In the antibiotic treatment of skin abscesses, some studies suggest that incision and drainage (I&D) alone may be sufficient for immunocompetent patients.(4) However, other data suggests that certain patients who's infections may be caused by MRSA benefit from the use of antibiotics as well as I&D.(5) There is an increasing prevalence of MRSA in Western Australia.(6) This highlights the complexity of the issue and the need for guidelines to assist in management. An audit conducted in the hospital of interest in 2010 showed MRSA rates as high as 31%. The rates of MRSA in abscesses at the hospital have not been specifically established thus highlighting the importance of obtaining microscopy and culture (MC&S) data from the abscess sample, a vital component of the guidelines.
A retrospective audit was conducted comparing current practice at a Western Australian peripheral hospital with established guidelines with the aim of assessing management of patients with abscesses that required surgical I&D. The Therapeutic Guidelines Antibiotic, published in 2010 (TGA14), is the standard reference for antibiotic prescribing in Australia and was used as the standard for this audit