Randomized Controlled Trial of Antibiotics in the Management of Children With Community-Acquired Abscess

The emergence of community acquired methicillin-resistant Staphylococcus aureus (MRSA) as a
pervasive cause of skin and soft tissue infections has increased the number of children
requiring incision and drainage (I&D) procedures and heightened concerns about the optimal
treatment strategy. Data on patients with methicillin-sensitive Staphylococcus aureus (MSSA)
abscesses, as well as emerging data on children with minor MRSA skin and soft tissue
abscesses suggest that I&D alone is sufficient therapy. However, given concerns about the
pathogenicity of MRSA infections, many patients who require hospital admission and I&D in
the operating room receive postoperative antibiotics. The primary objective of this
randomized controlled trial is to compare the effect of 5 days versus 1 day of postoperative
antibiotics on the rate of treatment failure following I&D of abscesses in children in the
era of pervasive MRSA infection. Secondary outcomes to be measured include incidence of
additional skin and soft tissue infections in other body sites and incidence of these
infections in family members and household contacts. Prospective data will be collected from
wound cultures, as well as from nasal, rectal and skin cultures sent at the time of initial
I&D to assess for MRSA carrier status. Finally, survey data will be used to assess
epidemiologic risk factors.

Inclusion Criteria:

- Children between 1 month and 17 years of age who undergo Incision and Drainage of a
skin and soft tissue abscess by a member of the Children's Memorial Hospital
pediatric surgery faculty.

Exclusion Criteria:

- Children who developed their infection while hospitalized or within 2 weeks of
unrelated hospital discharge will be excluded.

- Children with surgical site infections will be excluded.

- Children with inherent or acquired immunodeficiency, including but not limited to
transplant patients and patients on chemotherapy or systemic corticosteroids will be
excluded.

- Patients admitted to the Infectious Disease service may be excluded at the discretion
of the ID attending.

- Patients who are found to have no discreet fluid collections at the time of attempted
incision and drainage will be excluded.

- Patients allergic or intolerant to both bactrim and clindamycin will be excluded.

- Patients with cellulitis greater than 5 cm beyond the lateral margin of the abscess
(as determined by intraoperative measurements) will be excluded.