Please enable it to take advantage of the complete set of features! Abscess drainage is usually a safe and effective way of treating a bacterial infection of the skin. Infections can be classified as simple (uncomplicated) or complicated (necrotizing or nonnecrotizing), or as suppurative or nonsuppurative. It is the primary treatment for skin and soft tissue abscesses, with or without adjunctive antibiotic therapy. Wounds often become colonized by normal skin flora (gram-positive cocci, gram-negative bacilli, and anaerobes), but most immunocompetent patients will not develop an infection. Author disclosure: No relevant financial affiliations. Bookshelf BROOKE WORSTER, MD, MICHELE Q. ZAWORA, MD, AND CHRISTINE HSIEH, MD. Often, this is performed in an operating theatre setting; however, this may lead to high treatment costs due to theatre access issues or unnecessary postoperative stay. An official website of the United States government. They can be drained surgically, carried out under general or local anaesthetic, depending on location of abscess and patient tolerance. How long does it take for an abscess to heal? Hearns CW. Simple infection with no systemic signs or symptoms indicating spread, Infection with systemic signs or symptoms indicating spread, Infection with signs or symptoms of systemic spread, Infection with signs of potentially fatal systemic sepsis, Immunocompromise (e.g., human immunodeficiency virus infection, chemotherapy, antiretroviral therapy, disease-modifying antirheumatic drugs), Collection of pus with surrounding granulation; painful swelling with induration and central fluctuance; possible overlying skin necrosis; signs or symptoms of infection, Cat bites become infected more often than dog or human bites (30% to 50%, up to 20%, and 10% to 50%, respectively); infection sets in 8 to 12 hours after animal bites; human bites may transmit herpes, hepatitis, or human immunodeficiency virus; may involve tendons, tendon sheaths, bone, and joints, Traumatic or spontaneous; severe pain at injury site followed by skin changes (e.g., pale, bronze, purplish red), tenderness, induration, blistering, and tissue crepitus; diaphoresis, fever, hypotension, and tachycardia, Infection or inflammation of the hair follicles; tends to occur in areas with increased sweating; associated with acne or steroid use; painful or painless pustule with underlying swelling, Genital, groin, or perineal involvement; cellulitis, and signs or symptoms of infection, Walled-off collection of pus; painful, firm swelling; systemic features of infection; carbuncles are larger, deeper, and involve skin and subcutaneous tissue over thicker skin of neck, back, and lateral thighs, and drain through multiple pores, Common in infants and children; affects skin of nose, mouth, or limbs; mild soreness, redness, vesicles, and crusting; may cause glomerulonephritis; vesicles may enlarge (bullae); may spread to lymph nodes, bone, joints, or lung, Spreading infection of subcutaneous tissue; usually affects genitalia, perineum, or lower extremities; severe, constant pain; signs or symptoms of infection. You may be taught how to change the gauze in your wound. Epub 2020 Aug 1. Will urgent care drain an abscess? - nskfb.hioctanefuel.com Do not keep packing in place more than 3 Cover the wound with a clean dry dressing. It offers faster recovery than open surgical drainage. All Rights Reserved. Call 612-273-3780. The site is secure. Incisions along the radial side of the digit should be avoided to prevent painful scar with pinch maneuvers. If a gauze packing was put in your wound, it should be removed in 1 to 2 days, or as directed. 8600 Rockville Pike But you may not need them to treat a simple abscess. Tips and Tricks When doing a field block, after the first injection always reinsert the needle through anesthetized skin to minimize the number of painful pricks. Prophylactic oral antibiotics are generally prescribed for deep puncture wounds and wounds involving the palms and fingers. Our website services, content, and products are for informational purposes only. Abscess - incision & drainage - Sunnybrook Hospital Curr Opin Pediatr. Patients with complicated infections, including suspected necrotizing fasciitis and gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, and surgical consultation for. Incision and Drainage of Abscesses | Procedures | 5MinuteConsult Make sure you wash your hands after changing the packing or cleaning the wound. An abscess can also form after treatment if you develop a methicillin-resistant Staphylococcus aureus (MRSA) infection or other bacterial infection. Antibiotics: Take your antibiotics as prescribed until they are gone , even if your swelling has gone down. Along with the causes of dark, Split nails are often caused by an injury such as a stubbed toe or receiving a severe blow to a finger or thumb. JMIR Res Protoc. This is most commonly caused by a bacterial infection and can occur anywhere on the body. The gauze dressing on the skin over the wound incision may need to be in place for a couple of days or a week for an abscess that was especially large or deep. Patients with complicated infections, including suspected necrotizing fasciitis and gangrene, require empiric polymicrobial antibiotic coverage, inpatient treatment, and surgical consultation for debridement. Many boils can be treated at home. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This field is for validation purposes and should be left unchanged. If you have liver disease or ever had a stomach ulcer, talk with your healthcare provider before using these medicines. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Boils themselves are not contagious, however the infected contents of a boil can be extremely contagious. Incision and drainage of subcutaneous abscesses without the use of packing. A systematic review of 13 studies of skin antiseptics used before clean surgical incisions found no high-quality evidence of significant differences in effectiveness.3 A systematic review of seven randomized controlled trials (RCTs) demonstrated no significant difference in the risk of infection when using tap water vs. sterile saline when cleaning acute or chronic wounds.4 A single-blind RCT involving 715 patients demonstrated similar rates of infection with tap water and sterile saline irrigation (4% vs. 3.3%, respectively) in uncomplicated skin lacerations requiring staple or suture repair.5 Three RCTs found no significant difference in infection rates with tap water irrigation vs. no cleansing.4 A small RCT involving 38 patients found that warm saline was preferred over room temperature solution.6. Abscess Incision and Drainage | NEJM Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated. Now with an ingress and an egress, you can decompress the abscess. Superficial mild infections (e.g., impetigo, mild cellulitis from abrasions or lacerations) are usually caused by staphylococci and streptococci and can be treated with topical antimicrobials, such as bacitracin, polymyxin B/bacitracin/neomycin, and mupirocin (Bactroban).31 Metronidazole gel 0.75% can be used alone or in combination with other antibiotics if anaerobes are suspected. Do not put gauze directly over wound. It will stick to the packing and possibly pull it out at the next dressing change. Prophylactic antibiotics have little benefit in healthy patients with clean wounds. Large incisions are not necessary to drain breast abscesses. Healthline Media does not provide medical advice, diagnosis, or treatment. Abscess (Incision & Drainage) - Fairview Management is determined by the severity and location of the infection and by patient comorbidities. hb````0e```b Also get the facts on causes and risk, Boils are painful skin bumps that are caused by bacteria. Older age, cardiopulmonary or hepatorenal disease, diabetes mellitus, debility, immunosenescence or immunocompromise, obesity, peripheral arteriovenous or lymphatic insufficiency, and trauma are among the risk factors for SSTIs (Table 2).911 Outbreaks are more common among military personnel during overseas deployment and athletes participating in close-contact sports.12,13 Community-acquired MRSA causes infection in a wide variety of hosts, from healthy children and young adults to persons with comorbidities, health care professionals, and persons living in close quarters. Bite wounds may be reevaluated after antibiotic treatment for delayed primary closure.14, A 1988 case series of 204 minor, noninfected suture repair wounds that did not involve nerves, blood vessels, tendons, or bones found significantly higher rates of healing for wounds closed up to 19 hours after injury compared with later closure (92% vs. 77%).12 Scalp and facial wounds repaired later than 19 hours after injury had higher healing rates compared with wounds involving other body areas (96% vs. 66%).12 There have been no RCTs comparing primary closure with delayed closure of nonbite traumatic wounds.13, Simple lacerations are often closed with sutures or staples. Duong M, Markwell S, Peter J, Barenkamp S. Ann Emerg Med. Will urgent care drain an abscess? Explained by Sharing Culture Therefore, it would be appropriate to bill these more specific incision and drainage codes. Learn the Signs, Overview of Purpuric Rash, a Symptom of Some Conditions, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, How to Get Rid of Dark Circles Permanently. While the number of studies is small, there is data to support the elimination of abscess packing and routine avoidance of antibiotics post-I&D in an immunocompetent patient; however, antibiotics should be considered in the presence of high risk features. About 1 in 15 of these women can develop breast abscesses. Abscess Drainage, Percutaneous - Radiologyinfo.org Data Sources: A PubMed search was completed using the key term skin and soft tissue infections. Incision and drainage (I&D) remains the standard of care; however, significant variability exists in the treatment of abscesses after I&D. Some recent evidence has suggested that routinely performed treatment modalities may not be beneficial. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Smaller abscesses may not need to be drained to disappear. MeSH Abscess Incision and Drainage, a Photographic Tutorial About 10% to 30% of all breast abscesses occur after pregnancy, when nursing mothers breastfeed newborns. Do this as long as you have pain in your anal area. Incision, debridement, and packing are all key components of the treatment of an intrascrotal abscess, and failure to adequately treat may lead to the need for further debridement and drainage. We reviewed available literature for any published observational or randomized control trials on the treatment of abscesses via packing and antibiotics. Brody A, Gallien J, Reed B, Hennessy J, Twiner MJ, Marogil J. A systematic review of 11 studies comparing tissue adhesive with standard wound closure for acute lacerations found that tissue adhesives are less painful and require less procedure time.17 The review found no difference in cosmetic outcomes; however, there was a small but statistically significant increased rate of dehiscence and erythema with tissue adhesives. Apply non-stick dressing or pad and tape. This content is owned by the AAFP. Taking all of your antibiotics exactly as prescribed can help reduce the odds of an infection lingering and continuing to cause symptoms. An abscess is an area under the skin where pus collects. LESS THAN. An abscess is sometimes called a boil. (2012). 2017 May 1;6(5):e77. Noninfected wounds caused by clean objects may undergo primary closure up to 18 hours from the time of injury. If so, it should be removed in 1 to 2 days, or as advised. The Infectious Diseases Society of America uses several clinical indicators to help stage the severity of wounds: those without purulence or inflammation are considered noninfected, and infected wounds are classified as mild, moderate, or severe based on their size and depth, surrounding cellulitis, tissue involvement, and presence of systemic or metabolic findings30,32 (Table 23033 ). Z48.817 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. However, there are several reasons for hospitalization or referral (Table 3).2830,36,38,39, Patients with severe wound infections may require treatment with intravenous antibiotics, with possible referral for exploration, incision, drainage, imaging, or plastic surgery.38,39, Necrotizing fasciitis is a rare but life-threatening infection that may result from traumatic or surgical wounds. An abscess is an infected fluid collection within the body. Change the dressing if it becomes soaked with blood or pus. The incision site may drain pus for a couple of days after the procedure. There are, however, other causes of. Your doctor may send a sample of the pus to a lab for a culture to determine the cause of the bacterial infection. <> But treatment for an abscess may also require surgical drainage. Occlusion of the wound is key to preventing contamination. endstream endobj startxref <> Antibiotics after incision and drainage for uncomplicated skin Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The skin is left open and the cavity heals from inside out . Change thedressing if it becomes soaked with blood or pus. Discover home remedies for boils, such as a warm compress, oil, and turmeric. 18910 South Dixie Hwy., Cutler Bay 305-585-9230 Schedule an Appointment. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Gently pull packing strip out -1 inch and cut with scissors. These infections are contagious and can be acquired in a hospital setting or through direct contact with another person who has the infection. However, if the infection wasnt eliminated, the abscess could reform in the same spot or elsewhere. 2005-2023 Healthline Media a Red Ventures Company. Initial antimicrobial choice is empiric, and in simple infections should cover Staphylococcus and Streptococcus species. V+/T >`xG; |L\rC/.)cOs[&`(&I{WVj6}\,2a PMC Service. Abscess - Cleveland Clinic: Every Life Deserves World Class Care Once the abscess has been located, the surgeon drains the pus using the needle. 2000-2022 The StayWell Company, LLC. The incision and drainage can be performed with local anesthesia. In the case of lactational breast abscesses, milk drainage is performed to resolve the infection and relieve pain. You can pull the dirty gauze out, and gently tuck a fresh strip of ribbon gauze (use one-quarter inch width ribbon gauze for most abscesses, which you can buy at a drugstore) inside the wound. This, and sometimes a course of antibiotics, is really all thats involved. We will help to teach you (or a family member) how to care for your wound. Scrotal Abscess Drainage: Overview, Preparation, Technique - Medscape It is not intended as medical advice for individual conditions or treatments. Learn more about the differences. The wound may drain for the first 2 days. Because E. corrodens is resistant to most oral antibiotics, clenched-fist bite wounds should be treated with parenteral ampicillin/sulbactam.30, Burns. Incision and Drainage - StatPearls - NCBI Bookshelf An abscess can happen with an insect bite, ingrown hair, blocked oil gland, pimple, cyst, or puncture wound. endobj Incision and Drainage Procedure to Treat Abscesses - Verywell Health Your healthcare provider has drained the pus from your abscess. None of the studies demonstrated a difference in treatment failure rates, recurrence rates, or need for secondary interventions in non-packed wounds; however, packing groups had more pain. After incision and drainage, treat with antistaphylococcal antibiotics and warm soaks and have frequent follow-up visits. Rhle A, Oehme F, Brnert K, Fourie L, Babst R, Link BC, Metzger J, Beeres FJ. DISCHARGE INSTRUCTIONS: Contact your healthcare provider if: The area around your abscess has red streaks or is warm and painful. Before a skin abscess drainage procedure, you may be started on a course of antibiotic therapy to help treat the infection and prevent associated infection from occurring elsewhere in the body. Methods: All Rights Reserved. A small plastic drain is placed through the wound and this allows continued . An abscess doesnt always require medical treatment. This may cause the hair around the abscess to part and make the abscess more visible to you. Predisposing factors for SSTIs include reduced tissue vascularity and oxygenation, increased peripheral fluid stasis and risk of skin trauma, and decreased ability to combat infections. Family physicians often treat patients with minor wounds, such as simple lacerations, abrasions, bites, and burns. Also searched were the Cochrane database, the National Institute for Health and Care Excellence guidelines, and Essential Evidence Plus. Although it is less invasive, needle aspiration of abscess contents is not recommended . Doral Urgent Care. Wound care instructions from your doctor may include wound repacking, soaking, washing, or bandaging for about 7 to 10 days. If it is covered in pus and blood, that is good, because it means that the abscess is draining well. An RCT of 426 patients with uncomplicated wounds found significantly lower infection rates with topical bacitracin, neomycin/bacitracin/polymyxin B, or silver sulfadiazine (Silvadene) compared with topical petrolatum (5.5%, 4.5%, 12.1%, and 17.6%, respectively).22, Topical silver-containing ointments and dressings have been used to prevent wound infections. Incision and Drainage (Abscess) Wound Care Instructions Leave pressure dressing on and dry for 24 hours. hbbd```b``"A$da`8&A$-}Drt`h hf k5@0{"'t5P0 0r YL{54| Open Access Emerg Med. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Place a maxi pad or gauze in your underwear to absorb drainage from your abscess while it heals. You may do this in the shower. Call your healthcare provider right away if any of these occur: Red streaks in the skin leading away from the wound, Continued pus draining from the wound 2 days after treatment, Fever of 100.4F (38C) or higher, or as directed by your provider. Medically reviewed by Drugs.com. What is abscess drainage? Superficial mild wound infections can be treated with topical agents, whereas deeper mild and moderate infections should be treated with oral antibiotics. Abscess Incision and Drainage - Primary Care: Clinics in Office Practice 2022 Darst Dermatology: Charlotte Dermatologist, 2 Convenient Locations - South Charlotte & Monroe, NC. In these cases, systemic antifungals with coverage of Candida, Aspergillus, and Zygomycetes should be considered.28,29,37, Most wounds can be managed by primary care clinicians in the outpatient setting. If a gauze packing was placed inside the abscess pocket, you may be told to remove it yourself. Preauricular abscess drainage without Incision: No Incision-Dr D K Gupta. An abscess incision and drainage (I and D) is a procedure to drain pus from an abscess and clean it out so it can heal. sharing sensitive information, make sure youre on a federal Skin abscesses can be a significant source of morbidity and are frequently encountered by physicians across the country. Epub 2020 Nov 1. Most severe wound infections, and moderate infections in high-risk patients, require initial parenteral antibiotics, with transition to oral antibiotics after therapeutic response. Randomized Controlled Trial of a Novel Silicone Device for the Packing of Cutaneous Abscesses in the Emergency Department: A Pilot Study. That said, the incision and drainage procedure is usually performed on an outpatient basis. Posted in Cyst Popping Tagged abscess drainage procedure., abscess drainage videos, abscess healing stages, care after abscess incision and drainage, hard lump after abscess drained, how to drain abscess at home, how to tell if abscess is healing, what to expect after abscess drainage Leave a Comment on Inflamed Abscess Drainage Post . Cover the wound with a clean dry dressing. If a gauze packing was placed inside the abscess pocket, you may be told to remove it yourself. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Before this procedure, patients might need to begin with antibiotic therapy to treat and prevent any other infections. Prophylactic systemic antibiotics are not necessary for healthy patients with clean, noninfected, nonbite wounds. If everything looks good, you may be shown how to care for the wound and change the dressing and inside packing going forward. 2021 Jul 27;13:335-341. doi: 10.2147/OAEM.S317713. Clipboard, Search History, and several other advanced features are temporarily unavailable. It happens when bacteria get trapped under the skin and start to grow. If the abscess pocket was large, your provider may have put in gauze packing. Evaluating the extent and severity of the infection will help determine the proper treatment course. For the first few days after the procedure, you may want to apply a warm, dry compress (or heating pad set to low) over the wound three or four times per day. Antibiotics for Uncomplicated Skin Abscesses After Incision and Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. The most reliable way to remove a cyst is to have your doctor do it. Mayo Clinic Staff. Patients who undergo this procedure are usually hospitalized. National Library of Medicine One solution is to perform abscess drainage as a day- Stopping your antibiotics too early may increase your risk of having the infection return. Clean area with soap and water in shower. %%EOF The wound may drain for the first 2 days. PDF Care for Your Open Wound, or Draining Abscess - Kaiser Permanente The wound will take about 1 to 2 weeks to heal depending on the size of the cyst. Antibiotics may have been prescribed if the infection is spreading around the wound. Wound culture and antibiotics do not improve healing, but packing wounds larger than 5 cm may reduce recurrence and . PDF Post-Operative Instructions after Incision and Drainage of a Dental First, your healthcare provider will apply a local anesthetic to the area around the abscess. A skin abscess, sometimes referred to as a boil, can form just about anywhere on the body. Abscess Incision and Drainage (Discharge Care) - Drugs.com Routine cultures and antibiotics are usually unnecessary if an abscess is properly drained. It may be helpful to hold the abscess wall open with a pair of sterile curved hemostats after making the incision to prevent collapse of the cavity once the contents begin to drain.3 The NP then inflates the catheter balloon tip with 2-3 mL of sterile saline until it is securely fitted inside the Bartholin gland ( Photograph 3 ). A dressing that gets wet will need to be changed. Incision and Drainage (Abscess) Wound Care Instructions 33O(d9r"nf8bh =-*k6M&4B 3J=yD)S'|}Zy#O 5\TCwE#!,k4Uy>vkcb/NB/] %H837 q'_/e2rM4^zU7z5V^(5*|mfR7`fz6B Percutaneous abscess drainage is generally used to remove infected fluid from the body, most commonly in the abdomen and pelvis. It involves making an incision into the abscess, breaking down the loculated areas, and washing out the pus as thoroughly as possible. and transmitted securely. Breast abscess treatment available online today Superficial mild infections can be treated with topical antibiotics; other infections require oral or intravenous antibiotics. You may also see pus draining from the site. A small abscess with little pain, swelling, or other symptoms can be watched for a few days and treated with a warm compress to see if it recedes. HHS Vulnerability Disclosure, Help Skin and Soft Tissue Infections - Incision, Drainage, and Debridement endobj Get the latest updates on news, specials and skin care information. A cruciate incision is made through the skin allowing the free drainage of pus. You have a fever or chills. Antibiotics may not be required to treat a simple abscess, unless the infection spreads into the skin around the wound. When is an abscess drainable? Explained by Sharing Culture A doctor will numb the area around the abscess, make a small incision, and allow the pus inside to drain. An observational study of 100 patients who washed their sutured wounds within 24 hours showed no infection or dehiscence of the wound.18 An RCT of 857 patients found no increased incidence of infection in patients who kept their wounds dry and covered for 48 hours vs. those who removed their dressing and got their wound wet within the first 12 hours (8.9% vs. 8.4%, respectively).19. Mohamedahmed AYY, Zaman S, Stonelake S, Ahmad AN, Datta U, Hajibandeh S, Hajibandeh S. Langenbecks Arch Surg. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. This causes an infection and inflammation along with pain and redness. Careers. Although patients are often instructed to keep their wounds covered and dry after suture placement, sutures can get wet within the first 24 to 48 hours without increasing the risk of infection. 4 0 obj Examples of local anesthetics include lidocaine and bupivacaine. Nursing Interventions. An abscess appears like a large and deep bump or mass within or underneath the tissue of the body. It is normal to see drainage (bloody, yellow, greenish) from the wound as long as the wound is open. Patient information: See related handout on wound care, written by the authors of this article. Rationale: Reduces risk of spread of bacteria. Abscess drainage is usually a safe and effective way of treating a bacterial infection of the skin. The doctor may have cut an opening in the abscess so that the pus can drain out. You may do this in the shower. Secondary infections from burns may progress rapidly because of loss of epithelial protection. Your doctor will treat an MRSA abscess the same as another similar abscess by draining it and prescribing an appropriate antibiotic. Redness and swelling forms around the sore area. Abscess Incision and Drainage Procedure Hold the scalpel between the thumb and forefinger to make initial entry directly into the abscess. Preauricular abscess drainage without Incision: No Incision-Dr D K Gupta The signs are listed below. See permissionsforcopyrightquestions and/or permission requests. Lack of purulent drainage or inflammation, Cellulitis extending less than 2 cm from the wound and at least two of the following: erythema, induration, pain, purulence, tenderness, or warmth; limited to skin or superficial tissues; no evidence of systemic illness, Abscess without surrounding cellulitis: incision and drainage, destruction of loculations, dry dressing, Superficial infections (e.g., impetigo, abrasions, lacerations): topical mupirocin (Bactroban); bacitracin and neomycin less effective, Deeper infections: oral penicillin, first-generation cephalosporin, macrolide, or clindamycin, Topical mupirocin, oral trimethoprim/sulfamethoxazole, or oral tetracycline for MRSA, At least one of the following: cellulitis extending 2 cm or more from wound; deep tissue abscess; gangrene; involvement of fascia; lymphangitis; evidence of muscle, tendon, joint, or bone involvement, Cellulitis: five-day course of penicillinase-resistant penicillin or first-generation cephalosporin; clindamycin or erythromycin for patients allergic to penicillin, Bite wounds: five- to 10-day course of amoxicillin/clavulanate (Augmentin); doxycycline or trimethoprim/sulfamethoxazole, or fluoroquinolone plus clindamycin for patients allergic to penicillin, Trimethoprim/sulfamethoxazole for MRSA; patients who are immunocompromised or at risk of noncompliance may require parenteral antibiotics, Acidosis, fever, hyperglycemia, hypotension, leukocytosis, mental status changes, tachycardia, vomiting, In most cases, hospitalization and initial treatment with parenteral antibiotics, Cellulitis: penicillinase-resistant penicillin, first-generation cephalosporin, clindamycin, or vancomycin, Bite wounds: ampicillin/sulbactam (Unasyn), ertapenem (Invanz), or doxycycline, Linezolid (Zyvox), daptomycin (Cubicin), or vancomycin for cellulitis with MRSA; ampicillin/sulbactam or cefoxitin for clenched-fist bite wounds, Progressive infection despite empiric therapy, Spreading of infection, new symptoms (e.g., fever, metabolic instability), Treatment should be guided by results of Gram staining and cultures, along with drug sensitivities, Vancomycin, linezolid, or daptomycin for MRSA; consider switching to oral trimethoprim/sulfamethoxazole if wound improves, Treatment for an infected wound should begin with cleansing the area with sterile saline.