Khalil P N, Huber-Wagner S, Altheim S, Bürklein D, Siebeck M, Hallfeldt K, Mutschler W, Kanz G G
Division of Surgical Emergency Medicine, Department of Surgery, Downtown Medical Centre, Ludwig-Maximilians-University, Munich, Germany.
Eur J Med Res. 2008 Sep 22;13(9):415-24.
Skin and soft tissue abscesses are common findings in injecting drug users (IDUs) who present to the surgical emergency department for evaluation and treatment. Although most cases can be managed by incision and drainage, they do require special considerations as compared to abscesses which are not caused by intravenous drug abuse.
Skin and soft tissue abscesses treated in the emergency department between 2005 and 2007 were reviewed and a systematic literature search of skin and soft tissue abscesses in IDUs was conducted, including the etiology, occurrence, risk factors, and treatment options, thus providing the rationale for the treatment algorithm presented herein.
The drugs injected, the technique by which they were injected, the attendant circumstances, as well as the immunological status of the IDUs were major factors for the development of abscesses. Skin and soft tissue abscesses in IDUs should be incised and drained under local or general anesthesia depending on the size, location, and association with neurovascular structures. Different factors have been taken into account when treating soft tissue abscesses in this population which predict their specific risks and therefore further therapy needs. The incidence of tetanus is high among IDUs compared to the general population, giving rise to the recommendation for a strict booster policy if the vaccination status is unclear when the patient presents to the emergency department. The presence of fever requires hospitalisation and evaluation for the presence of endocarditis. Foreign bodies, such as broken needles, should be ruled out by radiography, and duplex sonography should be performed to identify the presence of vascular complications. Prior to incision and drainage, prophylactic antimicrobial agents should be administered to every patient and as therapy for high-risk patients, such as immunocompromised patients and patients with fevers and chills.
IDUs presenting with skin and soft tissue abscesses can be managed safely if some special issues are taken in account. The presented algorithm may help facilitate the decision-making in this context.
皮肤和软组织脓肿是注射吸毒者（IDU）常见的病症，他们会前往外科急诊科进行评估和治疗。尽管大多数病例可通过切开引流进行处理，但与非静脉药物滥用引起的脓肿相比，它们确实需要特殊考虑。
回顾了2005年至2007年在急诊科治疗的皮肤和软组织脓肿病例，并对IDU的皮肤和软组织脓肿进行了系统的文献检索，包括病因、发生率、危险因素和治疗选择，从而为本处提出的治疗方案提供依据。
注射的药物、注射技术、伴随情况以及IDU的免疫状态是脓肿形成的主要因素。IDU的皮肤和软组织脓肿应根据大小、位置以及与神经血管结构的关联，在局部或全身麻醉下进行切开引流。在治疗该人群的软组织脓肿时，已考虑到不同因素，这些因素可预测其特定风险以及进一步的治疗需求。与普通人群相比，IDU中破伤风的发生率较高，因此如果患者前往急诊科时疫苗接种情况不明，建议采取严格的加强免疫政策。发热需要住院并评估是否存在心内膜炎。应通过放射照相排除异物，如断针，并应进行双功超声检查以确定是否存在血管并发症。在切开引流之前，应给每位患者使用预防性抗菌药物，并作为高危患者（如免疫功能低下患者以及有发热和寒战的患者）的治疗药物。
如果考虑到一些特殊问题，患有皮肤和软组织脓肿的IDU可以得到安全的治疗。此处提出的方案可能有助于在此背景下促进决策制定。
