Shooter's Abscess

Happy Friday! Abscesses--these are an everyday occurrence, we’re either performing an I&D or seeing a patient for their 2-3 day follow-up. While regular abscesses are second nature to us, today we will be talking about a shooters abscess which are approached and treated a bit differently
 
I had 2 cases of these. This a summary of HippoEd’s UC rap June 2020 podcast chapter titled: “Shooter’s abscess." 

All my blogs are free but if you want access to all episodes of UC rap by HippoEd, use my link: here for $25 off. ​I do get a small amount of money if you use my link which allows me to continue to do these :)

What is a shooter’s abscess?
 IV drug users are at higher risk for an abscess due to introduction of bacteria from a dirty needle and/or an inflammatory reaction to the drug substance
 
Signs and symptoms will be similar to a non-shooters abscess with erythema, warmth, tenderness and fluctuance, however tend to be larger and deeper 
 
Before you perform an I&D:

• consider obtaining an x-ray to rule out a retained foreign bodies (needles)—keep yourself and the patient safe. Do not go probing with fingers!
• Often these are large/deep abscesses (drainage of >200 cc's) so prep appropriately—consider suction or prior to incision you can aspirate with 18 gauge needle
• Follow up within 24-48 hours 

 
Which bacteria are present? 

• These are usually polymicrobial: strep, MRSA, but also consider presence of anaerobes due to patients licking needles prior to injection

 
Wound culture? Start antibiotics or not?

• Wound culture and antibiotics are usually indicated
• Consider single drug choices: Clindamycin, doxycycline, and TMP-SMX

 
Don’t forget to: perform a full neuro exam
 
Should I treat this abscess in UC?

• Most will be able to be drained in UC
• Consider transfer if 
  
  • Signs of systemic infection—fever, tachycardia, hypotension
    
  • suspect necrotizing fasciitis
    
  • Neuro abnormalities

See you all next week......wondering what I'll see this upcoming weekend which may inspire me with a topic haha!