Incision and Drainage of Cutaneous Abscess

Cutaneous abscesses form when bacteria (most commonly Staphylococcus aureus, including MRSA in community-acquired cases) invade subcutaneous tissue through breaks in the skin barrier. The innate immune system responds with neutrophil recruitment to the site, forming a localized collection of purulent material (dead neutrophils, bacteria, and necrotic tissue). The abscess wall is composed of granulation tissue and a fibrous capsule that limits bacterial spread but also prevents antibiotic penetration, making surgical drainage the definitive treatment. Abscess maturation progresses through cellulitic (diffuse, indurated), fluctuant (liquefied center), and pointing (spontaneous drainage) stages. MRSA prevalence in community-acquired skin and soft tissue infections ranges from 50-70%, influencing empiric antibiotic selection when antibiotics are indicated. Antibiotics alone are insufficient for mature abscesses because poor drug penetration into the walled-off collection fails to achieve bactericidal concentrations.