Boils and furunculosis (recurrent staphylococcal skin infections)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Single boil: complicated or at risk of complications
Bacteriology, before the antibiotic
- Bacteriological sample of pus from the boil (culture, susceptibility testing)
Do not order
Furunculosis (recurrent boils): flare and search for predisposing factors
Bacteriology, before the antibiotic
- Bacteriological sample of pus from a boil (culture, susceptibility testing)
Fasting laboratory tests
- Fasting plasma glucose
- FBC
- Serum ferritin
- HIV serology (if risk factor or if never done)if neededHIV infection is among the comorbidities that favour Staphylococcus aureus infections, including boils, according to the rationale of the recommendation [6].
Do not order
- Screening for S. aureus carriage (nose, throat, perineum) before a first decolonisation: not recommended, done only after failure of a first decolonisation [2,10].
- HbA1c to screen for diabetes: the NABM covers HbA1c only in monitoring of glycaemic control [11]; fasting plasma glucose is enough.
- Testing for Panton-Valentine leucocidin: no value routinely [2]; the laboratory scientist looks for it when MRSA is isolated in a community setting [10].
Recurrence after a first decolonisation: screening of carriage sites
Screening for Staphylococcus aureus carriage by swab
- Nasal, throat and perineal or anal swabs (state the sites; susceptibility testing including mupirocin sensitivity)
- Offer the same screening to people living under the same roof.
Do not order
- Control swab after successful local decolonisation: not recommended [10].
Sources (11)
- Shallcross LJ, Hayward AC, Johnson AM, Petersen I. Incidence and recurrence of boils and abscesses within the first year: a cohort study in UK primary care. Br J Gen Pract. 2015;65(639):e668-76.
- Haute Autorité de santé, Société française de dermatologie, Société de pathologie infectieuse de langue française. Prise en charge des infections cutanées bactériennes courantes. Recommandation de bonne pratique, texte des recommandations, février 2019.
- Haute Autorité de santé. Choix et durées d'antibiothérapies : prise en charge des furoncles chez l'adulte et chez l'enfant. Fiche mémo, juillet 2021, mise à jour juillet 2024.
- Ramakrishnan K, Salinas RC, Agudelo Higuita NI. Skin and soft tissue infections. Am Fam Physician. 2015;92(6):474-483.
- Health Protection Agency (sous-groupe PVL du Steering Group on Healthcare Associated Infection). Guidance on the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-SA) in England. 2e édition, 7 novembre 2008 (publiée sur gov.uk).
- Haute Autorité de santé, Société française de dermatologie, Société de pathologie infectieuse de langue française. Prise en charge des infections cutanées bactériennes courantes. Argumentaire scientifique, février 2019.
- Haute Autorité de santé. Choix et durées d'antibiothérapies dans les furonculoses. Fiche mémo, juillet 2021.
- Ibler KS, Kromann CB. Recurrent furunculosis — challenges and management: a review. Clin Cosmet Investig Dermatol. 2014;7:59-64.
- Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52.
- Haut Conseil de la santé publique. Conduite à tenir lors d'épisodes de cas groupés d'infections cutanées suppuratives liées aux souches de SARM Co. Avis et rapports, juillet 2014.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1577 (HbA1c), 0214 (recherche d'une bactérie nommément désignée), 5215 (plaie, écoulement purulent).