SRS385 - Audit of routine pus swabbing in abscess drainage: are we following guidance?

Aims Routine pus swabbing during incision and drainage of uncomplicated cutaneous abscesses remains common despite guidance recommending selective use for recurrent, persistent, or treatment-resistant cases. This audit assessed whether routine swabbing influences clinical outcomes and evaluated adherence to current guidance in emergency general surgery practice. Methods A retrospective audit of 122 consecutive abscess I&D cases was conducted between January and April 2025. Data were extracted from electronic records and operation notes. Firth penalised logistic regression was used to analyse associations between patient and treatment factors and 30-day readmission and reoperation, adjusted for age, sex, diabetes, abscess site and discharge on antibiotics. Descriptive statistics summarised case-mix and swab utilisation patterns. Results Median age was 38 years; 57.4% were male. Pus swabs were taken in 76/122 (62.3%) cases, with results acted upon in only 5/76 (6.6%). Thirty-day recurrence was nearly similar for swabbed versus non-swabbed patients (3.9% versus 4.3%). Discharge on antibiotics was associated with higher odds of recurrence (aOR 13.76; 95% c.i. 2.11–151.91; P = 0.004). Notably, 80% of recurrences occurred in patients discharged on antibiotics. Age, sex, diabetes, and abscess site were not significant; Reoperation events were rare (3/122); adjusted estimates had very wide 95% CIs and should be interpreted cautiously. Conclusions Routine swabbing rarely altered management and showed no outcome benefit, with likely confounding by indication for antibiotics–recurrence signal. Current practice appears to over-utilise swabbing relative to guidance. A selective swab policy targeting complex, recurrent or systemically unwell patients, or where antibiotics are planned, could optimise resources.