þ Adam Singer:
Randomizing to primary vs. delayed primary closure in progress.

Llera: Ann Emerg Med 1985: if I and D, antibiotics don't help
Ped Infec Dis J 2004;23:123: Antibiotics help if MRSA on culture, so culture.
British
Abraham Aus New A J Surg 1997:67:173 closed excision technique heals
better in a week.

                                Abscesses
                                =========

  Treatment of cellulitis and abscesses rarely depend upon results of
culture and gram stain with the possible exception of patients who are
immunocomprimized (9) or those with suspected clostridial myonecrosis (12).

(9)

Meislin HW
Pathogen identification of abscesses and cellulitis.
Ann Emerg Med 1986 Mar;15(3):329-32

The goal of culturing abscesses and/or cellulitis is to identify the
offending pathogen in order to understand and treat the infection.
Abscesses respond to incision and drainage. Antibiotics are not indicated
in the patient with normal host defense, and thus in these patients
cultures and Gram stains are not indicated. In immunocompromised patients,
in patients with abscesses of the central face, and in those with abscesses
that contain gas or involve muscle or fascia, Gram stain, culture, and
antibiotics are necessary. The Gram stain is a reliable indicator of
sterile abscesses, abscesses in pure culture (especially Staphylococcus
aureus), and those in mixed anaerobic culture. Location and odor of
abscesses are clues to offending bacteria. Cultures of tissue or blood in
patients with cellulitis usually are positive in less than 40% of cases,
regardless of the technique used. Hemophilus influenzae cellulitis in
pediatric patients is an exception; blood cultures are positive in more
than two-thirds of cases. Although not specific, certain types of
cellulitis show different clinical characteristics. Treatment with
elevation, warm soaks, and antibiotics is still the mainstay of therapy.
Gram stain and culture are limited to those patients who do not respond to
initial therapy or who are immunocompromised.

(12)
Miskew DB, Pinzur MS, Pankovich AM
Clostridial myonecrosis in a patient undergoing oxacillin therapy for
exacerbation of chronic foot ulcers and osteomyelitis. A case report.
Clin Orthop 1979 Jan-Feb;(138):250-3

Gas gangrene developed from a chronic foot ulcer in the absence of
periferal vascular disease or diabetes mellitus in a hospitalized patient
undergoing parenteral antibiotic therapy. Within a 6 hour period the
patient developed profound toxemia necessitating emergency and life saving
leg amputation. Classically clostridial myonecrosis is diagnosed by the
clinical course and the gram stain. In this case, 2 preoperative gram
stains failed to show gram-positive rods. At the time of surgery, frank
fasical and muscle necrosis in the peroneal compartment dictated extending
the below knee amputation to above the knee. In retrospect demonstration of
clostridial species and myonecrosis in the pathological specimen confirmed
the clinical impression. The identified organism, Clostridium sporogenes
has rarely been implicated as a cause of gas gangrene.