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Boils, carbuncles, folliculitis, paronychia and staphylococcal whitlow - Management
Who should I swab for staphylococcal carriage (boils, carbuncles, folliculitis, paronychia, staphylococcal whitlow)?

  • Consider taking swabs for carriage of Staphylococcus aureus in people with recurrent or chronic boils, carbuncles, or folliculitis.
  • Swabbing for carriage of Staphylococcus aureus in recurrent cases of paronychia or staphylococcal whitlow can be considered, but if the person requires referral, this may be done in secondary care as part of their further management.
Clarification / Additional information
Basis for recommendation
  • These recommendations are pragmatic advice, based on the most likely causative organism (Staphylococcus aureus) and expert opinion from the medical literature [Lee et al, 2003; Ladhani and Garbash, 2005].
  • Taking swabs for Staphylococcus aureus will help to exclude autoinoculation as the cause.
    • Many studies have shown that people who are colonised with S. aureus are at higher risk of developing staphylococcal infections [Ladhani and Garbash, 2005].
    • S. aureus is a persistent member of the microbial flora in 10–20% of the population, and approximately 30–50% of healthy adults harbour S. aureus at some site at any given time [Lee et al, 2003].
    • S. aureus does not generally cause infection in people who are healthy, unless local barriers are broken [Ladhani and Garbash, 2005].

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