Breast abscess: Not just a puerperal problem

Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance

Objective

The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil.

Methods

This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022.

Results

Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus.

Conclusion

Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost.

Lactation mastitis: Promising alternative indicators for early diagnosis

Although lactation mastitis (LM) has been extensively researched, the incidence rate of LM remains a salient clinical problem. To reduce this incidence rate and achieve a better prognosis, early and specific quantitative indicators are particularly important. It has been found that milk electrolyte concentrations (chloride, potassium, and sodium) and electrical conductivity (EC) significantly change in the early stages of LM in an animal model. Several studies have evaluated EC for the detection of subclinical mastitis in cows. EC, chloride, and sodium content of milk were more accurate for predicting infection status than were other variables. In the early stages of LM, lactic sodium, chloride, and EC increase, but potassium decreases. However, these indicators have not been reported in the diagnosis of LM in humans. This review summarizes the pathogenesis and the mechanism of LM in terms of milk electrolyte concentration and EC, and aim to provide new ideas for the detection of sub-clinical mastitis in humans.

Microbiology of breast abscesses

INTRODUCTION

Treatment of breast abscesses is based on drainage and antibiotic therapy directed at the bacteria causing the infection. The aim of this study was to know the etiological agents of breast abscesses.

METHODS

Patients who had a culture-positive breast abscess between September 2015 and January 2020 were included in the study. Culture results were consulted in the laboratory database. It was collected from medical records if the patients presented the following risk factors: breastfeeding, diabetes or smoking. Abscesses secondary to surgical wound infection were excluded.

RESULTS

Sixty patients were included, 58 women and 2 men. Staphylococcus aureus was the most frequent agent in lactating women. Anaerobic bacteria were isolated in 28 (61%) of 46 abscesses in non-lactating patients. In non-lactating patients, the frequency of anaerobes in abscesses was lower in diabetics than in the rest (0/5 vs 26/38; P = .013). In non-lactating and non-diabetic patients, the proportion of abscesses with anaerobes was higher in smokers than in non-smokers (21/24 vs 5/14; P = .003). Aerobic gram-positive cocci were the most frequent agents in diabetics.

CONCLUSION

Anaerobes were the most frequent agents, followed by S. aureus. The etiology of breast abscesses varied with the risk factors studied.

Microbiology of breast abscesses

INTRODUCTION

Treatment of breast abscesses is based on drainage and antibiotic therapy directed at the bacteria causing the infection. The aim of this study was to know the etiological agents of breast abscesses.

METHODS

Patients who had a culture-positive breast abscess between September 2015 and January 2020 were included in the study. Culture results were consulted in the laboratory database. It was collected from medical records if the patients presented the following risk factors: breastfeeding, diabetes or smoking. Abscesses secondary to surgical wound infection were excluded.

RESULTS

Sixty patients were included: 58 women and 2 men. Staphylococcus aureus was the most frequent agent in lactating women. Anaerobic bacteria were isolated in 28 (61%) of 46 abscesses in non-lactating patients. In non-lactating patients, the frequency of anaerobes in abscesses was lower in diabetics than in the rest (0/5 vs 26/38; P=.013). In non-lactating and non-diabetic patients, the proportion of abscesses with anaerobes was higher in smokers than in non-smokers (21/24 vs 5/14; P=.003). Aerobic gram-positive cocci were the most frequent agents in diabetics.

CONCLUSION

Anaerobes were the most frequent agents, followed by S.aureus. The etiology of breast abscesses varied with the risk factors studied.

[Breast abscess: epidemiological, diagnostic and therapeutic features in patients hospitalized in the Main Hospital in Dakar]

Les abcès du sein sont des collections purulentes néoformées au niveau de la glande mammaire et du tissu péri glandulaire. Ils peuvent être lactants ou non lactants. L’objectif de notre étude était de décrire leurs caractéristiques épidémiologiques, diagnostiques et thérapeutiques au Service de Chirurgie Générale de l’Hôpital Principal de Dakar. Nous avions réalisé une étude rétrospective, descriptive sur une période de 4 ans portant sur tous les patients pris en charge pour un abcès du sein. Nous avions colligé 41 dossiers de patients tous de sexe féminin. L’âge moyen était de 31 ans. Le principal facteur de risque objectivé était la mastite au cours de l’allaitement (27%). Le délai moyen d’évolution était de 12 jours avec des extrêmes de 1 et 30 jours. L’abcès siégeait à gauche dans 61% des cas et se présentait le plus souvent sous la forme d’une tuméfaction inflammatoire (88%). Les quadrants supérieurs étaient le plus souvent concernés (43,9%). L’échographie mammaire était réalisée chez 51,2% des patientes. Le drainage chirurgical sous anesthésie générale était réalisé chez toutes les patientes. La quantité moyenne de pus était de 119 cc. Le germe le plus fréquemment isolé était le Staphylococcus aureus (79,5%). La durée moyenne d’hospitalisation était de 7 jours et la morbidité opératoire de 31,7%. La mortalité était nulle. La prévention des abcès lactants passe par l’enseignement des méthodes d’allaitement et l’antibiothérapie précoce en cas de mastite.