Ultrasound-guided drainage of breast abscesses: results in 151 patients

Predictors of primary breast abscesses and recurrence

BACKGROUND

We investigated the patients and microbiological risk factors that predispose to the development of primary breast abscesses and subsequent recurrence.

METHODS

Patients with a primary breast abscess requiring surgical therapy between January 1, 2000 and December 31, 2006 were reviewed. Recurrent breast abscess was defined by the need for repeated drainage within 6 months. Patient characteristics were compared to the general population and between groups.

RESULTS

A total of 89 patients with a primary breast abscess were identified; 12 (14%) were lactational and 77 (86%) were nonlactational. None of the lactational abscesses recurred, whereas 43 (57%) of the nonlactational abscesses did so (P < 0.01). Compared to the general population, patients with a primary breast abscess were predominantly African American (64% vs. 12%), had higher rates of obesity (body mass index > 30: 43% vs. 22%), and were tobacco smokers (45% vs, 23%) (P < 0.01 for all). The only factor significantly associated with recurrence in the multivariate logistic regression analysis was tobacco smoking (P = 0.003). Compared to patients who did not have a recurrence, patients with recurrent breast abscesses had a higher incidence of mixed bacteria (20.5% vs. 8.9%), anaerobes (4.5% vs. 0%), and Proteus (9.1% vs. 4.4%) but lower incidence of Staphylococcus (4.6% vs. 24.4%) (P < 0.05 for each).

CONCLUSIONS

Risk factors for developing a primary breast abscess include African American race, obesity, and tobacco smoking. Patients with recurrent breast abscesses are more likely to be smokers and have mixed bacterial and anaerobic infections. Broader antibiotic coverage should be considered for the higher risk groups.

Use of urokinase in percutaneous drainage of large breast abscesses

OBJECTIVE

The purpose of this study was to evaluate intracavitary urokinase therapy versus irrigation with a saline solution in percutaneous drainage of large breast abscesses.

METHODS

A prospective randomized study was conducted in 19 nonlactating women (median age, 35.7 years) with breast abscesses of greater than 3 cm. Percutaneous drainage with an ultrasound-guided catheter was performed in group A patients (saline solution) and group B patients (urokinase). Postdrainage care and ultrasound-guided drainage control were performed on an outpatient basis. The Student t test, Fisher exact test, chi(2) test, and Mann-Whitney U test were used for statistical analysis.

RESULTS

Percutaneous drainage with saline or urokinase irrigation was successful in all cases. No statistically significant differences were observed between groups A and B for clinical parameters and sonographic characteristics of the abscesses. However, a statistically significant difference was observed between the two groups for the average drainage times (P < 0.012), which were 3.8 days for the urokinase group and 5.3 days for the saline group. A recurrence was observed in 1 saline group patient who had a diagnosis of a chronic abscess, which was resolved with intracavitary urokinase irrigation.

CONCLUSIONS

Percutaneous drainage of large breast abscesses in nonlactating women with intracavitary urokinase irrigation is a simple and safe procedure. It reduces the treatment time and improves the clinical course of patients more than conventional drainage with saline irrigation.

Conquering common breast-feeding problems

Meeting mothers' personal breast-feeding goals depends on a number of factors, including the timely resolution of any problems she encounters. Nurses are often the first providers who interact with the mother during the perinatal period and are positioned to guide mothers through the prevention and solving of breast-feeding problems. Although many problems may be "common," failure to remedy conditions that cause pain, frustration, and anxiety can lead to premature weaning and avoidance of breast-feeding subsequent children. This article describes strategies and interventions to alleviate common problems that breast-feeding mothers frequently encounter.

Treatment of breast abscesses with ultrasound-guided aspiration and irrigation in the emergency setting

The purpose of our study was to describe the efficacy of ultrasound (US)-guided aspiration and intracavitary irrigation of breast abscesses in the emergency setting. Ten cases of mastitis clinically suspected of having a breast abscess were referred from the emergency department for breast ultrasound. Eleven abscesses depicted at US were treated with US-guided aspiration and intracavitary irrigation. All patients were given antibiotics, and the success of US-guided treatment was determined. Three abscesses that were smaller than 3 cm were treated with single aspiration and irrigation. Ninety-one percent of patients were cured with US-guided aspiration and irrigation requiring no further surgical intervention. One case of chronic mastitis fistulized to the skin and was drained surgically. No recurrences were observed in the follow-up period. US-guided percutaneous aspiration and irrigation is a successful method for treatment of breast abscesses in the emergency setting. This method is more successful in abscesses with a maximum dimension smaller than 3 cm and should be preferred to the surgical drainage.

Imaging Modalities in Wounds and Superficial Skin Infections

Open wounds and lacerations are the most commonly encountered problems in emergency medicine. Detection and removal of a foreign body is essential to avoid the many complications of a retained foreign body, which may include infection, inflammation, allergic reaction, and disability. Currently, there are several imaging modalities that the emergency medicine provider may use to aid in foreign body detection and wound management. Techniques and appropriate use of these imaging modalities for foreign bodies and soft tissue infections are discussed in this article.