Trends in non-lactation breast abscesses in a tertiary hospital setting

Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland

BACKGROUND

The aim of this multicentre prospective audit was to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland, with a specific focus on rates of surgical intervention.

METHODS

This audit was conducted in two phases from August 2020 to August 2021; a phase 1 practice survey and a phase 2 prospective audit. Primary outcome measurements for phase 2 included patient management pathway characteristics and treatment type (medical/radiological/surgical).

RESULTS

A total of 69 hospitals participated in phase 2 (1312 patients). The key findings were a high overall rate of incision and drainage (21.0 per cent) and a lower than anticipated proportion of ultrasound-guided aspiration of breast abscesses (61.0 per cent). Significant variations were observed regarding the rate of incision and drainage (range 0-100 per cent; P < 0.001) and the rate of needle aspiration (range 12.5-100 per cent; P < 0.001) between individual units. Overall, 22.5 per cent of patients were admitted for inpatient treatment, out of whom which 72.9 per cent were commenced on intravenous antibiotics. The odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment were significantly higher if patients presented at the weekend compared with a weekday (P ≤ 0.023). Breast specialists reviewed 40.9 per cent of all patients directly, despite the majority of patients (74.2 per cent) presenting within working hours on weekdays.

CONCLUSIONS

Variation in practice exists in the management of mastitis and breast abscesses, with high rates of incision and drainage in certain regions of the UK. There is an urgent need for a national best-practice toolbox to minimize practice variation and standardize patient care.

Breaking the Barrier: A Study on Multi-drug Resistance in Breast Abscess at an Academic Malaysian Hospital

BACKGROUND

In recent years, the increase in antibiotics usage locally has led to a worrying emergence of multi-drug resistant organisms (MDRO), with the Malaysian prevalence rate of methicillin-resistant Staphylococcus aureus (MRSA) ranging from 17.2 to 28.1% between 1999 and 2017. A study has shown that 7% of all non-lactational breast abscesses are caused by MRSA. Although aspiration offers less morbidities compared to surgical drainage, about 20% of women infected by MRSA who initially underwent aspiration subsequently require surgical drainage. This study is conducted to determine the link between aetiology, antimicrobial resistance pattern and treatment modalities of breast abscesses.

METHODS

Retrospective study of reviewing microbiology specimens of breast abscess patients treated at Universiti Malaya Medical Centre from 2015 to 2020. Data collected from microbiology database and electronic medical records were analysed using SPSS V21.

RESULT

A total of 210 specimens from 153 patients were analysed. One-fifth (19.5%) of the specimens isolated were MDRO. Lactational associated infections had the largest proportion of MDR in comparison to non-lactational and secondary infections (38.5%, 21.7%, 25.7%, respectively; p = 0.23). Staphylococcus epidermidis recorded the highest number of MDR (n = 12) followed by S. aureus (n = 8). Adjusted by aetiological groups, the presence of MDRO is linked to failure of single aspirations (p = 0.554) and significantly doubled the risk of undergoing surgical drainage for resolution (p = 0.041).

CONCLUSION

MDR in breast abscess should be recognised as an increasing healthcare burden due to a paradigm shift of MDRO and a rise of resistance cases among lactational associated infection that were vulnerable to undergo surgical incision and drainage for resolution.

Review of Breast Abscess Cases at a Tertiary Hospital in Addis Ababa, Ethiopia

Background

Breast abscess is a prevalent cause of morbidity in women occurring in 0.4% to 11% of patients after mastitis. The majority are benign, but worrisome etiologies such as inflammatory cancer and concomitant immune-compromising diseases should be addressed when a non-lactating patient presents with a breast abscess. The problem is high among women in developing countries (1). The purpose of this study is to assess the magnitude, clinical presentation, and treatment of breast abscess patients at a tertiary hospital.

Methodology

A descriptive cross-sectional study was conducted on all patients treated for breast abscesses from September 2015 to August 2020. A retrospective review of the clinical records was performed to collect data on sociodemographic, clinical, and management data using a data extraction form. The collected data were then cleaned and entered into SPSS for analysis.

Results

Two hundred and nine patients were included in this study over 5 years and lactational breast abscess (LBA) is more prevalent,182 (87.1%) than non-lactational breast abscess (NLBA), 27 (12.9%). Bilateral breast abscesses occurred in 16 (7.7%) patients. Patients presented at a median duration of 11 days and had been breastfeeding for 2 or more months. A spontaneously ruptured abscess was detected in, 30 (14.4%) of the patients. Comorbidities identified include diabetes mellitus (DM) in, 24 (11.5%), Hypertension in, 7 (3.3%), HIV in, 5 (2.4%) of patients. All women were treated with Incision and Drainage and had a median volume of 60 mL of pus drained. Following surgery, all patients were given ceftriaxone in the immediate post-operative days and either cloxacillin,167 (80.3%), or Augmentin,41 (19.7%) antibiotics p on discharge. Follow-up data were available for 201 (96.1%) patients and the recurrence rate was 5.8%.

Conclusions and Recommendations

Lactational breast abscesses are more common than non-lactational breast abscesses, particularly in primiparas. DM is the most common comorbidity in non-lactational breast abscesses and health-seeking behavior should be improved given the delayed presentation.

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.

Clinically Malignant Breast Lesion in an Adolescent Girl: A Case Report

Diseases of the breast in adolescent women are usually benign, and their treatment is simple using appropriate medical strategy and rarely surgical therapy. The whole team’s real challenge is when the girl presents malignant breast cancer symptoms such as a non-movable tumor, nipple discharge, nipple retraction, retraction of the skin, inflammatory infiltration of the breast, or ulceration. Presented here is a case of a 15-years-old girl with the features of a malignant neoplasm of the breast. There was an observed non-movable tumor, retraction of the nipple, inflammatory infiltration, and pain. The performed ultrasound and magnetic resonance imaging suggested a malignant lesion measuring 84 mm × 66 mm × 50 mm. After many diagnostic difficulties, the lesion evacuated spontaneously, and the abscess was diagnosed. In conclusion, not all features of a malignant breast tumor in adult women are typical for adolescent females. In young girls, breast diseases are usually benign, and appropriate diagnostics and therapy allow for an effective cure. Atypical breast lesions require the extraordinary cooperation of a multidisciplinary team.

Association of the Risk of Primary Sjögren's Syndrome With Fibrocystic Breast Disease: A Nationwide, Population-Based Study

Objective: Primary Sjögren's syndrome (pSS) is characterized by exocrine glandular inflammation; however, the association between preceding mammary-gland-inflammation-related diseases and newly diagnosed pSS remains unexplored.

Methods: We used the 2003–2013 data retrieved from Taiwan's National Health Insurance Research Database (NHIRD) to conduct the present population-based study. We identified newly diagnosed pSS female patients during the 2001–2013 period, as well as age-matched (1:20) and propensity-score-matched (1:2) non-SS individuals (as controls). We explored the associations between pSS and a history of mastitis and fibrocystic breast disease by determining adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a conditional logistical regression analysis after controlling for potential confounders.

Results: We identified 9,665 patients with pSS and 193,300 age-matched non-SS controls, as well as 9,155 SS cases and 18,310 propensity-score-matched non-SS controls. We found that fibrocystic breast disease (aOR, 1.75; 95% CI, 1.63–1.88) were independently associated with incident SS, whereas mastitis and childbirth-associated breast infections were not associated with incident SS. We also found positive associations between SS and previously reported SS-associated diseases, including cardiovascular diseases, thyroid diseases, pancreatitis, bronchiectasis, infectious diseases, osteoporosis, and ankylosing spondylitis. In the propensity-score-matched populations, the associations between pSS and fibrocystic breast disease (aOR, 1.74; 95% CI, 1.58–1.91) remained consistent.

Conclusion: The present population-based study revealed a previously unexplored association between pSS and history of fibrocystic breast disease, and the finding highlights the need to survey pSS in patients with mammary-gland-inflammation-associated diseases.

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.

Nonpuerperal breast abscess due to Prevotella bivia

Contrary to puerperal abscess, nonpuerperal breast abscess is often caused by anaerobic bacteria; polymicrobial aerobic-anaerobic infections are also frequent. Empiric first-choice treatment with broad-spectrum antibiotics should be considered.

Breast Abscesses Caused by Anaerobic Microorganisms: Clinical and Microbiological Characteristics

The objectives of this study were to report the antimicrobial susceptibility of 35 clinically significant anaerobic bacteria isolated from breast abscesses between March 2017 and February 2020 in a tertiary hospital in Granada (Spain) and to describe key clinical features of the patients. Species identification was performed mainly by MALDI-TOF MS. Antimicrobial susceptibility tests were carried out against benzylpenicillin, amoxicillin-clavulanic acid, imipenem, moxifloxacin, clindamycin, metronidazole, and piperacillin-tazobactam using the gradient diffusion technique and European Committee on Antimicrobial Susceptibility Testing EUCAST breakpoints (except for moxifloxacin). The most frequent anaerobes were Finegoldia magna (31.4%; n = 11), Actinomyces spp. (17.1%; n = 6), Propionibacterium spp. (17.1%; n = 6), and Prevotella spp. (14.2%; n = 5). Imipenem, amoxicillin-clavulanic acid, and piperacillin-tazobactam were universally active against all genera tested. High overall resistance rates to clindamycin were observed, especially for Gram-positive anaerobic cocci (56.2%) and Gram-positive anaerobic bacilli (38.4%). High resistance rates to metronidazole were also observed for Gram-positive (76.9%) and Gram-negative anaerobic bacilli (50%). High resistance rates to moxifloxacin were found for Gram-negative anaerobic bacilli (50%) and Gram-positive anaerobic cocci (31.2%). No breast abscess cases of Bacteroides spp. were detected. Routine antimicrobial susceptibility testing for anaerobes in breast abscesses may contribute to allow empirical therapies to be selected in accordance with local data on resistant strains.

Sonographic features of inflammatory conditions of the breast

Inflammatory conditions of the breast can be a diagnostic challenge, and ultrasound is a proven valuable tool in this setting. In acute infective conditions, ultrasound is often a superior tool to mammography due to the impracticality of applying compression to the breast and the increased parenchymal density of these often younger patients. Although infective processes comprise the majority of inflammatory conditions in the breast, not infrequently other various disease processes can masquerade as infections. In particular, inflammatory breast cancer can be easily misdiagnosed as an infective process and sonography can play an important role in expediting the correct diagnosis. Furthermore, aspiration, drainage and biopsy are frequently required in managing breast inflammation and breast disease generally, and ultrasound is the most practical imaging modality facilitating such interventions. This article provides a review of the ultrasound characteristics of some of the more frequently encountered inflammatory disorders of the breast which span a spectrum of acute to chronic conditions. The various conditions in this report are described in terms of their specific sonographic imaging features as well as pathogenesis, common clinical presentations, and aspects of management are outlined where appropriate.