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Ammann AM, Pratt CG, Lewis JD, Ahmad SA, Shaughnessy E, Heelan AA. Breast infections: A review of current literature. Am J Surg 2024; 228:78-82. [PMID: 37949727 DOI: 10.1016/j.amjsurg.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
Breast infections are common, affect women of all ages, and are associated with significant morbidity. Despite overall prevalence, treatment varies significantly based on provider or institution and no central treatment guidelines exist to direct the management of breast infections. This article provides a summary of the current trends in management of breast infections. The etiology, epidemiology, risk factors, presentation, diagnosis, and treatment of mastitis and breast abscesses (and their relative subdivisions) are explored based on the current literature. Trends in microbiology are reviewed and an approach to antibiotic coverage is proposed. Overall, there is a lack of randomized-controlled trials focused on the treatment of breast infections. This has resulted in an absence of clinical practice guidelines for the management of breast abscesses and variable practice patterns. The development of best-care protocols or pathways could provide more uniformity in care of breast infections.
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Affiliation(s)
- Allison M Ammann
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Catherine G Pratt
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Jaime D Lewis
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Elizabeth Shaughnessy
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
| | - Alicia A Heelan
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
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Zhou F, Li Z, Liu L, Wang F, Yu L, Xiang Y, Zheng C, Huang S, Yu Z. The effectiveness of needle aspiration versus traditional incision and drainage in the treatment of breast abscess: a meta-analysis. Ann Med 2023; 55:2224045. [PMID: 37350731 PMCID: PMC10291949 DOI: 10.1080/07853890.2023.2224045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/16/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Breast abscess is a common and intractable clinical condition and the use of needle aspiration (NA) or incision and drainage (ID) in treatment is controversial. This meta-analysis aimed to systematically compare the clinical effectiveness of NA and ID in treating breast abscesses. METHODS The Web of Science, ScienceDirect, PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wanfang Data were searched for randomized controlled trials (RCTs) published from inception to January 7, 2022. The ROB-2 tool assessed risk of bias; the GRADE methodology rated certainty in outcomes; and Stata 16.0 performed data analyses. RESULTS Nine RCTs were included, including 703 patients. The results showed there was no significant difference in cure rate between the two groups (relative risk [RR] = 0.96, 95% confidence interval [CI] [0.86, 1.07]; p = .469), and after subgroup analysis, we found that it was not related to the use of ultrasound guidance or not. There was no significant difference in the recurrence rate (RR = 0.68, 95% CI [0.35, 1.30]; p = .241). Furthermore, the NA group was associated with shorter healing time (weighted mean differences = -11.02, 95% CI [-15.14, -6.90]; p < .001), lower incidence of breast fistula (RR = 0.21, 95% CI [0.06, 0.72]; p = .013), lower interrupted breastfeeding rate (RR = 0.28, 95% CI [0.20, 0.39]; p < .001), and higher satisfaction rate of appearance (RR = 1.51, 95% CI [1.03-2.21]; p = .035). CONCLUSION NA has better advantages in terms of healing time, avoidance of breast fistula, continuous breastfeeding, and patient satisfaction. Although NA and ID have similar cure and recurrence rates, NA, with or without ultrasound guidance, could be used as a first-line treatment for breast abscesses. Patients with large volumes, multicompartmental abscesses, or those who have been ineffective against multiple NA, should be considered for ID.KEY MESSAGESBreast abscess is a common and intractable clinical condition in general surgery.Compared with ID for breast abscesses, NA has better advantages in terms of healing time, avoidance of breast fistula, continuous breastfeeding, and patient satisfaction and could be used as a first-line treatment for breast abscesses.Patients with large volumes, multicompartmental abscesses, or those who have been ineffective against multiple NA, should be considered for ID.
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Affiliation(s)
- Fei Zhou
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Zhaohui Li
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Liyuan Liu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Fei Wang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Lixiang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Yujuan Xiang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Chao Zheng
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Shuya Huang
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital of Shandong University, Jinan, China
- Institute of Translational Medicine of Breast Disease Prevention and Treatment, Shandong University, Jinan, China
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Lee CJ, Lai LL, See MH, Velayuthan RD, Doon YK, Lim PE, Lim CSY, Poong SW, Chong CSC, Lee PY, Tan YH. Breaking the Barrier: A Study on Multi-drug Resistance in Breast Abscess at an Academic Malaysian Hospital. World J Surg 2023; 47:2743-2752. [PMID: 37491402 DOI: 10.1007/s00268-023-07108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
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.
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Affiliation(s)
- Choon Jiat Lee
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Lee Lee Lai
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mee Hoong See
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | | | - Yoke Kiet Doon
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Phaik Eem Lim
- Institute of Ocean and Earth Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Crystale Siew Ying Lim
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Sze Wan Poong
- Institute of Ocean and Earth Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Pui Yuei Lee
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Yong Hui Tan
- Department of Biotechnology, Faculty of Applied Sciences, UCSI University, Kuala Lumpur, Malaysia
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Snider HC. Management of Mastitis, Abscess, and Fistula. Surg Clin North Am 2022; 102:1103-1116. [DOI: 10.1016/j.suc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Li Y, Ma XJ, He XP. Clinical characteristics of lactational breast abscess caused by methicillin-resistant Staphylococcus aureus: hospital-based study in China. Int Breastfeed J 2021; 16:80. [PMID: 34641942 PMCID: PMC8513335 DOI: 10.1186/s13006-021-00429-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to identify the differences in clinical characteristics, puncture efficacy, antibiotic use, treatment duration, breastfeeding post-illness, and recurrence of patients with breast abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-susceptible Staphylococcus aureus (MSSA) infection during lactation. Methods The clinical data of patients with breast abscesses during lactation who were treated from January 2014 to February 2017 at Haidian Maternal and Child Health Hospital, Beijing, were reviewed. According to bacterial culture results, they were divided into MRSA (n = 260) and MSSA (n = 962) groups. Hospitalization (whether or not the patients were hospitalized), postpartum period, maternal age, location of abscess cavities, number of abscess cavities, amount of pus, frequency of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration, cessation of breastfeeding and recurrence were compared between the two groups using a t-test and a chi-squared test. Results We noted that only the cessation of breastfeeding was statistically significantly different between the two groups (P = 0.018). Hospitalization, postpartum period, maternal age, location of abscess cavities, number of abscess cavities, amount of pus, number of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration and recurrence showed no statistically significant differences (P = 0.488, P = 0.328, P = 0.494, P = 0.218, P = 0.088, P = 0.102, P = 0.712, P = 0.336, P = 0.512, P = 0.386 and P = 0.359, respectively). Conclusions There was no difference in clinical characteristics between breast abscesses infected by MRSA and those infected by MSSA. Ultrasound-guided needle aspiration could be the first choice for MRSA-infected breast abscess treatment. There is no need to increase antibiotic use because of MRSA infection, unless it is necessary. The reason why more patients with MRSA infected breast abscesses terminated breastfeeding is unclear from this study.
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Affiliation(s)
- Yan Li
- Center for Prevention and Treatment of Breast Diseases, Haidian Maternal and Child Health Hospital, Beijing, China.
| | - Xiang-Jun Ma
- Center for Prevention and Treatment of Breast Diseases, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Xiang-Ping He
- Center for Prevention and Treatment of Breast Diseases, Haidian Maternal and Child Health Hospital, Beijing, China
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Clinical Application of Minimally Invasive Therapy of Lactational Breast Abscess. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02290-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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7
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Clinical practice guidelines for diagnosis and treatment of patients with non-puerperal mastitis: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021. Chin Med J (Engl) 2021; 134:1765-1767. [PMID: 34039865 PMCID: PMC8367070 DOI: 10.1097/cm9.0000000000001532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Menegas S, Moayedi S, Torres M. Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians. J Emerg Med 2020; 60:310-320. [PMID: 33298356 DOI: 10.1016/j.jemermed.2020.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/02/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses. OBJECTIVE This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department. DISCUSSION Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative. CONCLUSIONS This review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.
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Affiliation(s)
- Samantha Menegas
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Siamak Moayedi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mercedes Torres
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Egbe TO, Njamen TN, Essome H, Tendongfor N. The estimated incidence of lactational breast abscess and description of its management by percutaneous aspiration at the Douala General Hospital, Cameroon. Int Breastfeed J 2020; 15:26. [PMID: 32276628 PMCID: PMC7146872 DOI: 10.1186/s13006-020-00271-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/06/2020] [Indexed: 01/14/2023] Open
Abstract
Background Lactational breast abscesses are uncommon in the puerperium but when they do develop, delays in specialist referral may occur especially in resource low settings. There is a dearth of studies regarding lactational breast abscesses in Cameroon. We aimed to estimate the incidence of lactational breast abscess and describe its management by percutaneous aspiration at the Douala General Hospital, Cameroon. Methods We conducted an observational prospective study of 25 breastfeeding women at the Douala General Hospital from January 1, 2015, to October 31, 2015. Participants were consenting breastfeeding women who completed a baseline questionnaire after diagnosis of lactational breast abscesses and underwent percutaneous needle aspiration under local anaesthesia. Data were analyzed by using descriptive statistics. Results The estimated incidence of lactational breast abscesses was 0.74% (28/3792). The age range of babies at the onset of breast abscess was 4 to 35 weeks; mean 28.3 ± 10.85 weeks. Forty-four per cent of participants underwent three lactational abscess aspirations and in 24 to 28% of them, it took 8 to 9 days for the abscess to resolve. In 72% of participants, treatment was with needle aspiration plus flucloxacillin. Seventy-six per cent of participants continued breastfeeding after abscess treatment. Conclusion The estimated incidence of lactational breast abscess at the Douala General Hospital is 0.74%. Percutaneous needle aspiration under local anaesthesia is an effective treatment for superficial lactational breast abscesses in most cases with or without ultrasound guidance and should be recommended worldwide as first line treatment. Further research is needed to understand the outcome of local infiltration of antibiotics on the abscess cavity.
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Affiliation(s)
- Thomas Obinchemti Egbe
- Faculty of Health Sciences, University of Buea, Box 63, Buea, Cameroon. .,Department of Obstetrics and Gynecology, Douala General Hospital, P.O. Box 4856, Douala, Cameroon.
| | - Theophile Nana Njamen
- Faculty of Health Sciences, University of Buea, Box 63, Buea, Cameroon.,Department of Obstetrics and Gynecology, Douala General Hospital, P.O. Box 4856, Douala, Cameroon
| | - Henri Essome
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.,Department of Obstetrics and Gynecology, Laquintinie Hospital Douala, Douala, Cameroon
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Packing versus mushroom catheters following incision and drainage in anorectal abscess. Ir J Med Sci 2019; 188:1343-1348. [PMID: 30675692 DOI: 10.1007/s11845-018-01958-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/18/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Management of anorectal abscess is traditionally by incision and drainage with packing. This study assessed the use of mushroom catheters compared with packing of anorectal abscess after incision and drainage in adults. Placement of a mushroom catheter to allow ongoing drainage of the cavity may have advantages by eliminating the need for painful dressing changes. METHODS This was a retrospective observational study. Following ethical approval, a chart review of 167 patients treated for anorectal abscess with either packing or mushroom catheter at Cork University Hospital from 2010 to 2015 was performed. Treatment decision was based on individual surgeon preference. Outcome measures included recurrence and fistula development. Telephone follow-up was also performed to assess patient satisfaction and quality of life (EQ-5D-3L). RESULTS One hundred and twenty-nine patients were treated with incision and drainage with packing, and 38 patients were treated with mushroom catheter. There was no statistically significant difference in recurrence (p = 0.691) or fistula development (p = 0.299) between the groups. Twenty-three patients had Crohn's disease, 17 patients had diabetes and 66 patients were smokers. There was no statistically significant difference in recurrence or fistula development between the treatment groups in Crohn's (p = 0.493), diabetics (p = 0.949) and smokers (p = 0.275). On average, patients treated with mushroom catheter reported a statistically significant higher satisfaction score (9.2 ± 1.0) than patients treated with packing (7.6 ± 1.8, p = 0.013). CONCLUSION Mushroom catheter drainage of anorectal abscesses is a safe alternative to traditional packing and results in higher patient satisfaction. This study provides a rationale for a future randomised controlled trial.
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Rao R, Ludwig K, Bailey L, Berry TS, Buras R, Degnim A, Fayanju OM, Froman J, Golesorkhi N, Greenburg C, Ma AT, Mautner SK, Krontiras H, Sowden M, Wexelman B, Landercasper J. Select Choices in Benign Breast Disease: An Initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely ® Campaign. Ann Surg Oncol 2018; 25:2795-2800. [PMID: 29968026 DOI: 10.1245/s10434-018-6584-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Up to 50% of all women encounter benign breast problems. In contrast to breast cancer, high-level evidence is not available to guide treatment. Management is therefore largely based on individual physician experience/training. The American board of internal medicine (ABIM) initiated its Choosing Wisely® campaign to promote conversations between patients and physicians about challenging the use of tests or procedures which may not be necessary. The American society of breast surgeons (ASBrS) Patient safety and quality committee (PSQC) chose to participate in this campaign in regard to the management of benign breast disease. METHODS The PSQC solicited initial candidate measures. PSQC surgeons represent a wide variety of practices. The resulting measures were ranked by modified Delphi appropriateness methodology in two rounds. The final list was approved by ASBrS and endorsed by the ABIM. RESULTS The final five measures are as follows. (1) Don't routinely excise areas of pseuodoangiomatous stromal hyperplasia (PASH) of the breast in patients who are not having symptoms from it. (2) Don't routinely surgically excise biopsy-proven fibroadenomas that are < 2 cm. (3) Don't routinely operate for a breast abscess without an initial attempt to percutaneously aspirate. (4) Don't perform screening mammography in asymptomatic patients with normal exams who have less than a 5-years life expectancy. (5) Don't routinely drain nonpainful, fluid-filled cysts. CONCLUSIONS The ASBrS Choosing Wisely® measures that address benign breast disease management are easily accessible to patients via the internet. Consensus was reached by PSQC regarding these recommendations. These measures provide guidance for shared decision-making.
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Affiliation(s)
- Roshni Rao
- Department of Surgery, Division of Breast Surgery, Columbia University Medical Center, New York, NY, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle Sowden
- The University of Vermont Medical Center, Burlington, VT, USA
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David M, Handa P, Castaldi M. Predictors of outcomes in managing breast abscesses-A large retrospective single-center analysis. Breast J 2018; 24:755-763. [PMID: 29781232 DOI: 10.1111/tbj.13053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
We have retrospectively examined a wide range of clinical characteristics, sonographic features, microbiology, and antibiotic regimens in patients with breast abscesses to seek predictive features related to outcome. Because consensus for optimal treatment of breast abscesses has moved toward minimally invasive management using single or repeated needle aspiration (ASP) coupled with adjuvant antibiotics, we assessed whether any factors correlate with the need for repeat procedures by analyzing the number of ASPs and/or surgical incision and drainage (I&D) per abscess. We examined 127 abscesses in 114 patients from a single urban public hospital, and among clinical characteristics, we found that only smoking history (P = .021) and the presence of nipple rings (P = .005) were associated with greater likelihood of necessitating repeat for abscess resolution procedures. Neither diabetes, lactational status, and HIV nor ultrasound features imaging of an abscess including size >3 cm, multiloculation, rind thickness, or central vs peripheral location were correlated with the need for a repeat procedure. Likewise, no specific micro-organisms predicted a greater likelihood of requiring repeat procedures, and no specific initial antibiotic regimen (gram-positive and/or gram-negative or multiresistance coverage) impacted clinical outcomes. Our data indicate that no specific imaging abscess characteristics, type of micro-organism, or initial choice of antibiotics affect outcomes, and therefore, these features should not preclude attempts at conventional therapy by repeated aspiration and antibiotic treatment. While a smoking history and presence of a nipple ring may increase the risk of a prolonged course, the decision to change antibiotics or repeat aspiration should rely instead on clinical evaluation and judgment by experienced physicians.
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Affiliation(s)
- Miriam David
- Department of Radiology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Priyanka Handa
- Department of Radiology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria Castaldi
- Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Kalan C, Femling J. Skin and Soft Tissue Infections. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Laas E, Touboul C, Kerdraon O, Catteau-Jonard S. Mastites inflammatoires et infectieuses du sein en dehors de la grossesse et de la période d’allaitement : recommandations. ACTA ACUST UNITED AC 2015; 44:996-1016. [DOI: 10.1016/j.jgyn.2015.09.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
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Abstract
BACKGROUND The benefits of breastfeeding are well known, and the World Health Organization recommends exclusive breastfeeding for the first six months of life and continuing breastfeeding to age two. However, many women stop breastfeeding due to lactational breast abscesses. A breast abscess is a localised accumulation of infected fluid in breast tissue. Abscesses are commonly treated with antibiotics, incision and drainage (I&D) or ultrasound-guided needle aspiration, but there is no consensus on the optimal treatment. OBJECTIVES To assess the effects of different treatments for the management of breast abscesses in breastfeeding women. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trial Register (27 February 2015). In addition we searched African Journals Online (27 February 2015), Google Scholar (27 February 2015), ProQuest Dissertations and Theses Databases (27 February 2015) and the WHO International Clinical Trials Registry Platform (ICTRP) search portal (27 February 2015). We also checked reference lists of retrieved studies and contacted experts in the field as well as relevant pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials (RCTs) investigating any intervention for treating lactational breast abscesses compared with any other intervention. Studies published in abstract form, quasi-RCTs and cluster-RCTs were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, assessed risk of bias and extracted data. Data were checked for accuracy. MAIN RESULTS We included six studies. Overall, trials had an unclear risk of bias for most domains due to poor reporting. Two studies did not stratify data for lactational and non-lactational breast abscesses, and these studies do not contribute to the results. This review is based on data from four studies involving 325 women. Needle aspiration (with and without ultrasound guidance) versus incision and drainage (I&D) Mean time (days) to complete resolution of breast abscess (three studies) - there was substantial heterogeneity among these data (Tau(2) = 47.63, I(2) = 97%) and a clear difference between subgroups (with or without ultrasound guidance; Chi(2) = 56.88, I(2) = 98.2%, P = < 0.00001). We did not pool these data in a meta-analysis. Two studies excluded women who had treatment failure when they calculated the mean time to complete resolution. One study found that the time to complete resolution of breast abscess favoured needle aspiration over I&D (mean difference (MD) -6.07; 95% confidence interval (CI) -7.81 to -4.33; n = 36), but excluded 9/22 (41%) women in the needle aspiration group due to treatment failure. Another study reported faster resolution in the needle aspiration group (MD -17.80; 95% CI -21.27 to -14.33; n = 64) but excluded 6/35 (17%) women in the needle aspiration group due to treatment failure. A third study also reported that needle aspiration was associated with a shorter time to complete resolution of breast abscess (MD -16.00; 95%CI -18.73 to -13.27; n = 60); however, the authors did not indicate the number of women who were lost to follow-up for either group, and it is unclear how many women contributed to this result. Considering the limitations of the available data, we do not consider the results to be informative. Continuation of breastfeeding, after treatment (success): results favoured the needle aspiration group, but we did not pool data from the two studies because of substantial unexplained heterogeneity (I(2) = 97%). One study reported that women in the needle aspiration group were more likely to continue breastfeeding (risk ratio (RR) 2.89; 95% CI 1.64 to 5.08; n = 60), whereas the other study found no clear difference (RR 1.09; 95% CI 0.97 to 1.22 n = 70). Treatment failure was more common among women treated with needle aspiration compared to those who underwent I&D (RR 16.12; 95% CI 2.21 to 117.73; two studies, n = 115, low quality evidence). In one study, treatment with needle aspiration failed in 9/22 women who subsequently underwent I&D to treat their breast abscess. In another study, treatment with needle aspiration failed in 6/35 women, who subsequently underwent I&D. All abscesses in the I&D group were successfully treated.The included studies provided limited data for the review's secondary outcomes. No data were reported for adverse events. One study (60 women) reported that women in the needle aspiration group were more satisfied with their treatment than women who received I&D to treat their breast abscesses. Incision and drainage (I&D) with or without antibioticsOne study (150 women) compared the value of adding a broad-spectrum cephalosporin (single dose or a course of treatment) to women who underwent I&D for breast abscesses.The mean time to resolution of breast abscess was reported as being similar in all groups (although women with infection were excluded). Mean time to resolution for women who received a course of antibiotics was reported as 7.3 days, 6.9 days for women who received a single dose of antibiotics and 7.4 days for women who did not receive antibiotics. Standard deviations, P values and CIs were not reported and prevented further analysis. No data were reported for any continuation of breastfeeding after treatment (success). For treatment failure, there was no clear difference between the groups of women who received antibiotics (either a single dose or a course of antibiotics) and those who did not (RR 1.00; 95% CI 0.36 to 2.76).Included studies rarely reported this review's secondary outcomes (including adverse events). For post-operative complications/morbidity, there was no difference in the risk of wound infections between the antibiotics and no antibiotics groups (RR 0.58; 95% CI 0.29 to 1.17), irrespective of whether women received a single dose or a course of antibiotics. AUTHORS' CONCLUSIONS There is insufficient evidence to determine whether needle aspiration is a more effective option to I&D for lactational breast abscesses, or whether an antibiotic should be routinely added to women undergoing I&D for lactational breast abscesses. We graded the evidence for the primary outcome of treatment failure as low quality, with downgrading based on including small studies with few events and unclear risk of bias.
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Affiliation(s)
- Hayley Irusen
- Stellenbosch UniversityCommunity Health, Faculty of Medicine and Health SciencesFrancie van Zijl DriveParowCape TownWestern CapeSouth Africa
| | - Anke C Rohwer
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa7505
| | - D Wilhelm Steyn
- University of StellenboschObstetrics & GynaecologyDepartment of Obstetrics & GynaecologyPO Box 19063TygerbergStellenboschSouth Africa7505
| | - Taryn Young
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa7505
- South African Medical Research CouncilSouth African Cochrane CentrePO Box 19070TygerbergCape TownSouth Africa7505
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Management of superficial abscesses: scope for day case surgery. Surg Res Pract 2014; 2014:308270. [PMID: 25374949 PMCID: PMC4208470 DOI: 10.1155/2014/308270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/26/2014] [Accepted: 05/18/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Patients presenting with superficial abscesses are often regarded as low priority and given a less efficient service. Aim. The aim of this study was to investigate the efficiency of emergency treatment of superficial abscesses and to identify areas for service improvement. Method. A retrospective case review of patients admitted to Derriford Hospital, Plymouth, over a four-month period. Results. Ninety-seven patients were included in the study. Seventy two (74%) arrived between 08.00 and 16.00 hours. Overall, 75 patients (77%) were referred on weekdays with 22 patients (23%) during weekends. Seventy-two patients (74%) had treatment under a general anaesthetic. Sixty-three percent of operations occurred within the working day. The time interval between admission and surgery ranged from 52 minutes to 38 hours (mean ± SD 16 ± 9.15). The length of admission ranged from 5.3 hours to 11 days (mean 36 hours). Of the one hundred overnight beds used by the 97 patients, 30 nights were spent awaiting surgery and 70 following surgery and awaiting discharge. Conclusion. Eighty-nine percent of the patients would have been suitable for treatment as day cases. This review shows that a simple service redesign has the potential of reducing inpatient bed occupancy and improving the patient's journey.
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Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations. Expert Rev Anti Infect Ther 2014; 12:753-62. [PMID: 24791941 DOI: 10.1586/14787210.2014.913982] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Literature review was carried out and studies reporting on treatment of breast abscesses were critically appraised for quality and their level of evidence using the Strength of Recommendation Taxonomy guidelines, and key recommendations were summarized. Needle aspiration either with or without ultrasound guidance should be employed as first line treatment of breast abscesses. This approach has the potential benefits of: superior cosmesis, shorter healing time, and avoidance of general anaesthesia. Multiple aspiration sessions may be required for cure. Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for treatment of larger abscesses (>3 cm). Surgical incision and drainage should be considered for first line therapy in large (>5 cm), multiloculated, or long standing abscesses, or if percutaneous drainage is unsuccessful. All patients should be treated concurrently with antibiotics. Patients with recurrent subareolar abscesses and fistulas should be referred for consideration of surgical treatment.
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Affiliation(s)
- Elaine Lam
- Department of Surgery, St Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
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