Breast Abscess Bacteriologic Features in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus Epidemics

Moazzez, Ashkan; Kelso, Rebecca; Towfigh, Shirin; Sohn, Helen J.; Berne, Thomas V.; Mason, Rodney J.

doi:10.1001/archsurg.142.9.881

Cited by 87 publications

(80 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among adults with an abscess and surrounding erythema, the presence of a central black eschar had a positive predictive value of 94% and a negative predictive value of 45% for an MRSA isolate (113). CA-MRSA abscesses can be found in diverse anatomical locations, including the breast (615,855,1003), vulva (898), hand after clenched-fist injury (63), and neck (353,426). However, SSTIs can vary in appearance and can also present as folliculitis, paronychia, furuncle, felon, cellulitis with drainage (628), or lymphadenitis (353).…”

Section: Patients With Sstismentioning

confidence: 99%

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

2010

View full text Add to dashboard Cite

SUMMARY Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.

show abstract

Section: Patients With Sstismentioning

confidence: 99%

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

2010

View full text Add to dashboard Cite

show abstract

“…Staphylococcus aureus is a pathogen frequently isolated from mastitis milk or mammary abscesses in the lapine, ovine, bovine, and human species (4,5,23,41,53). The recognition of S. aureus by the mammary gland is not as well known as the recognition of Escherichia coli, another major pathogen for the mammary gland.…”

mentioning

confidence: 99%

Muramyl Dipeptide Synergizes with Staphylococcus aureus Lipoteichoic Acid To Recruit Neutrophils in the Mammary Gland and To Stimulate Mammary Epithelial Cells

Bougarn

Cunha

Harmache

et al. 2010

Clin Vaccine Immunol

View full text Add to dashboard Cite

Staphylococcus aureus, a major pathogen for the mammary gland of dairy ruminants, elicits the recruitment of neutrophils into milk during mastitis, but the mechanisms are incompletely understood. We investigated the response of the bovine mammary gland to muramyl dipeptide (MDP), an elementary constituent of the bacterial peptidoglycan, alone or in combination with lipoteichoic acid (LTA), another staphylococcal microbial-associated molecular pattern (MAMP). MDP induced a prompt and marked influx of neutrophils in milk, and its combination with LTA elicited a more intense and prolonged influx than the responses to either stimulus alone. The concentrations of several chemoattractants for neutrophils (CXCL1, CXCL2, CXCL3, CXCL8, and C5a) increased in milk after challenge, and the highest increases followed challenge with the combination of MDP and LTA. MDP and LTA were also synergistic in inducing in vitro chemokine production by bovine mammary epithelial cells (bMEpC). Nucleotide-binding oligomerization domain 2 (NOD2), a major sensor of MDP, was expressed (mRNA) in bovine mammary tissue and by bMEpC in culture. The production of interleukin-8 (IL-8) following the stimulation of bMEpC by LTA and MDP was dependent on the activation of NF-B. LTA-induced IL-8 production did not depend on platelet-activating factor receptor (PAFR), as the PAFR antagonist WEB2086 was without effect. In contrast, bMEpC and mammary tissue are known to express Toll-like receptor 2 (TLR2) and to respond to TLR2 agonists. Although the levels of expression of the inflammatory cytokines tumor necrosis factor alpha (TNF-␣) and IL-1␤ were increased by LTA and MDP at the mRNA level, no protein could be detected in the bMEpC culture supernatant. The level of induction of IL-6 was low at both the mRNA and protein levels. These results indicate that MDP and LTA exert synergistic effects to induce neutrophilic inflammation in the mammary gland. These results also show that bMEpC could contribute to the inflammatory response by recognizing LTA and MDP and secreting chemokines but not proinflammatory cytokines. Overall, this study indicates that the TLR2 and NOD2 pathways could cooperate to trigger an innate immune response to S. aureus mastitis.

show abstract

“…Staphylococcus aureus and Staphylococcus epidermidis are the commonest pathogens isolated from breast abscesses, [5][6][7][8][9] with Proteus spp. and anaerobic bacteria (including Bacteroides spp.…”

Section: Discussionmentioning

confidence: 99%

“…Moazzez et al 5 found S. aureus in 32% of cultures, with more than half of these isolates being methicillin-resistant S. aureus (MRSA). Walker et al 6 found S. epidermidis to be the commonest isolated aerobic bacteria in their study, with 60% of cultures yielding this organism.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pseudomonal breast infection

Harji

Rastall

Catchpole

et al. 2010

annals

View full text Add to dashboard Cite

Pseudomonas aeruginosa is an opportunistic, Gramnegative pathogen, commonly causing urinary tract infections, lower respiratory tract infections and soft tissue infections in immunocompromised patients. Breast sepsis is not commonly recognised. We present two cases of breast infection secondary to P. aeruginosa infection in previously healthy women with a review of the current literature. Case history 1A 54-year-old woman presented with a week-long history of breast pain, fever and rigors. Prior to admission, she had received a course of co-amoxiclav which had been changed to erythromycin prior to presentation. There was no significant past medical history and she was a nonsmoker.Clinically, the patient showed signs of sepsis. Breast examination revealed a large, tender erythematous area at the 3-5 o'clock position of the left breast, with no associated palpable lesion or axillary lymphadenopathy.Blood results revealed a leukocytosis and raised Creactive protein. Intravenous co-amoxiclav and metronidazole were commenced. Ultrasound scan of the left breast revealed multiple, dilated, fluid-filled ducts in the subareolar region; however, there was no discrete collection amenable to drainage.Some 48 h later, this patient became cardiovascularly compromised. An arterial blood gas analysis suggested a metabolic acidosis. Her antibiotic regimen was changed to intravenous clindamycin and gentamicin upon discussion with the microbiology department. Although initially responding well to fluid resuscitation, she further became significantly more hypotensive and oliguric.The patient was admitted to the intensive care unit and the decision was made to proceed to theatre for an incision and drainage of the left breast to drain any sepsis.Intra-operatively, a circumareolar incision was made with blunt dissection to the chest wall. Scanty, organised loculations of pus were seen, with no abscess cavity being identifiable.The patient was commenced on ciprofloxacin ABSTRACT Breast infection and breast sepsis secondary to Pseudomonas aeruginosa is uncommon. We report two cases of pseudomonal breast infection leading to septic shock and abscess formation in women with non-responding breast infection. The management of breast infection is broadspectrum antibiotics and ultrasound with aspiration of any collection. To treat breast infection effectively, the causative organism must be isolated to enable appropriate antibiotic therapy. Pseudomonal breast infection

show abstract

Breast Abscess Bacteriologic Features in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus Epidemics

Cited by 87 publications

References 14 publications

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Muramyl Dipeptide Synergizes with Staphylococcus aureus Lipoteichoic Acid To Recruit Neutrophils in the Mammary Gland and To Stimulate Mammary Epithelial Cells

Pseudomonal breast infection

Contact Info

Product

Resources

About