Emergency management of puerperal breast abscess

Abstract

A 38-year-old woman, who was 1 month postpartum, presented with left breast pain. The patient reported a 5-day history of stabbing left breast pain, erythema, and tenderness. She had been breast feeding and pumping breast milk without difficulty, but recently noted blood, mucous, and purulent material within the pumped milk. The patient denied fevers, chills, breast trauma, a palpable mass, or right breast abnormalities. Ultrasound of the left breast demonstrated a 4.7 9 2.1 cm complex fluid collection with associated skin thickening, consistent with left breast cellulitis, mastitis, and a breast abscess (Fig. 1). Surgical consultation was obtained, and a trial of ultrasound-guided aspiration of the left breast abscess was completed (Fig. 2) that yielded 12 ml of purulent fluid. Aspirated samples were evaluated by microbiology with cultures positive for methicillin-resistant Staphylococcus aureus. Trimethoprim and sulfamethoxazole were initiated for 7 days. Repeat ultrasound of the left breast demonstrated complete resolution of the left breast abscess (Fig. 3). On return visit, the patient reported decreased pain, swelling, and drainage from the left breast, and has subsequently been able to resume left breast feeding and pumping. DiscussionCellulitis, mastitis, and breast abscesses exist along a continuum, with breast abscesses occurring in 5-11 % of lactating women with infectious mastitis [1]. Most breast abscesses develop secondarily to skin contamination with S. aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Peptostreptococcus, or Bacteroides [1]. Common symptoms of breast abscesses, as illustrated by this case, include breast pain, erythema, tenderness, and increased breast temperature with or without fever or a palpable breast mass. Ultrasonography is the imaging modality of choice due to its availability, painless use, ability to conduct repeat examinations during the course of therapy, and its ability to guide percutaneous drainage [2]. In cases of confirmed breast abscesses, ultrasonography usually demonstrates a multiloculated hypoechoic fluid collection of variable shape and size with a thickened periphery and increased vascularity. According to recently published 2011 algorithm, a trial of ultrasound guided drainage is recommended for all fluid collections suggesting an abscess, regardless of size, which occur during the breastfeeding period, are caused by S. aureus, and lack a multiloculated structure. The greatest success is achieved with abscesses that are \3 cm in diameter [3,4]. Abscesses that are multiloculated or larger than 3 cm in diameter may fail ultrasound-guided drainage; thus, in such instances, early surgical evaluation for incision and drainage is strongly recommended [4]. In addition to ultrasound-guided drainage, all suspected breast abscesses should be managed with antibiotics including cloxacillin 500 mg four times daily, clindamycin 300 mg four times daily, erythromycin 500 mg three times daily, or cefazolin 500 mg four times daily for a total of 7-10 days [4,5]. B...

The prevalence and predisposing factors of mastitis in lactating mothers in puerperium

“…The most common bacterium found in breast abscess secretion culture was Staphylococcus aureus, which coincides with our findings 15, 23-28 . Various other studies also reported MRSA in breast abscess secretion culture which is similar to our study 25,27 . A lactational breast abscess is usually bacterial in etiology and can be effectively managed with oral antibiotics.…”

Uncommon Benign Breast Abnormalities in Adolescents

“…20 It is generally recommended that lactating women continue to evacuate the affected breast by means of breastfeeding or pumping to promote expulsion of milk from the affected ducts and prevent stasis, which would favor abscess formation. 21 Infections associated with piercing of the nipple may present either early or late, and may be attributable to other organisms, such as β-hemolytic Streptococcus and Actinomyces, making culture and sensitivity of the causative organism of particular importance in this population. 22 Spontaneous nonpuerperal abscesses in adults are associated with smoking and diabetes, 23 conditions that also affect adolescents.…”

A case of Panton–Valentine leucocidin toxin‐positive Staphylococcus aureus‐mediated neonatal mastitis

“…In the context of maternal and infant health, many studies have described incidence and transmission of communityassociated and healthcare-associated strains, in addition to recommended antibiotic regimens, invasive and noninvasive management, and prevention strategies including decolonization (Saiman et al, 2003;Fortunov et al, 2007;Alsubaie et al, 2012;Jahanfar et al, 2013;Sheffield, 2013). With respect to mastitis specifically, most reports relate to incidence and treatment of S. aureus maternal infection (Branch-Elliman et al, 2012;Chick et al, 2012;Iatrakis et al, 2013;Perez et al, 2013) and, to a lesser degree, subsequent transmission of infection to (mostly pre-term and neonatal) infants (Behari et al, 2004;Gastelum et al, 2005;Kayiran et al, 2014). Mastitis in children is less common and is largely related to neonates and pubescent/ postpubescent age groups (Faden, 2005).…”