“Is our choice of empirical antibiotics appropriate for patients with methicillin resistant Staphylococcus aureus in breast abscess?”
Abstract
Background and Objectives: Breast abscesses remain as one of the most common reasons for females to come for a surgical consult. This retrospective cohort study includes both lactating and non-lactating females with breast abscesses. Due to changing trends in bacteriology of organisms, we need to reconsider our empirical choices of antibiotics. In our study, the main causative organism in breast abscess was Staphylococcus aureus with predominant species being MRSA.
Materials and Methods: This is an analytical review of all breast abscesses treated in a single center from 2012 to 2015. This study included bacterial cultures, antibiotic sensitivities and resistance pattern in breast abscesses.
Results: 268 patients were included in the study. 143 (53.4%) were Lactational abscesses and 125 (46.6%) were non-Lactational abscesses. 169 (63.0%) harbored S. aureus in which 86 (50.8%) were MRSA. MRSA was the predominant organism in the Lactational group while non-Lactational group had no growth or other organisms in culture in this study. Other growing organisms were Klebsiella pneumoniae, Bacteroides, Pseudomonas, Streptococcus species and Mycobacterium tuberculosis. On comparative analysis, MRSA showed statistically a significant difference with p<0.0001, when it comes to predominant growth in lactating mothers. First line prescribed empirical antibiotics received by the patient, which is amoxicillin clavulanate, is mostly resistant. It is recommended that the institutional antibiogram targeted treatment be offered to patients with breast abscess. We also recommend ciprofloxacin with clindamycin as initial empirical therapy.
Conclusion: MRSA was the most common organism seen in breast abscesses. Our first line treatment of antibiotics was resistant. Clindamycin and ciprofloxacin should be the preferred 1st choice for treatment.
Bharat A, Gao F, Aft RL, Gillanders WE, Eberlein TJ, Margenthaler JA, Predictors of primary breast abscesses and recurrence. World J Surg. 2009 Dec;33(12):2582-6.
Foxman B, D’Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol 2002;155:103– 114
Spencer JP, Management of mastitis in breastfeeding women. Am Fam Physician. 2008 Sep 15;78(6):727-31.
Kataria K, Srivastava A, Dhar A, Management of lactational mastitis and breast abscesses: review of current knowledge and practice. Indian J Surg. 2013 Dec;75(6):430-5.
Branch-Elliman W, Golen TH, Gold HS, Yassa DS, Baldini LM, Wright SB. Risk factors for Staphylococcus aureus post partum breast abscess. clinical Infectious Disease 2012;54:71–7.
Amir LH, Forster D, McLachlan H, Lumley J. Incidence of breast abscess in lactating women: report from an Australian cohort.BJOG. 2004 Dec; 111(12):1378-81
Abudu L, Blair I, Fraise A, Cheng KK. Methicillin-resistant Staphylococcus aureus (MRSA): a community-based prevalence survey.Epidemiol Infect 2001;126:351–6.
Dener C, Inan A. Breast abscesses in lactating women. World J Surg 2003;27:130–3.
Merz L, De Courten C, Orasch C. [Breast infections]. Rev Med Suisse. 2014 Apr 23;10(427):925-6, 928-30.
Dennis CL, Schottle N, Hodnett E, McQueen K An all-purpose nipple ointment versus lanolin in treating painful damaged nipples in breastfeedingwomen: a randomized controlled trial. Breastfeed Med. 2012 Dec;7(6):473-9.
Ahluwalia IB, Morrow B, Hsia J. Why do women stop breastfeeding? Findings from the Pregnancy Risk Assessment and Monitoring System. Pediatrics 2005;116:1408–1412.
Suthar KD, Mewada BN, Surati KN, Shah JK. Comparison of percutaneous ultrasound guided needle aspiration and open surgical drainage in management of puerperal breast abscess. International Journal of Medical Science and Public Health 2013;2(1):69–72.
Leung SS. Breast pain in lactating mothers. Hong Kong Med J. 2016 Aug;22(4):341-6
Montalto M, Lui B. MRSA as a cause of postpartum breast abscess in infant and mother. J Hum Lact. 2009 Nov;25(4):448-50
Abdelhadi MS, Bukharie HA.Breast infections in non-lactating women.J Family Community Med. 2005 Sep;12(3):133-7
Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N, Lalonde L. Breast abscesses: evidence-based algorithms for diagnosis, management, and follow-up. Radiographics. 2011 Oct;31(6):1683-99.
Branch-Elliman W, Lee GM, Golen TH, Gold HS, Baldini LM, Wright SB. Health and economic burden of post-partum Staphylococcus aureus breast abscess. PLoS One. 2013 Sep 5;8(9):e73155.
Chen CY, Anderson BO, Lo SS, Lin CH, Chen HM. Methicillin-resistant Staphylococcus aureus infections may not impede the success of ultrasound-guided drainage of puerperal breast abscesses.J Am Coll Surg. 2010 Feb;210(2):148-54.
Walker AP, Edmiston CE Jr, Krepel CJ, Condon RE, A prospective study of the microflora of nonpuerperal breast abscess. Arch Surg. 1988 Jul;123(7):908-11.
Maudsley J, Stone SP, Kibbler CC, et al. The community. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in older people living in their own homes: implications for treatment, screening and surveillance in the UK. J Hosp Infect 2004;57:258.
Gould IM, Antibiotics, skin and soft tissue infection and meticillin-resistant Staphylococcus aureus: cause and effect. Int J Antimicrob Agents. 2009 Jul;34 Suppl 1:S8-11.
Moazzez A, Kelso RL, Towfigh S, Sohn H, Berne TV, Mason RJ, Breast abscess bacteriologic features in the era of community-acquired methicillin-resistant Staphylococcus aureus epidemics. Archives of surgery (Chicago, Ill. : 1960). 2007
Schoenfeld EM, McKay MP, Mastitis and methicillin-resistant Staphylococcus aureus (MRSA): the calm before the storm? J Emerg Med. 2010 May;38(4):e31-4
Chen KT, Huard RC, Della-Latta P, Saiman L. Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol 2006; 108: 480-1.
Irusen H, Rohwer AC, Steyn DW, Young T. Treatments for breast abscesses in breastfeeding women. Cochrane Database of Systematic Reviews 2013, Issue 4.
Crepinsek MA, Crowe L, Michener K, Smart NA. Interventions for preventing mastitis after childbirth.Cochrane Database of Systematic Reviews 2012, Issue 10.
Singla SL, Bishnoi PK, Kadian YS, Pawanjit, Jindal O. Evaluation of the role of antibiotics in the surgical management of breast abscess. Tropical Doctor 2002; Vol.32, issue 3:165–6.
Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Sao Paulo Med J. 2016 May-Jun;134(3):273.
Stafford I, Hernandez J, Laibl V, Sheffield J, Roberts S, Wendel G Jr. Community-acquired methicillin-resistant Staphylococcus aureus among patients with puerperal mastitis requiring hospitalization.Obstet Gynecol. 2008 Sep;112(3):533-7.
Thomsen AC, Espersen T, Maigaard S, Course and treatment of milk stasis, noninfectious inflammation of the breast, and infectious mastitis in nursing women. Am J Obstet Gynecol. 1984 Jul 1;149(5):492-5.
Boccaccio C, Verdaguer Babic V, Botto L, Cervetto MM, Cetani S, Paladino S, Conti R, Lanzillota A, Herrera R, Amarante D. Methicillin-resistant Staphylococcus aureus (MRSA) isolation in breast abscesses in a Public Maternity.Medicina (B Aires). 2014;74(3):210-5.
Dabbas N, Chand M, Pallett A, Royle GT, Sainsbury R. Have the organisms that cause breast abscess changed with time?--Implications for appropriate antibiotic usage in primary and secondary care.Breast J. 2010 Jul-Aug;16(4):412-5.
Chuwa EW, Wong CM, Tan YY, Hong GS.MRSA breast abscesses in postpartum women.Asian J Surg. 2009 Jan;32(1):55-8.
Berens P, Swaim L, Peterson B Incidence of methicillin-resistant Staphylococcus aureus in postpartum breast abscesses. Breastfeed Med. 2010 Jun;5(3):113-5
Bhatta DR, Cavaco LM, Nath G, Kumar K, Gaur A, Gokhale S, Bhatta DR. Association of Panton Valentine Leukocidin (PVL) genes with methicillin resistant Staphylococcus aureus (MRSA) in Western Nepal: a matter of concern for community infections (a hospital based prospective study).BMC Infect Dis. 2016 May 15;16:199.
Manara J, Shears P. More than just a simple abscess: could it be caused by Panton-Valentine leukocidin positive Staphylococcus aureus? J Laryngol Otol. 2012 Mar;126(3):325-7.
Rebic V, Budimir A, Aljicevic M, Bektas S, Vranic SM, Rebic D. Typing of Methicillin Resistant Staphylococcus Aureus Using DNA Fingerprints by Pulsed-field Gel Electrophoresis. Acta Inform Med. 2016 Jul 16;24(4):248-252
Liu Y, Xu Z, Yang Z, Sun J, Ma L. Characterization of community-associated Staphylococcus aureus from skin and soft-tissue infections: a multicenter study in China. Emerg Microbes Infect. 2016 Dec 21;5(12):e127
Thapaliya D, Dalman M, Kadariya J, Little K, Mansell V, Taha MY, Grenier D, Smith TC. Characterization of Staphylococcus aureus in Goose Feces from State Parks in Northeast Ohio. Ecohealth. 2017 Mar 10.
Mehrshad S, Haghkhah M, Aghaei S. Epidemiology and molecular characteristics of methicillin-resistantStaphylococcus aureus from skin and soft tissue infections in Shiraz, Iran. Turk J Med Sci. 2017 Feb 27;47(1):180-187.
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Issue | Vol 10 No 6 (2018) | |
Section | Original Article(s) | |
Keywords | ||
Breast abscess Empirical antibiotics Staphylococcus aureus |
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