乳房感染——抗生素耐药时代的微生物学和治疗。
Breast infections - Microbiology and treatment in an era of antibiotic resistance.
机构信息
Mid-Western Breast Unit, University of Limerick Hospitals, Limerick, Ireland.
Department of Surgery, Lambe Institute, National University of Ireland Galway, Ireland.
出版信息
Surgeon. 2020 Feb;18(1):1-7. doi: 10.1016/j.surge.2019.03.008. Epub 2019 May 7.
INTRODUCTION
Primary breast abscesses occur in <1% of non-lactating women, rising to 11% in women with lactational mastitis. In patients undergoing breast cancer surgery, the inflammatory response to post-operative surgical site infection (SSI) has been implicated in recurrence. Anti-microbial resistance increasingly hampers treatment in each group.
AIMS
Describe the demographic and predisposing characteristics of patients with primary breast abscesses and secondary infections, identify the microbial and antimicrobial patterns and formulate an evidence-based protocol for treating breast infections.
METHODS
Retrospective cohort study of all breast infections (primary and post-operative) treated at UHL from 2014 to 2017. Data collected from microbiology databases and patient records was analysed using Minitab V18.
RESULTS
537 cultures from 108 patients were analysed. 47 (43.5%) had primary abscesses, 12 (11.1%) were lactational and 49 (45.4%) were post-operative SSI. For primary infections, the mean age was 41.9 (±12.2) and reinfection rate 33%. For SSIs the mean age was 51.8 (±14.52) and reinfection rate 11.8%. Overall, 29.3% were smokers, 6.4% diabetic and 2.9% pregnant. 60 (43%) patients required radiological drainage and 2 (1%) surgical drainage. 57.5% had mixed growth. The most common isolate was Staphylococcus aureus; cultured in 16.7% of primary abscesses and 24% of SSIs. 13 empiric antibiotic regimes were prescribed before 26.4% of patients changed to 12 different targeted regimes.
CONCLUSION
Breast infections are frequently polymicrobial with a wide variety of organisms isolated, suggesting the need for broad spectrum coverage until culture results become available. Based on our local culture results, the addition of clindamycin to flucloxacillin would provide excellent empiric coverage for all categories of breast infection. An evidence-based treatment guideline is required and should be formulated in close collaboration with microbiology specialists.
引言
非哺乳期女性原发性乳房脓肿的发病率<1%，哺乳期乳腺炎患者发病率则上升至 11%。在接受乳腺癌手术的患者中，术后手术部位感染（SSI）的炎症反应与复发有关。在这两组患者中，抗生素耐药性的增加都对治疗造成了阻碍。
目的
描述原发性乳房脓肿和继发性感染患者的人口统计学和易患特征，确定微生物和抗生素模式，并制定治疗乳房感染的循证方案。
方法
回顾性分析 2014 年至 2017 年在 UHL 治疗的所有乳房感染（原发性和术后）的患者。从微生物数据库和患者记录中收集的数据使用 Minitab V18 进行分析。
结果
对 108 名患者的 537 个培养物进行了分析。47 例（43.5%）为原发性脓肿，12 例（11.1%）为哺乳期乳腺炎，49 例（45.4%）为术后 SSI。对于原发性感染，平均年龄为 41.9（±12.2）岁，再感染率为 33%。对于 SSI，平均年龄为 51.8（±14.52）岁，再感染率为 11.8%。总体而言，29.3%的患者为吸烟者，6.4%的患者为糖尿病患者，2.9%的患者为孕妇。60 例（43%）患者需要放射状引流，2 例（1%）患者需要手术引流。57.5%的患者有混合性生长。最常见的分离株是金黄色葡萄球菌，在 16.7%的原发性脓肿和 24%的 SSI 中培养出来。在 26.4%的患者更换 12 种不同的靶向治疗方案之前，共开出了 13 种经验性抗生素方案。
结论
乳房感染通常为多种微生物混合感染，分离出的微生物种类繁多，这表明需要广谱覆盖，直到获得培养结果。根据我们当地的培养结果，在氟氯西林中加入克林霉素将为所有类型的乳房感染提供极好的经验性覆盖。需要制定循证治疗指南，并且应该与微生物学专家密切合作制定。
Zotero 插件