Tsai Ming-Jui, Huang Wei-Chia, Wang Jann-Tay, Wang Ming-Yang, Lee Yi-Hsuan, Lin Shu-Wen, Pan Sung-Ching, Chang Shan-Chwen
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2020 Dec;53(6):875-881. doi: 10.1016/j.jmii.2020.03.028. Epub 2020 Apr 4.
The incidence of mastitis has increased, and this disease can lead to long antibiotic courses and complications. Here, we aimed to identify the factors associated with antibiotic duration and recurrence of complicated mastitis.
This retrospective cohort study was conducted in a tertiary hospital in Taiwan. All hospitalized patients diagnosed with mastitis (ICD-9 code 611.0) from Jan. 1, 2012, to Dec. 31, 2016, were enrolled. Patient characteristics and clinical data were obtained from the medical charts. Recurrence was defined as mastitis within the first year after the discontinuation of antibiotics for at least 7 days.
In total, 214 females with a median age of 37 years old (IQR 33-45) were enrolled. A total of 148 patients (69.2%) underwent debridement, and 122 (57.0%) underwent biopsy. Histopathological examinations revealed granulation tissue in 44.6% (62/139) of the patients. Positive cultures were obtained in 65.9% (141/214) of the patients. Coagulase-negative staphylococci (64/141, 45.4%) was the most common pathogen, followed by Corynebacterium species (42/141, 29.8%). The median hospitalization length and antibiotic course were 7 (IQR 4-13) and 37 days (IQR 22-77), respectively. Three patients died of breast cancer during treatment. The recurrence rate was 18.5% (39/211). Younger age, corynebacterial infection, and pregnancy were associated with longer treatment durations (P < 0.001, 0.003, <0.001). Corynebacterial infection was associated with a 2.16-fold (95% CI: 1.11-4.20) increase in recurrence after adjusting for age.
Corynebacterial infection is associated with longer treatment courses and an increased recurrence rate of complicated mastitis. Therefore, specific treatments should be considered.
乳腺炎的发病率有所上升，这种疾病会导致抗生素疗程延长及并发症。在此，我们旨在确定与复杂性乳腺炎抗生素使用时长及复发相关的因素。
这项回顾性队列研究在台湾一家三级医院开展。纳入了2012年1月1日至2016年12月31日期间所有诊断为乳腺炎（国际疾病分类第九版编码611.0）的住院患者。患者特征及临床数据从病历中获取。复发定义为抗生素停用至少7天后的第一年内发生乳腺炎。
共纳入214名女性，中位年龄37岁（四分位间距33 - 45岁）。共有148例患者（69.2%）接受了清创术，122例（57.0%）接受了活检。组织病理学检查显示44.6%（62/139）的患者有肉芽组织。65.9%（141/214）的患者培养结果呈阳性。凝固酶阴性葡萄球菌（64/141，45.4%）是最常见的病原体，其次是棒状杆菌属（42/141，29.8%）。中位住院时长和抗生素疗程分别为7天（四分位间距4 - 13天）和37天（四分位间距22 - 77天）。3例患者在治疗期间死于乳腺癌。复发率为18.5%（39/211）。年龄较小、棒状杆菌感染和妊娠与较长的治疗时长相关（P < 0.001、0.003、<0.001）。调整年龄后，棒状杆菌感染与复发风险增加2.16倍（95%置信区间：1.11 - 4.20）相关。
棒状杆菌感染与复杂性乳腺炎更长的治疗疗程及更高的复发率相关。因此，应考虑采取针对性治疗。
