Boston Children's Hospital, Department of Emergency Medicine, United States of America.
Boston Children's Hospital, Department of Emergency Medicine, United States of America; Boston Children's Hospital, Department of Pediatirc Infectious Disaeses, United States of America; Boston Children's Hospital, Clinical Informatics Fellowship Program, United States of America.
Am J Emerg Med. 2021 Mar;41:193-196. doi: 10.1016/j.ajem.2020.11.018. Epub 2020 Nov 11.
Limited data exist regarding the presentation and bacteriology of nonneonatal pediatric breast abscess.
To determine the bacteriology and characteristic presentation of pediatric breast abscesses in a tertiary care center.
Cross-sectional study of patients age 1 month to 21 years admitted to a pediatric Emergency Department (ED) between 1996 and 2018 with a breast abscess. Patients with pre-existing conditions were excluded. Records were reviewed to determine demographics, history, physical exam findings, wound culture results, imaging and ED disposition. We used descriptive statistics to describe prevalence of different bacteria.
We identified 210 patients who met study criteria. Median age was 13.6 years [IQR 6.6, 17.4], and 91% (191/210) were females. Ninety-two patients (43.8%) were 'pre-treated' with antibiotics prior to ED visit, and 33/210 (16%) were febrile. Ultrasound was obtained in 85 patients (40.5%), 69 patients had a single abscess and 16 had multiple abscesses. Most patients were treated with antibiotics and 100 had a surgical intervention, of these 89 had I&D and 11 a needle aspiration. Admission rate was 45%. Culture results were available for 75 (75%). Thirty-three (44%) had a negative culture, or grew non-aureus staphylococci or other skin flora. Culture were positive for MSSA 21 (28%), MRSA 13 (17%), Proteus mirabilis 2 (2.6%), Serratia 1 (1.3%). Other organisms include Gram-negative bacilli, group A Streptococcus and enterococcus.
Non-neonatal pediatric breast abscess bacteriology is no different than data published on other skin abscesses. MRSA coverage should be considered based on local prevalence in skin infections.
关于非新生儿儿科乳房脓肿的临床表现和细菌学数据有限。
确定三级保健中心儿科乳房脓肿的细菌学和特征表现。
对 1996 年至 2018 年间在儿科急诊部（ED）就诊的年龄在 1 个月至 21 岁的患有乳房脓肿的患者进行横断面研究。排除有基础疾病的患者。记录患者的人口统计学、病史、体格检查结果、伤口培养结果、影像学和 ED 处置情况。我们使用描述性统计方法来描述不同细菌的患病率。
我们确定了 210 名符合研究标准的患者。中位年龄为 13.6 岁[IQR 6.6, 17.4]，91%（191/210）为女性。92 名（43.8%）患者在 ED 就诊前接受过抗生素“预治疗”，33/210（16%）患者发热。85 名患者（40.5%）接受了超声检查，69 名患者有单个脓肿，16 名患者有多个脓肿。大多数患者接受了抗生素治疗，100 名患者接受了手术干预，其中 89 例行切开引流术，11 例行脓肿抽吸术。入院率为 45%。75 份（75%）的培养结果可用。33 份（44%）培养结果为阴性，或培养出非金黄色葡萄球菌或其他皮肤菌群。21 株（28%）、13 株（17%）、2 株（2.6%）、1 株（1.3%）分别为 MSSA、MRSA、奇异变形杆菌、沙雷氏菌。其他病原体包括革兰氏阴性杆菌、A 组链球菌和肠球菌。
非新生儿儿科乳房脓肿的细菌学与其他皮肤脓肿的报道数据无差异。根据皮肤感染中 MRSA 的当地流行情况，应考虑覆盖 MRSA。
