Department of Woman, Child and Neonate, Buzzi Children Hospital, ASST Fatebenefratelli Sacco, Via L. Castelvetro 32, 20154 Milan, Italy.
Departmental Breast Unit, ASST Fatebenefratelli Sacco, University of Milan, Via G.B. Grassi 74, 20157 Milan, Italy.
Int J Environ Res Public Health. 2022 May 9;19(9):5762. doi: 10.3390/ijerph19095762.
(1) Background: Breast abscess (BA) is a condition leading in the majority of cases to breastfeeding interruption. Abscesses are commonly treated with antibiotics, needle aspiration or incision and drainage (I&D), but there is still no consensus on the optimal treatment. Since there are no well-defined clinical guidelines for abscess management, we conducted a retrospective, observational study with the aim of assessing ultrasound (US)-guided management of BA without surgery, regardless of the BA size. The secondary objective was the microbiologic characterization and, in particular, the methicillin resistance identification. (2) Methods: our population included 64 breastfeeding mothers with diagnosis of BA. For every patient, data about maternal, perinatal and breastfeeding features were collected. All patients underwent office US scans and 40 out of 64 required a more detailed breast diagnostic ultrasound performed by a radiologist. In all cases, samples of milk or abscess material were microbiologically tested. All patients received oral antibiotic treatment. We performed needle aspiration, when feasible, even on abscesses greater than 5 cm. (3) Results: most of the women developed BA during the first 100 days (68.8% during the first 60 days) after delivery and 13 needed hospitalization. Four abscesses were bilateral and 16 had a US major diameter greater than 5 cm. All patients were treated with antibiotic therapy according to our clinical protocol and 71.9% (46/64) underwent fine needle aspiration. None of them required I&D. The average duration of breastfeeding was 5 months (IR 2; 9.5) and 40.6% of women with BA continued to breastfeed for more than 6 months. Only 21 mothers interrupted breastfeeding before 3 months. (4) Conclusions: our observational data suggest, regardless of the size and the clinical features of the BA, a conservative approach with antibiotic therapy targeted at the Methicillin-Resistant (MRSA) identified and needle aspiration, if feasible. In our experience, treatment with needle aspiration is a cost- effective method. Unlike drainage, it is an outpatient procedure, easily repeatable, with no cosmetic damage. In addition, it has lower risk of recurrences since, differently from surgical incision, it does not cause interruption of the ducts. Moreover, needle aspiration is less painful, does not require the separation of the mother-child dyad and allows for a quicker, if not immediate, return to breastfeeding.
(1) 背景：乳腺脓肿（BA）是一种导致大多数情况下中断母乳喂养的疾病。脓肿通常采用抗生素、针吸或切开引流（I&D）治疗，但对于最佳治疗方法仍未达成共识。由于没有明确的脓肿管理临床指南，我们进行了一项回顾性观察研究，旨在评估无论脓肿大小，均不进行手术的超声（US）引导下 BA 管理。次要目标是微生物学特征，特别是耐甲氧西林的鉴定。(2) 方法：我们的研究人群包括 64 名被诊断为 BA 的哺乳期母亲。每位患者均收集了有关产妇、围产期和母乳喂养特征的数据。所有患者均行门诊 US 扫描，其中 40 例需要由放射科医生进行更详细的乳腺诊断性 US。所有患者均进行了乳汁或脓肿标本的微生物学检测。所有患者均接受口服抗生素治疗。只要可行，我们就会进行针吸，即使脓肿大于 5cm 也如此。(3) 结果：大多数女性在分娩后 100 天内（68.8%在分娩后 60 天内）出现 BA，其中 13 例需要住院治疗。4 例脓肿为双侧，16 例 US 最大直径大于 5cm。所有患者均根据我们的临床方案接受抗生素治疗，71.9%（46/64）行细针抽吸。他们均无需进行 I&D。母乳喂养的平均持续时间为 5 个月（IR 2；9.5），40.6%的 BA 患者继续母乳喂养超过 6 个月。只有 21 名母亲在 3 个月前中断母乳喂养。(4) 结论：我们的观察性数据表明，无论 BA 的大小和临床特征如何，我们都采用一种保守方法，针对耐甲氧西林金黄色葡萄球菌（MRSA）进行抗生素治疗，并在可行的情况下进行针吸。在我们的经验中，针吸治疗是一种具有成本效益的方法。与引流不同，它是一种门诊手术，易于重复，无美容损伤。此外，由于它不会像手术切开那样导致导管中断，因此复发风险较低。此外，针吸术疼痛较轻，不需要母婴分离，并且可以更快地（即使不是立即）恢复母乳喂养。
