Department of Breast and Thyroid Surgery, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), Chongqing, China.
Department of Medical Ultrasonics, General Hospital of Chonggang, Chongqing, China.
PLoS One. 2022 Sep 1;17(9):e0273967. doi: 10.1371/journal.pone.0273967. eCollection 2022.
Breast abscess is developed on the basis of acute mastitis, which will cause damage to the physical and mental health of lactating women and is an important factor affecting the rate of breastfeeding. This study examined the risk factors for mastitis to develop into breast abscess, and analyzed the distribution of pathogenic bacteria, bacterial resistance, and treatment outcome.
The medical records of 316 cases of mastitis and 219 cases of breast abscess were retrospectively collected. We analyzed the bacterial distribution of mastitis and breast abscess, and compared the differences of bacterial drug resistance. Univariate analysis and binary logistic regression were used to analyze the following aspects: age, primiparity or not, history of breast surgery, body temperature, puerperium or not, onset time, located in the nipple/areolar complexe area or not, history of massage by non-professionals, staphylococcus aureus/methicillin-resistant staphylococcus aureus (MRSA) infection or not, diabetes and white blood cell count.
Of the 535 patients, 203 (37.9%) were positive for staphylococcus aureus. There were 133 (65.5%) cases of methicillin-sensitive staphylococcus aureus (MSSA) and 70 (34.5%) cases of MRSA. Concerning bacterial drug resistance, a statistical analysis showed that MSSA had high resistance rate to penicillin (96.2%), ampicillin (91%), clindamycin (42.9%) and erythromycin (45.9%). MRSA had a high resistance rate to penicillin (100%), ampicillin (98.6%), oxacillin (95.7%), erythromycin (81.4%), clindamycin (80%), and amoxicillin (31.7%). Risk factors for progression of mastitis to breast abscess include a body temperature<38.5°C, a postpartum time ≥ 42 days, an onset time ≥ 2 days, lesions in the nipple/areolar complex area, a history of massage by non-medical staff and bacterial cultures for milk or pus that test positive for staphylococcus aureus or MRSA (P < 0.001).
The most common pathogenic bacteria of mastitis and breast abscess is staphylococcus aureus. There are many risk factors for mastitis to develop into breast abscess. We should take effective measures for its risk factors and select sensitive antibiotics according to the results of bacterial culture to reduce the formation of breast abscess.
乳腺炎基础上发生乳腺脓肿，会对哺乳期妇女的身心健康造成损害，是影响母乳喂养率的重要因素。本研究旨在探讨乳腺炎发展为乳腺脓肿的危险因素，并分析其病原菌分布、细菌耐药性及治疗转归。
回顾性收集 316 例乳腺炎和 219 例乳腺脓肿患者的病历资料，分析乳腺炎和乳腺脓肿的病原菌分布情况，并比较细菌耐药性的差异。采用单因素分析和二项 Logistic 回归分析方法，对年龄、初产妇与否、乳腺手术史、体温、产褥期、发病时间、是否位于乳晕区、是否接受非专业人员按摩、金黄色葡萄球菌/耐甲氧西林金黄色葡萄球菌（MRSA）感染、糖尿病及白细胞计数等方面进行分析。
535 例患者中，金黄色葡萄球菌阳性 203 例（37.9%），其中甲氧西林敏感金黄色葡萄球菌（MSSA）133 例（65.5%），MRSA 70 例（34.5%）。细菌耐药性分析显示，MSSA 对青霉素（96.2%）、氨苄西林（91%）、克林霉素（42.9%）、红霉素（45.9%）耐药率较高；MRSA 对青霉素（100%）、氨苄西林（98.6%）、苯唑西林（95.7%）、红霉素（81.4%）、克林霉素（80%）、阿莫西林（31.7%）耐药率较高。乳腺炎进展为乳腺脓肿的危险因素包括体温<38.5℃、产后时间≥42 天、发病时间≥2 天、乳晕区病变、非医务人员按摩史及奶汁或脓液金黄色葡萄球菌或 MRSA 阳性培养（P<0.001）。
乳腺炎和乳腺脓肿的主要病原菌为金黄色葡萄球菌，乳腺炎发展为乳腺脓肿的危险因素较多，针对其危险因素采取有效措施，并根据细菌培养结果选择敏感抗生素，可减少乳腺脓肿的形成。
