Trends in non-lactation breast abscesses in a tertiary hospital setting

Abstract

Background: The aim of this paper was to retrospectively review non-lactation breast abscesses treated in Princess Alexandra Hospital over a 10-year period and to illustrate the trends in size, risk factors, microbiological profile and management.

Methods: A computerized search of the medical records was undertaken to identify all adult patients with a diagnosis of breast abscesses during June 2005-June 2015. Patients concurrently breastfeeding were excluded. A retrospectively review of the clinical records was performed.

Results: Eighty-five abscesses were identified in 77 patients. The median patient age was 45 years and 93.7% were females. Smoking and diabetes mellitus were associated with a longer inpatient hospital stay. There was a significant difference in microbiology of abscesses in relation to size. Smaller abscesses (≤3.0 cm) predominantly had mixed anaerobes (54%), whereas larger abscesses had a dominance of Staphylococcus aureus (29%) and other aerobic microbes (33%) (P < 0.05). Seven percent of all abscesses had methicillin-resistant S. aureus. Flucloxacillin was prescribed solely in majority of the cases (45%) with addition of suitable mixed anaerobic cover in 12% cases. Of the 85 abscesses, 58.8% were managed non-operatively with antibiotics ± percutaneous drainage. Percutaneous aspiration had a shorter inpatient stay compared with patients who underwent operative management.

Conclusion: This represents the first Australian study solely analysing non-lactation breast abscess. Size was correlated significantly to characteristic bacteriology and empiric therapy should include both aerobic and anaerobic cover. The majority of non-lactation breast abscesses can be managed non-operatively with a combination of antibiotics and percutaneous aspiration.

Keywords: abscess; breast; epidemiology; management; non-lactational.