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Postpartum Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Elena R. Magro-Malosso, Sarah K. Dotters-Katz, Daniele Di Mascio
Treatment for mastitis begins with frequent removal of milk, hydration, and analgesia. Healthy term infants can continue to feed on the affected side. Antibiotics are used if conservative management is ineffective or the patient is acutely ill.
Postpartum infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Appropriate therapy for mastitis includes routine emptying of the breast and administration of antibiotics. Breastfeeding from both breasts should continue. If the infected breast is too sore for nursing, gentle pumping may be employed to reduce congestion. Weaning may increase the risk of abscess formation (97,99,105). Choice of antibiotic may be empirical or based on culture of expressed breast milk. S. aureus is the organism isolated in 35% to 50% of breast infections, and 50% to 70% show penicillin resistance in vitro (97,100,104,106). Other common pathogens include coagulase-negative staphylococci, streptococci, E. coli, Klebsiella pneumoniae, and Bacteroides fragilis (100). Cultures of breast milk may be prudent, since methicillin-resistant S. aureus, primarily community-acquired, is emerging as a pathogen in mastitis (107), even in those without predisposing factors (108).
Breast Abscess
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Jennifer Tomlins, Simon Tiberi
A breast abscess is a walled-off collection of inflammatory exudate (pus). It most commonly occurs as a complication of mastitis but may also be a primary presentation of breast infection. It is seen frequently in women aged 15–45 years and may be secondary to lactational mastitis or non-lactational causes such as duct ectasia (Table 4.8.1). Other causes including neonatal mastitis and systemic infection such as tuberculosis are rare. Mastitis during breastfeeding is common, with recent estimated prevalence reaching as high as 33%, and may lead to abscess in 3%–11% of these women. Duct ectasia occurs in older women, is associated with squamous metaplasia resulting in duct obstruction and has a prevalence of 5%–9%.
Treatment of lactational breast abscesses with cavity diameter larger than 5 cm via combined ultrasonography-guided percutaneous catheter placement and hydrostatic pressure irrigation
Published in Journal of Obstetrics and Gynaecology, 2022
Zhihui Du, Lei Liu, Xing Qi, Peisen Gao, Shumin Wang
Breast infection is a common problem among lactating women presenting with mastitis to abscess formation. The incidence of lactational breast abscesses ranges from 4% to 11% (Benson 1989). Milk stasis provides a lactose-rich culture medium for bacteria, of which Staphylococcus aureus (S. aureus), Staphylococcus epidermidis, and streptococci are the major contributing organisms (Givens and Luszczak 2002). Traditional management of breast abscesses involves surgical incision and drainage and a resultant frequent need for general anaesthesia and daily dressing changes. In recent years, ultrasonography (US)-guided percutaneous drainage of breast abscesses using needle aspiration or catheter drainage under local anaesthesia has been used as an alternative to surgical incision and drainage (Berna-Serna et al. 2004; Christensen et al. 2005; Chandika et al. 2012). Compared with traditional drainage though surgical incision, US-guided interventional treatment has better cosmetic effects, a shorter healing time, and does not require general anaesthesia (Eryilmaz et al. 2005; Fahrni et al. 2012).
Bacteria Associated with Granulomatous Lobular Mastitis and the Potential for Personalized Therapy
Published in Journal of Investigative Surgery, 2022
Xin-Qian Li, Hong-Li Wu, Jing-Ping Yuan, Tian-gang Liu, Sheng-Rong Sun, Chuang Chen
The relationship between GLM and breast cancer is a key concern for doctors and patients. Six cases of non-puerperal mastitis concurrent with breast cancer were identified by PubMed search. Five of the patients involved were diagnosed with GLM. Notably, the stages of breast cancer were very early. The cases included three cases of ductal carcinoma in situ (DCIS) [78–80], two cases of invasive breast carcinoma [81,82] and one case of invasive breast carcinoma and DCIS [83]. Most of the cases involved the right breast [79–83], and over half of the patients were more than 40 years old [78,80,81,83]. However, in only one case was Corynebacterium infection identified, on the same breast as DCIS [78], indicating that further investigation of the association between GLM-associated bacteria and breast cancer is warranted. Nevertheless, patients with a history of non-puerperal mastitis might be at increased risk of breast cancer [84]. Peters et al. [85] found that the risk of breast cancer in patients with non-puerperal mastitis was significantly increased within twelve months after mastitis treatment. Furthermore, a recent study in a large population in China showed that patients with a history of non-lactation mastitis were at high risk for breast cancer, especially those under 50 years of age, of lower socioeconomic status or receiving hormone drugs [86]. However, the intrinsic relationships between non-puerperal mastitis and breast cancer need further investigation.
Treatment of idiopathic granulomatous mastitis using ultrasound-guided microwave ablation: a report of 50 cases
Published in International Journal of Hyperthermia, 2021
Lisheng Lin, Zifang Zheng, Jinfan Zhang, Xiaoli Liu, Dar-Ren Chen, Hongling Wang
Currently, most physicians use oral glucocorticoids combined with surgical resection to treat IGM. The expert consensus on the diagnosis and treatment of non-lactation mastitis in China [22] is that surgery should be performed during the non-acute stage when the lesion is stable and limited. The underlying principle is that all visible lesion tissues should be completely and fully excised during surgery, otherwise, recurrence is likely. Nonetheless, the recurrence rate is still 5.5% after treatment [23–27]. Most patients with IGM are women of childbearing age who are uncomfortable with the side effects of simple mastectomy, such as a large surgical resection range, long postoperative scars, deformity of the affected breast, and reduced breast volume. Moreover, when mastectomy is performed for benign diseases, overtreatment is suspected.