Journal Club 12/05/03

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Journal Club 12/05/03

• Breast Abscesses
• in Lactating Women
• Cenap Dener, MD. Aydin Inan, MD
• World Journal of Surgery 27, 130-133, 2003

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Brief overview of topic

• Breast infection common
• varying degrees of severity
• Mastitis to abscess formation
• Treatment range from OP Abx and continuing of
  breast feeding to requiring a hospital admission,
  GA and ID, and mulitple dressings
• Mastitis incidence in lactating women 2.5-33
• Delayed treatment leads to abscess in 4.6 - 11

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Choosing the Article

• Premedline
• Title word search only
• Breast, Abscess and Lactational

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Aims

• Assess contributing factors to puerperal breast
  abscess formation
• Evaluation of treatment options of breast
  abscesses

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Study Design

• Criteria for inclusion
• Self presentation through outpatient with
  clinical signs of mastitis or abscess
• Prospective Study
• Not Randomised - Trial of aspiration

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Method

• 4yrs (May 97 - May 01)
• 128 Nursing women presented
• 102 (80) mastitis
• 26 (20) abscess
• USS in all cases
• Amoxicillin/clavilunate 1g bd orally 1/52
• Milk cultures

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Method

• Abscess - 18 gauge needle aspiration with
  irrigation of sterile saline USS guidance
• Successful - every second day until USS clear
• Unsuccessful (thick pus) surgical drainage with
  LA

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Results
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Results

• Mastitis
• All were symptom free after 1/52 of Antibiotics
• None progressed to Abscess

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Results

• Aspiration Surgical
• 10 (38) 16
  (62)
• Mean healing time days 8.6 (5-12)
  10 (6-15)
• 13 (10.2) - recurrent breast infection during FU
• (11 mastitis and 2 abscesses)
• 9 (7) Previous mastitis while breast feeding

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Conclusions

• Not clear - incorporated into discussion
• Mastitis inevitable in some percentage of
  lactating women due to faulty nursing technique
• Regularly empty breasts helps to prevent abscess
  formation - not an end point from this paper
• Time is a factor in abscess formation.
  Significant finding in this study. Conclusion
  Treat early
• Treat nipple cracks
• USS great clinical value for diagnosis and follow
  up

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Conclusions

• In selected cases the abscess can be drained
  with needle aspiration. No selection made
• Clinical significance of 38 reduction in
  patients requiring surgery

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Conclusions
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Conclusions

• Niebyl and co workers
• mastitis is a subcutaneous cellulitis and
  isolating organisms form milk may not always be
  possible, so milk culture is not important in
  guiding the therapy.
• Paper from 1978
• Better knowledge and application of antibiotics

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Strengths and Weaknesses

• All pts had USS
• Clinically positive abscesses were not detected
  by USS in 34 - 50 of patients thought to have
  one
• Endpoints not clearly met
• Not controlled
• FU of mean 24 weeks

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Application of the Study

• Treat mastitis early
• Possible trail of aspiration
• If fails - ?Continuous catheter drainage
• If fails - Surgical Inscision and Drainage

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ATTENTION!!!!!

• DINNER FOR CONSULTANTS/ REGISTRARS AND RMOS
• 16th MAY - This Friday
• FOX STUDIOS
• PLEASE CONFIRM AND PAY ASAP