Breast Abscesses in Nonlactating Women With Diabetes: Clinical Features and Outcome
The association between diabetes and breast abscess in nonlactating women has not been previously reported in the literature.
Retrospective analysis of all cases of breast abscess in nonlactating women in a community teaching hospital from 2000 to 2006. We analyzed their clinical characteristics, prevalence of diabetes mellitus (DM), management, and clinical outcome.
We identified 116 breast abscesses in 98 nonlactating women [age 48 +/- 14, (mean +/- SD), 89% African Americans]. At presentation, 63 patients (64%) had a known history of DM (duration: 8.5 +/- 5 years) and 8 patients (8%) had newly diagnosed DM. Among the remaining 27 women, 7 (26%) developed DM within 5 years of follow-up. The odds ratio of having diabetes in nonlactating women with breast abscess relative to those without breast abscess was estimated as 14.24 (95% confidence interval, 6.72-30.17). Most patients (89%) had a single abscess. Patients with DM had increased length of hospital stay (P < 0.01) and a more severe clinical course during follow-up. Most patients (70%) were treated with incision and drainage and antibiotics. Glycemic control was suboptimal with only 46% of subjects receiving insulin therapy during the hospital stay.
Our study indicates a strong association between DM and breast abscess in nonlactating women. The high prevalence of DM (72%) and their more severe clinical course suggest that breast abscesses in nonlactating women should be considered among the "typical" infections associated with DM. Increased awareness and intensified glycemic control might improve clinical outcome in nonlactating women with breast abscesses.
Available from: Anurag Srivastava
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ABSTRACT: Most breast abscesses develops as a complication of lactational mastitis. The incidence of breast abscess ranges from 0.4 to 11 % of all lactating mothers. The traditional management of breast abscesses involves incision and drainage of pus along with antistaphylococcal antibiotics, but this is associated with prolonged healing time, regular dressings, difficulty in breast feeding, and the possibility of milk fistula with unsatisfactory cosmetic outcome. It has recently been reported that breast abscesses can be treated by repeated needle aspirations and suction drainage. The predominance of Staphylococcus aureus allows a rational choice of antibiotic without having to wait for the results of bacteriological culture. Many antibiotics are secreted in milk, but penicillin, cephalosporins, and erythromycin, however, are considered safe. Where an abscess has formed, aspiration of the pus, preferably under ultrasound control, has now supplanted open surgery as the first line of treatment.
Available from: Nik Hauser
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ABSTRACT: BACKGROUND: The aim of our study was to analyze diagnostic results, different treatment modalities, and the outcome of patients with breast abscesses treated at our institution in a multi-modality breast team, to determine whether minimally invasive treatments are successful. METHODS: 110 patients with mastitis and suspected breast abscesses at our institution between January 2000 and end of September 2007 were retrospectively analyzed. Abscesses were diagnosed using ultrasonography (US), and the material obtained using US-guided fine needle aspiration (FNA) was further examined. RESULTS: 29% of the patients were treated conservatively with antibiotics only, 51% were treated with US-guided FNA or drainage placement. 11% of the patients underwent additional surgery after minimally invasive treatment (i.e. conversion rate). 9% of the patients underwent primary surgery. Early complications occurred in 7% of patients treated minimally invasive but not in patients treated with surgery alone. Late complications occurred in 5% of patients who underwent minimally invasive treatments and in 30% of patients who underwent surgery. CONCLUSIONS: US-guided FNA as a minimally invasive therapy in combination with antibiotics was found to successfully treat most breast abscesses and, in cases where a larger volume of pus was involved, the placement of an additional drainage catheter was effective.
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