title: Have the organisms that cause breast abscess changed with time?--Implications for appropriate antibiotic usage in primary and secondary care.
abstract: Many patients with breast abscess are managed in primary care. Knowledge of current trends in the bacteriology is valuable in informing antibiotic choices. This study reviews bacterial cultures of a large series of breast abscesses to determine whether there has been a change in the causative organisms during the era of increasing methicillin-resistant Staphylococcus aureus (MRSA). Analysis was undertaken of all breast abscesses treated in a single unit over 2003 - 2006, including abscess type, bacterial culture, antibiotic sensitivity and resistance patterns. One hundred and ninety cultures were obtained (32.8% lactational abscess, 67.2% nonlactational). 83% yielded organisms. Staphylococcus aureus was the commonest organism isolated (51.3%). Of these, 8.6% were MRSA. Other common organisms included mixed anaerobes (13.7%), and anaerobic cocci (6.3%). Lactational abscesses were significantly more likely to be caused by S. aureus (p < 0.05). Methicillin-resistant Staphylococcus aureus rates were not statistically different between lactational and nonlactational abscess groups. Appropriate antibiotic choices are of great importance in the community management of breast abscess. Ideally, microbial cultures should be obtained to institute targeted therapy but we recommend the continued use of flucloxacillin with or without metronidazole (or amoxicillin-clavulanate as a single preparation) as initial empirical therapy.
authors.affiliation: Breast Surgery Unit, Southampton General Hospital, Southampton, UK. ndabbas@gmail.com
authors.forename: Natalie
authors.initials: N
authors.lastname: Dabbas
authors.forename: Manish
authors.initials: M
authors.lastname: Chand
authors.forename: Ann
authors.initials: A
authors.lastname: Pallett
authors.forename: Gavin T
authors.initials: GT
authors.lastname: Royle
authors.forename: Richard
authors.initials: R
authors.lastname: Sainsbury
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents