Aislamiento de Staphylococcus aureus meticilino resistente en abscesos de mama en una Maternidad Pública / Methicillin-resistant Staphylococcus aureus (MRSA) isolation in breast abscesses in a Public Maternity

La mastitis y los abscesos de mama representan un factor de riesgo para el abandono de la lactancia. Se incluyen dentro de las infecciones de piel y partes blandas y comparten los cambios epidemiológicos que llevan a replantear el tratamiento empírico inicial. Se estudiaron 137 casos de abscesos de mama desde enero de 2007 a diciembre de 2011. Se analizó incidencia, días postparto, factores de riesgo, datos microbiológicos y tratamiento antibiótico. Desde 2007a 2011 se observó un constante aumento de la incidencia de casos: 0.19 vs. 0.84% (p < 0.001). Días postparto de aparición del absceso 41.9 ± 35.8 días (Media ± DE), primiparidad 70.6%. Los factores de riesgo más frecuentemente encontrados fueron grietas del pezón e ingurgitación mamaria (95%). Staphylococcus aureus (SA) fue el responsable de 82.3 a 95.0% de los abscesos según los años; la resistencia a oxacilina de las cepas de SA superó el 60%. Las cepas aisladas de SA meticilino resistentes (SAMR) fueron sensibles a eritromicina clindamicina, gentamicina, rifampicina, ciprofloxacina y trimetroprima-sulfametoxasol en diferentes porcentajes según los años. Requirieron drenaje el 100% de los casos; en 60% el tratamiento empírico inicial fue inadecuado. Continuaron amamantando 90% de las madres. Estos datos enfatizan la necesidad de prevenir los factores de riesgo: grietas del pezón e ingurgitación mamaria. La modificación del tratamiento antibiótico inicial requiere el estudio bacteriológico de las infecciones de piel y partes blandas dado que la prevalencia de SAMR no es uniforme y varía en diferentes poblaciones y ubicaciones geográficas.

Mastitis and breast abscess in lactating women are risk factors for early breastfeeding cessation. This pathology is included in the group of skin and soft tissue infections. A descriptive study was performed with an advanced outlook. As of January 2007 through December 2011 a total of 137 breast abscesses were treated in our institution. We analyzed incidence, parity, postpartum days, risk factors, microbiological isolation and the adequacy of initial antibiotic treatment. In that period we observed a steady and significant increase in breast abscesses. Incidence from 0.19 to 0.84% in lactating women 2007 vs. 2011 p = 0.0001 IC 95% (-0.009; 0.003), 70.6% of them primiparous and a mean interval from delivery to breast abscess of 41.9 ± 35.8 days. The most frequent risk factors were sore nipples and breast engorgement. Staphylococcus aureus was isolated in 82.3 to 95.0%. Methicillin resistance was higher than 60%. These strains were susceptible to erythromycin, clindamycin, gentamicin, rifampicin, ciprofloxacin and trimethoprim-sulfamethoxazol. All the cases were surgically drained; the initial empirical treatment was inadequate in 60% of them, 90% of patients could maintain breast feeding after the procedure. In conclusion: these data emphasize the need to prevent risk factors associated to breast abscesses: sore nipples and breast engorgement. In order to determine the adequate antibiotic treatment, bacteriological studies are required at every collection because SAMR prevalence varies according to diverse populations and geographic location.

Breast tuberculosis--a case report.

Breast tuberculosis is a rare disease. It usually mimics carcinoma breast in its presentation both clinically as well as radiologically. Since breast conservation is possible in tuberculous mastitis and it may be a presenting feature of HIV, it is important to recognise this condition. One case of a 50-year female despite strong clinical suspicion of malignancy though could not be histologically proven is reported here. Following a breast conserving surgery, Langhans' giant cells were seen on histopathology. Patient was started on antituberculous therapy and responded well.

Tuberculosis of the breast

Tuberculosis of the breast is an uncommon disease even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high. Clinical presentation is usually of a solitary, ill-defined, unilateral hard lump situated in the upper outer quadrant of the breast. This disease can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. Incorporating a highly sensitive technique like polymerase chain reaction [PCR] may be helpful in establishing the usefulness of such technology and can aid in conforming the diagnosis early. The disease is curable with antitubercular drugs, and surgery is rarely required

Breast tuberculosis: diagnosis, clinical features & management.

The significance of breast tuberculosis is due to rare occurrence and mistaken identity with breast cancer and pyogenic breast abscess. Breast tuberculosis was scarcely reported even from endemic areas until lately when several reports have come up from South Africa and India. The incidence of tubercular mastitis although decreasing in the West, could show a resurgence with the global pandemic of AIDS. Breast tuberculosis has no defined clinical features. Radiological imaging is not diagnostic. Diagnosis is based on identification of typical histological features or the tubercle bacilli under microscopy or culture. Antitubercular therapy for 6 months with or without minimal surgical intervention forms the mainstay of treatment today. Over the years since the first description of tubercular mastitis in 1829, the incidence, clinical presentation, diagnostic and treatment methodology of breast tuberculosis has gradually changed. This review discusses the important issues relating to the diagnosis, clinical features, and management of breast tuberculosis.

Candida spp. occurrence in oral cavities of breastfeeding infants and in their mothers' mouths and breasts

This study aimed to determine the occurrence of Candida spp. in the oral cavity of predominantly breastfed infants and in their mothers' mouths and breasts, as well as in the oral cavity of bottlefed infants and in non-lactating women. One hundred and sixty nine women and eighty-five milk-fed infants took part in this study and were divided into four groups: 1) infants predominantly on breastfeeding (n = 55) and their mothers (n = 55); 2) infants on bottlefeeding (n = 30); 3) non-lactating women on whom oral collections were performed (n = 80) and, 4) non-lactating women on whom breast collections were performed (n = 34). Oral and mammary swabs were cultured on Sabouraud agar dextrose with chloramphenicol. The Candida yeast strains found were isolated and identified through morphological and biochemical tests. Candida species were much less frequent in infants who were predominantly breastfed than in those who were bottlefed. Yeasts were much more frequent on the breasts of lactating women, with statistical difference in relation to the control group

Tuberculosis of the breast.

Nowadays, tuberculosis of the breast is relatively rare compared to other forms of extrapulmonary tuberculosis. The incidence of tuberculosis of the breast has decreased mainly due to effective antituberculous chemotherapy. We report two cases of tuberculosis of the breast.