ABC of Breast Diseases: Breast Infection

doi:10.1136/bmj.309.6959.946

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J M Dixon

Breast infection is now much less common than it used to be. It is seen occasionally in neonates, but it most commonly affects women aged between 18 and 50; in this age group it can be divided into lactational and non-lactational infection. The infection can affect the skin overlying the breast, when it can be a primary event, or it may occur secondary to a lesion in the skin such as a sebaceous cyst or to an underlying condition such as hidradenitis suppurativa.

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Organisms responsible for breast infection

Treatment

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Antibiotics most appropriate for treating breast infections*

A breast abscess in right hand breast.

There are four guiding principles in treating breast infection

Appropriate antibiotics should be given early to reduce formation of abscesses
Hospital referral is indicated if the infection does not settle rapidly with antibiotics
If an abscess is suspected it should be confirmed by aspiration before it is drained surgically
Breast cancer should be excluded in patients with an inflammatory lesion which is solid on aspiration or which does not settle despite apparently adequate treatment

All abscesses in the breast can be managed by repeated aspiration or incision and drainage. Few breast abscesses require drainage under general anaesthesia except those in children, and placement of a drain after incision and drainage is unnecessary.

Neonatal infection

Neonatal breast infection is most common in the first few weeks of life when the breast bud is enlarged. Although Staphylococcus aureus is the usual organism, Escherichia coli is occasionally the pathogen. If an abscess develops the incision to drain the pus should be placed as peripheral as possible to avoid damaging the breast bud.

Neonatal breast abscess.

Lactating infection

Better maternal and infant hygiene and early treatment with antibiotics have considerably reduced the incidence of abscess formation during lactation. Infection is most frequently seen within the first …