新人999脓肿如何治疗配图，仅供参考
Management of Breast AbscessesBreast abscesses rarely resolve with antibiotics alone. Abscesses generally require drainage in conjunction with antibiotics.
Non-MRSA breast abscesses
In adults,if MRSA has not been isolated or infection occurring in an area where MRSA is not prevalent,then intravenous (IV) or oral antibiotics with activity against methicillin-sensitive S. aureus (MSSA) (e.g. flucloxacillin: 250–500 mg orally four times daily or 0.5 to 2 g intravenously every 6 hours) should be started alongside supportive care. Supportive measures include analgesia if required. Antibiotic duration should be 7–10 days. The choice to start IV or oral antibiotics should be guided by the severity of the condition and the clinical judgement of the treating clinician.
In infant’s children and neonates,if MRSA can be excluded,a breast abscess can be treated with an intravenous antibiotic that is active against MSSA (e.g. flucloxacillin: children: 12.5 to 25 mg/kg orally four times daily; consult specialist for guidance on neonatal doses). Duration of treatment will be guided by the clinical response but is generally 7 to 10 days. Doxycycline (Chanelle Medical,County Galway,Ireland) is not appropriate for those less than 8 years of age. Supportive measures including analgesia should also be administered as appropriate.
MSRA breast abscesses
If MRSA is isolated or suspected a non-beta lactam antibiotic should be selected in addition to supportive care. If Community-acquired MRSA (CA-MRSA) is suspected or confirmed,or in a patient with a penicillin allergy,trimethoprim/sulfamethoxazole (160/800 mg orally twice daily),doxycycline (100 mg orally twice daily),or clindamycin (150–300 mg orally four times daily) can be used. Mothers should not continue to breastfeed on trimethoprim/sulfamethoxazole if the infant is younger than 2 months of age. Mothers should not breastfeed at all if on doxycycline. Vancomycin (15 mg/kg intravenously every 12 hours) can be used in more severe cases and in hospitalized patients where hospital-acquired MRSA is suspected. Alternatives,especially for patients exhibiting signs of systemic illness,include linezolid,tigecycline,and daptomycin. Antibiotic duration should be 7–10 days.
In neonates,infants and children,if CA-MRSA is suspected or confirmed,or the patient has a penicillin allergy,trimethoprim/sulfamethoxazole or clindamycin can be used. Doxycycline may only be used if the child is >8 years old. Vancomycin can be used in more severe cases and in hospitalized patients where hospital-acquired MRSA is suspected. The antibiotic treatment course should also be 7 to 10 days. The decision to start oral or intravenous antimicrobials at the time of initial presentation depends on clinical judgement and the severity of illness.
The diagnosis and treatment will need to be re-assessed,with adjustment made if there is no response to antibiotics within 48 hours. Antibiotic therapy should be adjusted depending on the specific pathogen(s) isolated. If gram-negative bacilli are isolated,a quinolone (e.g.,levofloxacin) can be used,if the patient is not breastfeeding. Alternatively,a third-generation cephalosporin (e.g.,ceftriaxone or cefotaxime) can be used for infection with gram-negative bacilli.
Surgical intervention
Surgical intervention is required for mature fluctuant abscesses. Needle aspiration (18- to 21-gauge needle) using adequate local anesthesia,with or without ultrasound guidance can be used to drain an abscess ) ). Once the pus has been aspirated,the abscess cavity should be irrigated with approximately 50 mL of 1% lidocaine and adrenaline (or serum physiologic solution) ). Aspiration gives excellent palliation and cosmesis. Multiple aspirations over time (daily aspiration for 5 to 7 days) may be necessary for complete drainage,which can be followed by ultrasound scan if available. Aspiration is continued until no further fluid is visible in the abscess cavity or the fluid aspirated does not contain pus. The majority of lactational breast abscesses can be managed in this manner. If the skin overlying the abscess is compromised and is thin and shiny or necrotic a mini-I&D ) should be performed by infiltrating local anesthetic into the skin overlying the abscess and then a small stab incision with a number 15 blade should be made over the point of maximum fluctuation (ultrasound guidance may be of assistance) ). Any necrotic tissue should be excised. The contents of the cavity should be drained and then the cavity irrigated with local anesthetic solution. This should be repeated every couple of days until there is no evidence of leakage,it is possible to get wound closure and no pus remains. On the majority of occasions,this is possible under local anesthetic in the outpatient clinic setting. Large I&D (which usually requires general anesthesia ) is not normally necessary and the small incision gives excellent cosmesis. Large I&D should be reserved for patients in whom aspiration/small incision fails and/or for large abscesses (>5 cm in diameter) ). The placement of percutaneous drains and/or insertion of packing rarely has a role in the modern day management of breast abscesses ). However,in cases where a larger volume of pus is involved,the placement of an additional drainage catheter may be beneficial ).
[](https://ncbi.nlm.nih.gov/pmc/articles/PMC6092150/figure/f3-ejbh-14-3-136/)
[Open in a separate window](https://ncbi.nlm.nih.gov/pmc/articles/PMC6092150/figure/f3-ejbh-14-3-136/?report=objectonly) [Figure 3](https://ncbi.nlm.nih.gov/pmc/articles/PMC6092150/figure/f3-ejbh-14-3-136/)
US-guided aspiration of a breast abscess
[](https://ncbi.nlm.nih.gov/pmc/articles/PMC6092150/figure/f4-ejbh-14-3-136/)
[Open in a separate window](https://ncbi.nlm.nih.gov/pmc/articles/PMC6092150/figure/f4-ejbh-14-3-136/?report=objectonly) [Figure 4. a,b](https://ncbi.nlm.nih.gov/pmc/articles/PMC6092150/figure/f4-ejbh-14-3-136/)
Surgical management of lactational breast abscesses (a) shows a lactational breast abscess with erythema,thin overlying skin and necrotic tissue (b) small I&D of a breast abscess
Granulomatous mastitis should be treated with corticosteroids and then surgical excision two weeks following the end of medical treatment ).
Purulent material should be sent for microbiology studies and cytological examination. Antibiotics should be continued for up to 10 days after drainage. If the abscess is
