Primary and Recurrent Breast Abscess in Non Lactational Women, Assessment of Risk Factors and Bacteria Involved. A prospective Cohort Study for Patients and Healthy Control

Background: Although inflammatory disease of the breast are uncommon in non lactional women, but it poses a diagnostic and therapeutic dilemma with considerable morbidity.Diabetes mellitus, smoking, obesity, low socioeconomic state are blamed to be a risk factors for mastitis with the subsequent sequel of breast abscess in non lactating women. Poly microbial infection, both aerobic and anaerobic bacteria represent up to 40% of isolates in breast abscess predominantly in non nursing women. Methods: From February 2012 to May 2019, eighty nine patients attending the department of surgery at Al Diwaniyha teaching hospital with primary and recurrent non lactational breast abscess were included in a prospective cohort study. Pus specimens were obtained at the time of drainage which is subjected to gram stain, Ziehl Neelsen stain, aerobic and anaerobic cultures. one hundred age matched healthy female enrolled in the study as a control. Results: Breast abscess was more frequent in the age group 35-45 years.Smoking found to be significantly more prevalent in patients than controls as 41.5 % of patients with breast abscess were smokers as compared to 20% of controls.Diabetes found to significantly more prevalent in patients than controls(24.7 % Vs 8%).Forty six percent of women with breast abscess were with moderate to severe obesity. Only smoking and diabetes was found to significantly more prevalent in recurrence(84.6 % and 76.9%) respectively. p value =0.001. Mixed aerobic and anaerobic bacteria were the commonest isolate 58.4 %, followed by pure aerobic bacteria 12.35 %, while pure anaerobic bacterial isolate comes last 10.1 %. Moreover 17 (19.1 %) out of 89 breast abscess were sterile among which one was positive for AFB. Amoxiclav has the greatest activity upon the gram positive aerobic cocci. Gram negative bacteria were mostly sensitive to cephalosporin and Ciprofloxacin. Metronidazol is still the most effective drug against anaerobic cocci and bacteroids. Conclusion: Smoking, diabetes, overweight / obesity and short breast feeding regimen, all have strong association with primary breast abscess. Only smoking and diabetes have significant association with recurrent abscess. Mixed infection by aerobic and anaerobic bacteria predominates. Anaerobic cocciare the commonest isolated bacterium.