Breast infection

Acute infections of the breast have become less common in the UK with improvements in personal hygiene and the prescription of antibiotics. Breast infection is divided into lacational and non-lactational. Either can cause abscess formation, which can be avoided by the early prescription of appropriate antibiotics, although once established an abscess requires aspiration or incision and drainage. Lactational infection (including neo-natal mastitis) comprises around 25% of breast infections. They are usually caused by skin commensal organisms such as Staphylococcus aureus, and the route of infection is usually through a defect in the skin such as a cracked nipple. Treatment is with flucloxacillin or erythromycin. Non-lactational infection, perductal mastitis, affects young women. The most common organisms are Staphylococcus aureus, enterococci, anaerobic streptococci and bacteroides. Non-lactational breast infection is treated with co-amoxiclav, flucloxacillin or erythromycin, and metronidazole. It usually presents as periarelor inflammamation and will form an abscess if left untreated. If the abscess discharges or requires incision a mammillary duct fistula is likely to develop, which will require definitive surgical treatment by total duct excision and excision of the fistula.