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Cited by 16Antimicrobial Resistance in StaphylococcusBreast Lesions and CarcinomasBreastfeeding Practices and Influences

Clinical characteristics of lactational breast abscess caused by methicillin-resistant Staphylococcus aureus: hospital-based study in China

Open access
Li, Yan, Ma, Xiang-jun, He, Xiang-ping·2021·International Breastfeeding Journal
DOI 10.1186/s13006-021-00429-6PMC PMC8513335
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Abstract

Background: This study aimed to identify the differences in clinical characteristics, puncture efficacy, antibiotic use, treatment duration, breastfeeding post-illness, and recurrence of patients with breast abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-susceptible Staphylococcus aureus (MSSA) infection during lactation. Methods: The clinical data of patients with breast abscesses during lactation who were treated from January 2014 to February 2017 at Haidian Maternal and Child Health Hospital, Beijing, were reviewed. According to bacterial culture results, they were divided into MRSA (n = 260) and MSSA (n = 962) groups. Hospitalization (whether or not the patients were hospitalized), postpartum period, maternal age, location of abscess cavities, number of abscess cavities, amount of pus, frequency of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration, cessation of breastfeeding and recurrence were compared between the two groups using a t-test and a chi-squared test. Results: We noted that only the cessation of breastfeeding was statistically significantly different between the two groups (P = 0.018). Hospitalization, postpartum period, maternal age, location of abscess cavities, number of abscess cavities, amount of pus, number of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration and recurrence showed no statistically significant differences (P = 0.488, P = 0.328, P = 0.494, P = 0.218, P = 0.088, P = 0.102, P = 0.712, P = 0.336, P = 0.512, P = 0.386 and P = 0.359, respectively). Conclusions: There was no difference in clinical characteristics between breast abscesses infected by MRSA and those infected by MSSA. Ultrasound-guided needle aspiration could be the first choice for MRSA-infected breast abscess treatment. There is no need to increase antibiotic use because of MRSA infection, unless it is necessary. The reason why more patients with MRSA infected breast abscesses terminated breastfeeding is unclear from this study.

AI snapshot

Written from the paper’s full text.

TL;DR

In this retrospective hospital-based study of 1222 lactating women with *Staphylococcus aureus* breast abscesses, MRSA and MSSA infections had similar clinical characteristics, treatment outcomes, antibiotic use, and recurrence. The only significant difference was a higher cessation of breastfeeding rate in the MRSA group.

Key findings

  • Among 1222 included patients, 260 had MRSA and 962 had MSSA. Cessation of breastfeeding was significantly more common in the MRSA group: 10.8% (28/260) vs 6.5% (63/962), P = 0.018.
  • No statistically significant differences were found for hospitalization, postpartum period, maternal age, abscess cavity location, number of cavities, amount of pus, number of needle aspirations, failure of needle aspiration, antibiotic use, treatment duration, or recurrence (abstract P values ranged from 0.088 to 0.712).
  • Ultrasound-guided needle aspiration cured 1132 of 1222 patients (92.6%); failure did not differ significantly between MRSA (6.5%, 17/260) and MSSA (7.6%, 73/962) groups.
  • Antibiotic use was similar between groups: 31.5% (82/260) in MRSA vs 31.7% (305/962) in MSSA. Of 82 MRSA patients who received antibiotics, 37 did not receive sensitive antibiotics due to delayed culture results and all were cured.

Methods

  • Retrospective review of lactating patients with breast abscesses treated at Haidian Maternal and Child Health Hospital, Beijing, from January 2014 to February 2017. Of 1525 treated patients, 1222 met inclusion criteria after excluding 20 without bacterial culture, 24 lost to follow-up, and 259 with non-MRSA/non-MSSA culture results.
  • Patients were divided by culture into MRSA (n = 260) and MSSA (n = 962) groups. Mean maternal age was 30.6 years (range 21–44).
  • Comparisons used t-test, chi-squared test, and Mann-Whitney U test. All patients were treated with ultrasound-guided needle aspiration and irrigation; antibiotics were added if symptoms were not relieved, and surgery was considered if symptoms persisted. Follow-up was one month.

Limitations

  • The authors state it was retrospective; lacked criteria for antibiotic use, standard conversion from needle aspiration to surgery, and patient willingness to wean; and used disc diffusion, which cannot distinguish community-associated from healthcare-associated MRSA. They call for large prospective studies.
  • Evident from the text: it was a single-center hospital-based study with observational, non-randomized design, so treatment and breastfeeding decisions may be confounded by clinical judgment or patient preference.
  • Evident from the text: the abstract and Table 3 report different P values for amount of pus, number of aspirations, and treatment duration, indicating some inconsistency in reporting.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s13006-021-00429-6

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

9 of 19 cited sources checked · 7 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Breastfeeding was a protective factor against MRSA colonization in healthy children.

    “They analyzed the risk factors for MRSA and MSSA carriage, and found that breastfeeding, S. pneumoniae colonization, and upper respiratory tract infection within two weeks were protective factors against MSSA colonization, while only breastfeeding was a protective factor against MRSA colonization.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [14] Chen CH, Kuo KC, Hwang KP, Lin TY, Huang YC. Risk factors for and molecular characteristics of methicillin-resistant Staphylococcus aureus nasal colonization among healthy children in southern Taiwan, 2005-2010. J Microbiol Immunol Infect. 2019;52(6):929–36. https://doi.org/10.1016/j.jmii.2018.09.003. source
  • Premisecitation

    Without drainage of infected fluid, the use of antibiotics is ineffective.

    “Without drainage of infected fluid, the use of antibiotics is ineffective [21].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [21] Irusen H, Rohwer AC, Steyn DW, Young T. Treatments for breast abscesses in breastfeeding women. Cochrane Database Syst Rev. 2015;8:CD010490. https://doi.org/10.1002/14651858.CD010490.pub2. source
  • Premisecitation

    Breastfeeding can still be continued in patients with MRSA-infected breast abscesses during lactation.

    “Therefore, breastfeeding can still be continued in patients with MRSA-infected breast abscesses during lactation [13, 15].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [13] Reddy P, Qi C, Zembower T, Noskin GA, Bolon M. Postpartum mastitis and community-acquired methicillin-resistant Staphylococcus aureus. Emerg Infect Dis. 2007;13(2):298–301. https://doi.org/10.3201/eid1302.060989. source

      The Study reports treatment of breast abscesses but does not say whether affected women continued breastfeeding. The Conclusions note possible MRSA transmission through breast milk and call for further study of its consequences for infants; they do not recommend either continuing or stopping breastfeeding with an MRSA-infected abscess. Searches for breastfeeding continuation and interruption found no such guidance in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [15] Amir LH. The Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #4: Mastitis, Revised. March 2014. Breastfeed Med. 2014;9:239–43. source
  • Findingown data

    Repeated ultrasound-guided needle aspiration cured 1132 of 1222 patients (92.6%) with lactational breast abscess.

    “There were 1132 patients (92.6%) who were cured by repeated ultrasound-guided needle aspiration.”
    • Also stated in: § Discussion · plain
      “In our study, repeated ultrasound-guided needle aspiration resolved the problem in 1132 of 1222 participants, with a cure rate of 92.6%.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no statistically significant difference between the MRSA and MSSA groups in location of abscess cavities (P = 0.218).

    “Hospitalization, postpartum period, maternal age, location of abscess cavities, number of abscess cavities, amount of pus, number of needle aspiration, failure of needle aspiration, antibiotic use, treatment duration and recurrence showed no statistically significant differences (P = 0.488, P = 0.328, P = 0.494, P = 0.218, P = 0.088, P = 0.102, P = 0.712, P = 0.336, P = 0.512, P = 0.386 and P = 0.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 7
  • Classified as probably not a substantial claim. 11
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    Reddy's study showed that the cessation of breastfeeding rate after mastitis in the MRSA group was 16% and that in the MSSA group was 22%, without a statistical significance.

    “However, Reddy’s study [13] showed a different result. Their study showed that the cessation of breastfeeding rate after mastitis in the MRSA group was 16% and that in the MSSA group was 22%, without a statistical significance.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [13] Reddy P, Qi C, Zembower T, Noskin GA, Bolon M. Postpartum mastitis and community-acquired methicillin-resistant Staphylococcus aureus. Emerg Infect Dis. 2007;13(2):298–301. https://doi.org/10.3201/eid1302.060989. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    According to Luo and colleagues, antibiotics were not routinely used for the treatment of breast abscesses during lactation, but the success rate was similar to that of routine antibiotic use.

    “However, according to Luo and colleagues [20], antibiotics were not routinely used for the treatment of breast abscesses during lactation, but the success rate was similar to that of routine antibiotic use.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [20] Luo J, Long T, Cai Y, Teng Y, Fan Z, Liang Z, et al. Abscess drainage with or without antibiotics in lactational breast abscess: study protocol for a randomized controlled trial. Infect Drug Resist. 2020;13:183–90. https://doi.org/10.2147/IDR.S221037. source

  • Classified as probably not a substantial claim.

    Premisecitation

    A study in Taiwan reported a colonization rate of 8.1% MRSA in the nasal cavity of healthy children.

    “A study in Taiwan [14] reported a colonization rate of 8.1% MRSA in the nasal cavity of healthy children.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [14] Chen CH, Kuo KC, Hwang KP, Lin TY, Huang YC. Risk factors for and molecular characteristics of methicillin-resistant Staphylococcus aureus nasal colonization among healthy children in southern Taiwan, 2005-2010. J Microbiol Immunol Infect. 2019;52(6):929–36. https://doi.org/10.1016/j.jmii.2018.09.003. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Reducing the use of antibiotics can help reduce the emergence of antibiotic-resistant strains.

    “Therefore, reducing the use of antibiotics can also help reduce the emergence of antibiotic-resistant strains [22, 23].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [22] Lodhi N, Khurshaidi N, Soomro R, Saleem M, Rahman SS, Anwar S. Is our choice of empirical antibiotics appropriate for patients with methicillin resistant Staphylococcus aureus in breast abscess? Iran J Microbiol. 2018;10(6):348–53.
    • cites [23] Otto M. Community-associated MRSA: what makes them special? Int J Med Microbiol. 2013;303(6-7):324–30. https://doi.org/10.1016/j.ijmm.2013.02.007. source

  • Classified as probably not a substantial claim.

    Premisecitation

    In recent years, the detection rate of MRSA in the breast milk and pus of lactating patients has gradually increased.

    “In recent years, the detection rate of MRSA in the breast milk and pus of lactating patients has gradually increased [2, 3, 5].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [2] Stafford I, Hernandez J, Laibl V, Sheffield J, Roberts S, Wendel G Jr. Community-acquired methicillin-resistant Staphylococcus aureus among patients with puerperal mastitis requiring hospitalization. Obstet Gynecol. 2008;112(3):533–7. https://doi.org/10.1097/AOG.0b013e31818187b0. source
    • cites [3] Moazzez A, Kelso RL, Towfigh S, Sohn H, Berne TV, Mason RJ. Breast abscess bacteriologic features in the era of community-acquired methicillin-resistant Staphylococcus aureus epidemics. Arch Surg. 2007;142(9):881–4. https://doi.org/10.1001/archsurg.142.9.881. source
    • cites [5] Rimoldi SG, Pileri P, Mazzocco MI, Francesca R, Bestetti G, Calvagna N, et al. The role of Staphylococcus aureus in mastitis: a multidisciplinary working group experience. J Hum Lact. 2020;36(3):503–9. https://doi.org/10.1177/0890334419876272. source

      The indexed copy provides repository metadata and a PDF link, but no passage from the paper discussing MRSA detection rates. Searches for MRSA, breast milk, pus, and increasing incidence did not find evidence for the claimed trend. The claim cannot be assessed from the available text. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Among 1222 patients with Staphylococcus aureus lactational breast abscess, 962 were MSSA and 260 were MRSA.

    “According to bacterial culture results, they were divided into MRSA (n = 260) and MSSA (n = 962) groups.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The overall antibiotic utilization rate was 31.7% among the 1222 patients.

    “Our research showed a 31.7% antibiotic utilization rate.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    There was no statistically significant difference between the MRSA and MSSA groups in failure of needle aspiration (P = 0.336).

    “There was no statistical difference in the failure of needle aspiration between MRSA and MSSA groups (Table 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the MRSA group, 37 patients did not receive sensitive antibiotics due to delayed bacterial culture results and all were cured.

    “Meanwhile, we found that 37 patients in the MRSA group did not receive sensitive antibiotics due to delayed bacterial culture results and they were all cured.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    MRSA infection did not increase the recurrence rate or prolong the treatment duration of patients with lactational breast abscesses compared with MSSA infection.

    “Our study also showed that MRSA infection did not increase the recurrence rate or prolong the treatment duration of patients with lactational breast abscesses compared with MSSA infection.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Chen CY, Anderson BO, Lo SS, Lin CH, Chen HM. Methicillin-resistant Staphylococcus aureus infections may not impede the success of ultrasound-guided drainage of puerperal breast abscesses. J Am Coll Surg. 2010;210(2):148–54. https://doi.org/10.1016/j.jamcollsurg.2009.11.003. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was approved by the Ethics Committee of Beijing Haidian District Maternal and Child Health Hospital.

    “This study has been approved by the Ethics Committee of Beijing Haidian District Maternal and Child Health Hospital.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The disc diffusion method used to test MRSA cannot distinguish community-associated MRSA and healthcare-associated MRSA strains.

    “We also used the disc diffusion method to test MRSA in our study and this method can’t distinguish community-associated MRSA and healthcare-associated MRSA strains, so it is a limitation of the study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Ultrasound-guided needle aspiration has become the preferred treatment method for breast abscesses and is widely used in clinical practice.

    “With the development of minimally invasive treatment technology, ultrasound-guided needle aspiration has become the preferred treatment method for breast abscesses and is widely used in clinical practice [11, 16, 17].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [11] Colin C, Delov AG, Peyron-Faure N, Rabilloud M, Charlot M. Breast abscesses in lactating women: evidences for ultrasound-guided percutaneous drainage to avoid surgery. Emerg Radiol. 2019;26(5):507–14. https://doi.org/10.1007/s10140-019-01694-z. source
    • cites [16] Elder EE, Brennan M. Nonsurgical management should be first line therapy for breast abscess. World J Surg. 2010;34(9):2257–8. https://doi.org/10.1007/s00268-010-0509-1. source
    • cites [17] Lukassek J, Ignatov A, Faerber J, Costa SD, Eggemann H. Puerperal mastitis in the past decade: results of a single institution analysis. Arch Gynecol Obstet. 2019;300(6):1637–44. https://doi.org/10.1007/s00404-019-05333-3. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was retrospective.

    “This was a retrospective study.”
    • Also stated in: § Discussion · plain
      “Although the sample size in this study was large, it was a retrospective study and has some limitations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Lam et al. recommended that all patients with breast abscesses should be treated concurrently with antibiotics.

    “Lam et al. [19] reviewed the literature on the treatment of breast abscesses, and recommended that all patients with breast abscesses should be treated concurrently with antibiotics.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Lam E, Chan T, Wiseman SM. Breast abscess: evidence based management recommendations. Expert Rev Anti-Infect Ther. 2014;12(7):753–62. https://doi.org/10.1586/14787210.2014.913982. source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The lack of criteria for antibiotic use, standard conversion from needle aspiration to surgery, and patient's willingness to wean may affect the conclusions of the study.

    “The lack of criteria for antibiotic use, standard conversion from needle aspiration to surgery, and patient’s willingness to wean may affect the conclusions of the study.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Dr. Ding's 2019 retrospective analysis of 174 patients found no significant differences between MRSA and MSSA in abscess cavity location, abscess cavity size, abscess cavity number, antibiotic use and other factors.

    “Dr. Ding [9] retrospectively analyzed 174 patients in our hospital from January to July 2018, and found that there were no significant differences between MRSA and MSSA in abscess cavity location, abscess cavity size, abscess cavity number, antibiotic use and other factors.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Ding ST, He XP, Ma XJ, Zhang Y, Liu XX, Qin J. Lactational breast abscesses caused by methicillin-resistant or methicillin-sensitive Staphylococcus aureus infection and therapeutic effect of ultrasound-guided aspiration. Breastfeed Med. 2020;15(7):471–4. https://doi.org/10.1089/bfm.2020.0003. source
17 of 17

  • The paper relies on this without support.

    The termination of breastfeeding by patients with MRSA-infected breast abscesses was the patient's own decision, not an effect of MRSA infection.

    “Our results showed that patients with MRSA-infected breast abscesses were more likely to terminate breastfeeding, and it was a patients’ decision. This does not mean that MRSA affects breastfeeding.”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Number-of-aspirations P-values differ between abstract and table

    Major

    The abstract reports P = 0.712 for number of needle aspirations, whereas Table 3 reports 0.126.

  • Treatment-duration P-values differ between abstract and table

    Major

    The abstract reports P = 0.386 for treatment duration, whereas Table 3 reports 0.441.

  • Amount-of-pus P-values differ between abstract and table

    Major

    The abstract reports P = 0.102 for amount of pus, whereas Table 3 reports 0.556.

  • Erythromycin resistance percentage is incorrect

    Minor

    The table reports 226 resistant isolates out of 260, which is 86.9%, not 82.9%.

    Reported 82.9 · recomputed 86.923077

  • MRSA antibiotic-treatment count conflicts with its own fraction

    Minor

    The sentence says 87 MRSA patients received antibiotics but immediately gives 82/260; Table 4 also reports 82.

  • Abstract omits the reported Mann-Whitney U tests

    Minor

    The abstract says the comparisons used a t-test and chi-squared test, while the statistical-analysis section says three compared variables were analyzed with a Mann-Whitney U test.

  • Overall maternal-age range excludes ages in the MSSA group

    Minor

    The stated range for all 1222 patients is 21-44 years, but the MSSA group alone has a reported range of 20-48 years.

  • Aspiration ranges include zero despite treatment of all patients by aspiration

    Minor

    Table 3 gives a minimum of zero aspirations in both groups, while the treatment methods state that all patients underwent ultrasound-guided needle aspiration.

8 of 8

Cites

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Related

Authors
Li, Y., Ma, X.-J., & He, X.-P.
Corresponding author
Li, Yan
ORCID
Li, Yan
Venue
International Breastfeeding Journal
Publisher
Springer Science and Business Media LLC
Published
2021-10-12
Volume
16
Issue
1
Pages
80-80
ISSN
1746-4358 (ISSN-L)
DOI
10.1186/s13006-021-00429-6
PMC
PMC8513335
OpenAlex
W3206026006
Cited by
16
References
23
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 1
FWCI
0.74
Type
journal article
Language
en
Open access
Licence
Locations
  • International Breastfeeding Journal (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
  • Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
Keywords
methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, breastfeeding cessation, ultrasound-guided aspiration, antibiotic use, treatment duration, abscess recurrence, postpartum infection
MeSH terms
Abscess, Breast Feeding, Female, Hospitals, Humans, Lactation, Staphylococcal Infections, Methicillin-Resistant Staphylococcus aureus

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