Pseudomonas aeruginosa is an opportunistic, Gramnegative pathogen, commonly causing urinary tract infections, lower respiratory tract infections and soft tissue infections in immunocompromised patients. Breast sepsis is not commonly recognised. We present two cases of breast infection secondary to P. aeruginosa infection in previously healthy women with a review of the current literature.
Case history 1A 54-year-old woman presented with a week-long history of breast pain, fever and rigors. Prior to admission, she had received a course of co-amoxiclav which had been changed to erythromycin prior to presentation. There was no significant past medical history and she was a nonsmoker.Clinically, the patient showed signs of sepsis. Breast examination revealed a large, tender erythematous area at the 3-5 o'clock position of the left breast, with no associated palpable lesion or axillary lymphadenopathy.Blood results revealed a leukocytosis and raised Creactive protein. Intravenous co-amoxiclav and metronidazole were commenced. Ultrasound scan of the left breast revealed multiple, dilated, fluid-filled ducts in the subareolar region; however, there was no discrete collection amenable to drainage.Some 48 h later, this patient became cardiovascularly compromised. An arterial blood gas analysis suggested a metabolic acidosis. Her antibiotic regimen was changed to intravenous clindamycin and gentamicin upon discussion with the microbiology department. Although initially responding well to fluid resuscitation, she further became significantly more hypotensive and oliguric.The patient was admitted to the intensive care unit and the decision was made to proceed to theatre for an incision and drainage of the left breast to drain any sepsis.Intra-operatively, a circumareolar incision was made with blunt dissection to the chest wall. Scanty, organised loculations of pus were seen, with no abscess cavity being identifiable.The patient was commenced on ciprofloxacin ABSTRACT Breast infection and breast sepsis secondary to Pseudomonas aeruginosa is uncommon. We report two cases of pseudomonal breast infection leading to septic shock and abscess formation in women with non-responding breast infection. The management of breast infection is broadspectrum antibiotics and ultrasound with aspiration of any collection. To treat breast infection effectively, the causative organism must be isolated to enable appropriate antibiotic therapy.
Pseudomonal breast infection
Background Coping strategies used by women with breast cancer are vital for adjustment to their disease. Whilst it is clear that factors such as age at diagnosis, social support and ethnicity can influence coping mechanisms, there is currently no information about whether breast reconstruction changes mechanisms of coping for such patients. The aims of this study, therefore, were to determine how women who have had immediate breast reconstruction and mastectomy cope, compared to those who have mastectomy alone, and whether there are differences in coping mechanisms due to breast reconstruction surgery. Methods A retrospective cohort study, using a standardised questionnaire called the Brief Cope Scale. Inclusion criteria: all women who had had immediate breast reconstruction and mastectomy in Shropshire from 2003 to 2014 for ductal carcinoma in situ or node negative invasive breast cancer. Each patient was matched for year of diagnosis, adjuvant therapy and age to one woman who had mastectomy alone. Results 234 questionnaires were sent with a 58% response rate. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.66, P value 0.04) compared to those in the mastectomy alone cohort. In contrast, significantly more patients in the mastectomy alone cohort coped by active venting compared to the reconstruction cohort (T value 1.71, P value 0.04). Conclusion This study indicates for the first time that breast reconstruction may alter coping mechanisms in breast cancer survivors. Awareness of these coping mechanisms will enable clinicians to provide appropriate, individualised support.
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