Objective

Although the genus Prevotella is part of the general human flora, species of this anaerobic gram-negative bacteria have been described as cause of persisting nonpuerperal breast abscesses. Collecting punctate samples and testing these samples for anaerobic bacteria, is not part of the common diagnostic workflow in atypical breast abscesses. The causative anaerobic micro-organism can remain unclear and patients can be treated with multiple inadequate antibiotics and/or extensive surgical procedures. The aim of this cohort study of Prevotella induced breast abscesses is to gain more insights into the diagnostic procedures and treatment.

Methods

Medical charts of patients with a Prevotella induced breast abscess between 2015 and 2021, were retrospectively reviewed on patient characteristics, diagnostic procedures, treatment and outcome.

Results

Twenty-one patients were included. Six subspecies of Prevotella were determined by culturing. High susceptibility was observed for amoxicillin/clavulanic acid (100%, n = 12). Nine patients (43%) were treated with antibiotics, eight patients (38%) with antibiotics and incision and drainage, and four patients (19%) with only incision and drainage. Recurrence was observed in nine patients (43%), of whom five patients were treated with antibiotics and three patients had surgery. The mean duration of antibiotic administration in patients with recurrence was significantly shorter compared to those without recurrence (5.6 days vs. 19.5 days, p = 0.039).

Conclusion

Specific anaerobic culturing should be common practice in atypical breast abscesses to confirm Prevotella species. The high recurrence rate emphasizes the need of further research for optimal treatment. Prolonged duration of antibiotics could be considered and amoxicillin/clavulanic acid seems to be the first choice.

中文翻译：

---

罕见普氏菌引起的乳腺脓肿的诊断和治疗挑战：一项回顾性队列研究

客观的

尽管普雷沃氏菌属是一般人类菌群的一部分，但这种厌氧革兰氏阴性细菌的物种已被描述为持续性非产后乳房脓肿的原因。收集点状样本并测试这些样本中的厌氧菌，并不是非典型乳腺脓肿常见诊断工作流程的一部分。致病厌氧微生物可能仍不清楚，患者可以使用多种不适当的抗生素和/或广泛的外科手术进行治疗。这项普雷沃氏菌引起的乳腺脓肿队列研究的目的是获得更多关于诊断程序和治疗的见解。

方法

对 2015 年至 2021 年间普雷沃氏菌引起的乳腺脓肿患者的病历进行了回顾性审查，包括患者特征、诊断程序、治疗和结果。

结果

其中包括二十一名患者。通过培养鉴定出普雷沃氏菌的六个亚种。观察到阿莫西林/克拉维酸具有高敏感性（100%，n = 12）。9 名患者（43%）接受了抗生素治疗，8 名患者（38%）接受了抗生素加切开引流治疗，4 名患者（19%）仅接受了切开引流治疗。9 名患者（43%）出现复发，其中 5 名患者接受抗生素治疗，3 名患者接受手术。与未复发患者相比，复发患者的抗生素平均给药时间显着缩短（5.6 天 vs. 19.5 天，p = 0.039）。

结论

特异性厌氧培养应该是非典型乳腺脓肿的常见做法，以确认普氏菌属物种。高复发率强调需要进一步研究以获得最佳治疗。可以考虑延长抗生素疗程，阿莫西林/克拉维酸似乎是首选。