Lactation breast abscess treated with Gualou Xiaoyong decoction and painless lactation manipulation: A case report and review of literature

Table 1 The results of bacteria culture in the milk before/after administration and the resistance of penicillin and cephalosporin

Date	Before/after administration	Bacteria cultured in milk	Penicillin resistance	Cephalosporin resistance
August 31, 2022	Before	Staphylococcus epidermidis	Yes	Yes
September 2, 2022	After (Gualou Xiaoyong decoction)	Staphylococcus epidermidis	Yes	Yes
September 9, 2022	After (Gualou Xiaoyong decoction)	Staphylococcus aureus	Yes	Yes
September 16, 2022	After (Gualou Xiaoyong decoction)	Staphylococcus aureus	Yes	Yes
September 23, 2022	After (Gualou Xiaoyong decoction)	Staphylococcus epidermidis	Yes	Yes
September 30, 2022 (combined with cold)	After (Gualou Xiaoyong decoction)	Staphylococcus aureus	Yes	Yes
October 7, 2022 (add 2 boxes of azithromycin tablets)	Before (azithromycin tablets)	Staphylococcus aureus	Yes	Yes
October 17, 2022	After (azithromycin tablets)	Staphylococcus epidermidis	Yes	Yes

Table 2 Characteristics of similar cases

Ref.	Interventions	Population characteristics	Breastfeeding cessation rate	Outcome
Pileri et al[19], 2022	B-ultrasound guided fine needle puncture	13 of the 64 patients needed hospitalization, 4 cases of bilateral abscesses, 16 cases with the largest abscess diameter greater than 5 cm	The average breastfeeding time was 5 mo, and 40.6% of females with breast abscesses continued to breastfeed for more than 6 mo. 21 mothers stopped breastfeeding	All abscesses > 5 cm in diameter were positive for Staphylococcus aureus, 56% of which were antibiotic resistant. All patients received antibiotic treatment, 71.9% (46/64) of them underwent fine needle aspiration
Colin et al[29], 2019	The same as above, if necessary, VAB shall be used	92 lactating women, 105 abscesses in total, 82 of 92 patients (89%) had 1 abscess, 10 patients (11%) had 2 or more abscesses (range, 2-4 cm). 4 patients had bilateral abscesses	18% of women stop breastfeeding	A total of 202 ultrasound-guided fine-needle puncture operations were performed. The number of percutaneous punctures/aspirates per abscess ranged from 1% to 6.4% of patients failed puncture and received incision and drainage surgery
Elagili et al[30], 2007	The same as above, if necessary, abscessotomy shall be used	16 (53.3%) non-lactating women and 14 (46.7%) lactating women had abscess diameters ranging from 1 cm to 15 cm (median: 4 cm). The volume of pus was between 1 mL and 200 mL (median: 14 mL)	Breastfeeding was encouraged, but rates of continuing or stopping breastfeeding were not recorded	15 patients (50%) only needed one aspiration, 10 patients needed multiple aspiration, and 5 patients needed incision and drainage. Mean symptom duration was 11.63 d (range: 3-28 d)
Hagiya et al[31], 2014	Operative incision and drainage	A 27-year-old Japanese female presented with high fever, tender breast, red and swollen left breast 17 d after delivery	Stopped breastfeeding	Ceftriaxone, daptomycin, vancomycin and other antibiotics were used for intravenous drip successively. Surgical incision was performed to drain about 15 mL of purulent secretion. The patient was discharged on the 10th d and took clindamycin orally
Wang et al[32], 2013	VAB	40 cases of lactation and 30 cases of non-lactation breast abscess who failed to use antibiotics and/or needle aspiration	Stopped breastfeeding during drainage	The skin inflammation disappeared within 6 d in all patients (median: 3.02 ± 6.65 d)
Kang and Kim[15], 2016	Fine needle aspiration vs VAB	Fine needle aspiration in 25 patients with breast abscess and VAB in 19 patients with breast abscess	No information about breastfeeding	Compared with the VAB group, the cure rate of the needle aspiration group had no significant difference
Lou et al[13], 2022	Arthroscopic system	19 cases of breast abscess in lactation	1 patient with breast fistula stopped breastfeeding, the other 18 patients resumed breastfeeding within 2 wk, of which 13 patients resumed breastfeeding within 1 wk	All patients were cured and did not recur during the 6-mo follow-up period. 1 patient stopped breastfeeding due to milk fistula, and the rest were cured

VAB: Vacuum-assisted biopsy.