(31) Effective Management of Multi-Resistant Neonatal Breast Abscess Through Early and Precise Care.

Background: Neonatal breast abscess is a rare but significant condition, typically occurring in full-term infants due to the spread of skin flora, often Staphylococcus aureus, to the breast parenchyma. This condition, if not treated promptly, can result in serious complications such as breast hypoplasia or scarring. Recognizing early signs and appropriate management are crucial for a favorable outcome.

Case: We present the case of a 1-month-old female infant, full-term at 39+5 weeks gestation, with no prior medical history or hospitalizations, and up-to-date on her immunizations. She developed a right-sided breast abscess, presenting with a firm, warm, erythematous swelling with induration and tenderness. The patient had no fever but was tachycardic. Laboratory results showed a white blood cell count of 19.55 x 10³/µl and C-reactive protein of 25 mg/L. Breast ultrasound revealed a poorly defined hypoechoic lesion measuring 30 x 22 mm with a central, irregular liquid collection of 13 x 10 mm. Despite intravenous Cloxacillin, the patient showed no improvement by the third day. Surgical drainage was performed with the support of interventional radiology, extracting 2 cc of pus under ultrasound guidance. Cultures revealed multi-resistant Staphylococcus aureus. Vancomycin treatment was initiated, with dose adjustments made after the fifth dose. The infant was treated successfully, followed by a 10-day course of oral Cotrimoxazole. Full recovery was observed, with no further complications.
Ethics Approval: This case was reviewed and approved by the Ethics Committee of Hospital Dr. Luis Calvo Mackenna, in accordance with institutional guidelines.

Comments: This case emphasizes the importance of early diagnosis, timely surgical intervention, and the selection of appropriate antibiotic therapy, particularly in cases involving multi-resistant pathogens. Prompt treatment is critical to prevent complications such as damage to developing breast tissue. The adjustment of antibiotic dosing in young infants, as demonstrated with Vancomycin in this case, is crucial due to their unique pharmacokinetics, ensuring therapeutic effectiveness while minimizing toxicity. Additionally, the role of interventional radiology in enhancing precision during abscess drainage in neonatal patients is highlighted, contributing to successful outcomes and minimizing potential complications.

Financial Disclosure:
The authors have no financial relationships relevant to this case to disclose.