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The most common pathogen isolated from cases of puerperal mastitis is Staphylococcus aureus, representing 35e50% of isolates and being associated with a higher risk of abscess formation [1]. Recently, oxacillin-resistant S aureus (ORSA) has been reported to be the main pathogen in puerperal mastitis [2]. In the study of all cases of postpartum mastitis that were culture positive for S aureus, 44% isolates were oxacillin resistant [2]. Traditionally, a breast abscess was drained with surgical incision under general anesthesia followed by regular wet dressing and secondary wound closure [3]. However, the considerable pain and hospitalization often leads to early weaning from breastfeeding. A less invasive alternative is ultrasound-guided needle aspiration using local anesthesia [4]. Here, we present a case of ORSA puerperal mastitis with abscess formation successfully treated with aspiration and antimicrobial therapy. A 27-year-old woman had her first baby born via a vaginal delivery, and she expressed milk with a breast pump for feeding. Five weeks after delivery, a tender mass was found in the left upper quadrant of her right breast; and the skin became red and warm. Amoxicillin-clavulanate was prescribed by her obstetrician as empiric treatment. Because the local heat and redness progressed in the following 2 days, she came to our clinic for a second opinion. The redness was measured as being 15 cm wide. Breast sonar revealed two breast abscess loci. The shallower one was about 3 cm wide but the deeper one was beyond the limitations of our linear ultrasound probe (20 MHz; Toshiba, Japan). Under the guidance of ultrasound, 3 mL of pus was aspirated from the shallower abscess. The deeper abscess was difficult to be approached (Fig. 1). The empiric antimicrobial agent was shifted to a combination of amoxicillin-clavulanate and

Puerperal breast abscess caused by oxacillin-resistant Staphylococcus aureus successfully treated by aspiration and antimicrobial therapy