Mastitis: Difference between revisions

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*Occurs due to bacterial colonization secondary to areolar inflammation and glandular obstruction
*Occurs due to bacterial colonization secondary to areolar inflammation and glandular obstruction
*Often occurs during the first few weeks to months postpartum, usually staph species with breast milk as culture medium
*Often occurs during the first few weeks to months postpartum, usually staph species with breast milk as culture medium
*Post-menopausal usually [[E. coli]], [[Group D strep]], [[Staph]], [[anaerobes]]
*Post-menopausal usually [[E. coli]], [[Group D strep]], [[Staph]], [[anaerobes]]<ref>Eryilmaz R et al. Management of lactational breast abscesses. Breast. Oct 2005;14(5):375-9.</ref><ref>Dixon JM. Outpatient treatment of non-lactational breast abscesses. Br J Surg. Jan 1992;79(1):56-7.</ref>
**Usually sub-areolar area due to chronic duct inflammation
**Usually sub-areolar area due to chronic duct inflammation
**40% recurrence rates even after [[I&D]]
**40% recurrence rates even after [[I&D]]

Revision as of 02:25, 3 August 2015

Background

  • Occurs due to bacterial colonization secondary to areolar inflammation and glandular obstruction
  • Often occurs during the first few weeks to months postpartum, usually staph species with breast milk as culture medium
  • Post-menopausal usually E. coli, Group D strep, Staph, anaerobes[1][2]
    • Usually sub-areolar area due to chronic duct inflammation
    • 40% recurrence rates even after I&D

Clinical Features

  • Fever/chills
  • Flu-like symptoms
  • Breast exam shows erythematous region on breast w/ well-localized area of tenderness

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Diangosis

  • US useful to differentiate mastitis from breast abscess

Treatment

  • No need to routinely interrupt breastfeeding with puerperal mastitis.
  • For mild symptoms <24 hours, supportive care may be sufficient[3]
    • Effective milk removal (frequent breast feeding - use pumping to augment milk removal)
    • Analgesia (NSAIDs)

Treatment directed at S. aureus and Strep and E. coli

Disposition

  • If suspect breast abscess refer for immediate surgical drainage

References

  1. Eryilmaz R et al. Management of lactational breast abscesses. Breast. Oct 2005;14(5):375-9.
  2. Dixon JM. Outpatient treatment of non-lactational breast abscesses. Br J Surg. Jan 1992;79(1):56-7.
  3. Amir LH. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeeding Medicine. 2014;9(5):239-243. doi:10.1089/bfm.2014.9984.
  4. Levine BL. 2011 EMRA Antibiotic Guide. EMRA. Pg 78.