Mastitis: Difference between revisions
Line 2: | Line 2: | ||
*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
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
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
- Uncomplicated mastitis → 10 days of antibiotics (regardless of MRSA suspicion)[4]
- Dicloxacillin 500mg PO q6hrs, considered first line if breastfeeding given safety for infant OR
- Cephalexin 500mg PO q6hrs OR
- Clindamycin 450mg PO q8hrs (also provides MRSA coverage) OR
- Amoxicillin/Clavulanate 875mg PO q12hrs OR
- Azithromycin 500mg PO x1 on day 1, then 250mg PO daily for days 2-5
Disposition
- If suspect breast abscess refer for immediate surgical drainage
References
- ↑ Eryilmaz R et al. Management of lactational breast abscesses. Breast. Oct 2005;14(5):375-9.
- ↑ Dixon JM. Outpatient treatment of non-lactational breast abscesses. Br J Surg. Jan 1992;79(1):56-7.
- ↑ Amir LH. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeeding Medicine. 2014;9(5):239-243. doi:10.1089/bfm.2014.9984.
- ↑ Levine BL. 2011 EMRA Antibiotic Guide. EMRA. Pg 78.