Mastitis
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
- 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[1]
- 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)[2]
- 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