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For further information, see CMDT Part 19-15: Puerperal Mastitis

Key Features

  • Occurs sporadically in nursing mothers

  • Staphylococcus aureus is usually the causative agent

  • Women nursing for the first time and those with difficulty breastfeeding appear to be at greatest risk; strategies aimed at preventing mastitis have been unsuccessful

  • Nursing from the infected breast is safe for the infant, but inflammation of the nipple may complicate latching

  • Rarely, inflammatory carcinoma of the breast can be mistaken for puerperal mastitis

Clinical Findings

  • Frequently begins within 3 months after delivery

  • May start with an engorged breast and a sore or fissured nipple

  • Cellulitis is typically unilateral with the affected area of breast being red, tender, and warm

  • Fever and chills are common

Diagnosis

  • Clinical

  • Failure to respond to usual antibiotics within 3 days may represent an organizing abscess or infection with a resistant organism

  • Ultrasonography of the breast can help confirm presence of an abscess

Treatment

  • Antibiotics effective against penicillin-resistant staphylococci should be given (dicloxacillin 500 mg orally every 6 hours or a cephalosporin for 10–14 days)

  • Regular emptying of the breast by nursing or by using a mechanical suction device

  • When the causative organism is methicillin-resistant S aureus (MRSA), the risk for abscess formation is increased when compared with infection caused by nonresistant staphylococcal species

  • Aspiration or surgical evacuation is usually required to treat an abscess

  • Changing antibiotics based on culture sensitivity (to vancomycin or trimethoprim-sulfamethoxazole, for example) is useful, especially if the clinical course is not improving appropriately

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