Mastitis: Difference between revisions
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==Background== | ==Background== | ||
* | *Inflammation of the breast tissue - can be infectious or non-infectious in etiology.<ref name="Amir">Amir LH. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeeding Medicine. 2014;9(5):239-243. doi:10.1089/bfm.2014.9984.</ref> | ||
**Continuum of disease - Plugged ducts → engorgement → non-infectious inflammation → infectious inflammation → abscess | |||
**Infection 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]]<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> | *Post-menopausal usually due to [[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]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Erythematous region on breast w/ well-localized area of tenderness | |||
*[[Fever]]/chills | *[[Fever]]/chills | ||
*Flu-like symptoms | *Flu-like symptoms | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Postpartum emergencies DDX}} | {{Postpartum emergencies DDX}} | ||
== | ==Diangostic Evaluation== | ||
* | *Ultrasound useful to identify abscess | ||
*Routine labs not indicated unless<ref name="Amir" />: | |||
**Treatment failure | |||
**Recurrent episodes | |||
**Hospital-acquired | |||
**Severe cases with systemic illness | |||
== | ==Management== | ||
{{Mastitis antibiotics}} | {{Mastitis antibiotics}} | ||
==Disposition== | ==Disposition== | ||
* | *Admit for OR drainage if abscess suspected/identified | ||
*Otherwise discharge | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:OB/GYN]] | [[Category:OB/GYN]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 21:22, 7 September 2015
Background
- Inflammation of the breast tissue - can be infectious or non-infectious in etiology.[1]
- Continuum of disease - Plugged ducts → engorgement → non-infectious inflammation → infectious inflammation → abscess
- Infection 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 due to E. coli, Group D strep, Staph, anaerobes[2][3]
- Usually sub-areolar area due to chronic duct inflammation
- 40% recurrence rates even after I&D
Clinical Features
- Erythematous region on breast w/ well-localized area of tenderness
- Fever/chills
- Flu-like symptoms
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
Diangostic Evaluation
- Ultrasound useful to identify abscess
- Routine labs not indicated unless[1]:
- Treatment failure
- Recurrent episodes
- Hospital-acquired
- Severe cases with systemic illness
Management
- 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)[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
- Admit for OR drainage if abscess suspected/identified
- Otherwise discharge
References
- ↑ 1.0 1.1 1.2 Amir LH. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeeding Medicine. 2014;9(5):239-243. doi:10.1089/bfm.2014.9984.
- ↑ 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.
- ↑ Levine BL. 2011 EMRA Antibiotic Guide. EMRA. Pg 78.