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Mastitis
From WikEM
Contents
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
- Neonatal mastitis management is controversial, but typically requires IV and/or PO antibiotics with good staph coverage
Clinical Features
- Erythematous region on breast with well-localized area of tenderness
- Fever/chills
- Flu-like symptoms
Differential Diagnosis
Postpartum Emergencies
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- Postpartum endometritis
- Postpartum headache
- HELLP syndrome
- Postpartum hemorrhage
- Mastitis
- Peripartum cardiomyopathy
- Preeclampsia
- Retained products of conception
- Uterine rupture
Diagostic 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)
Antibiotics
Treatment directed at S. aureus and Strep and E. coli
- Uncomplicated mastitis → 10 days of antibiotics (regardless of MRSA suspicion)[4]
- Cephalexin 500mg PO q6hrs OR
- Clindamycin 450mg PO q8hrs (also provides MRSA coverage) OR
- Amoxicillin/Clavulanate 875mg PO q12hrs OR
- Dicloxacillin 500mg PO q6hrs 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.
