An Update on the Recognition and Management of Lactational Breast Inflammation

Christine M. Betzold, NP, CLC, MSN

Disclosures

J Midwifery Womens Health. 2007;52(6):595-605. 

In This Article

Background

While there is no question that lactational breast inflammation or mastitis occurs in all populations, the precise rates of occurrence are questionable. To date, reported rates range from 2% to 33%.[2] The wide variation in rates occurs for a number of reasons. First, there is no standard definition of mastitis; therefore, several different definitions are currently being used in clinical practice as well as in research studies. Secondly, attempting to define infectious mastitis rates by monitoring antibiotic prescriptions is not accurate, because antibiotics are over-prescribed.[4] Correspondingly, studies report wide variations in antibiotic prescription rates from 15%[5] to 97%[6] in women who seek treatment for mastitis. A third problem is that large prospective cohort studies have not been performed and/or most studies have major limitations. One limitation is the inability to clearly identify infectious (clinically or microbiologically) from noninfectious breast inflammation.

Abscesses also occur in all populations. Most estimates of breast abscess rates are from retrospective studies of patients with mastitis. Abscesses are more likely acquired within the first 6 weeks postpartum, but again, rates vary widely.[2] A 2004 survey of 1193 women at 6 months postpartum found that about 3% of women who experience breast inflammation will develop an abscess;[5,7] however, abscesses have emerged independent of an apparent previous breast infection.[2]

Epidemiology and incidence rates for infections of the ducts are poorly studied, and most of the documentation comes from case studies.[8] Rates of infections of the ducts caused by Candida albicans are difficult to assess secondary to the inhibitory effect of lactoferrin in human milk. Morrill et al[9] used a novel culturing technique in a study of 100 women and found a prevalence of 23% for C albicans colonization at 2 weeks postpartum, but not all of these women developed an infection.[10] However, ductal infections are also caused by Staphylococcus aureus,[11,12] and mixed infections[12] have been documented. Thus, rates of C albicans colonization reflect only partial numbers.

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