Mastitis: Rapid Evidence Review.

Mastitis represents a spectrum of inflammatory conditions. Lactational mastitis is the most common, with an approximate incidence of 10% in the United States, and it usually occurs in the first 3 months postpartum. Diagnosis is made clinically based on the presence of symptoms such as fever, malaise, focal breast tenderness, and overlying skin erythema or hyperpigmentation without the need for laboratory tests or imaging. However, obtaining milk cultures should be considered to guide antibiotic therapy, and ultrasonography should be performed to identify abscesses in immuno-compromised patients or those with worsening or recurrent symptoms. Because most cases of mastitis are caused by inflammation and not a true infection, a 1- to 2-day trial of conservative measures (i.e., nonsteroidal anti-inflammatory drugs, ice application, feeding the infant directly from the breast, and minimizing pumping) is often sufficient for treatment. If there is no improvement in symptoms, narrow-spectrum antibiotics may be prescribed to cover common skin flora (e.g., Staphylococcus, Streptococcus). Most patients can be treated as outpatients with oral antibiotics; however, if the condition worsens or there is a concern for sepsis, intravenous antibiotics and hospital admission may be required. Use of probiotics for treatment or prevention is not supported by good evidence. Factors that increase the risk of mastitis include overstimulation of milk production and tissue trauma from aggressive breast massage; therefore, frequent overfeeding, excessive pumping to empty the breast, heat application, and breast massage are no longer recommended because they may worsen the condition. The best prevention is a proper lactation technique, including a good infant latch, and encouraging physiologic breastfeeding rather than pumping, if possible.

Non-lactational mastitis with multiple sinus wounds treated by integrated traditional Chinese and Western medicine.

OBJECTIVE: Non-lactational mastitis (NLM) is a benign inflammatory disease of the mammary gland, with pain, swelling and redness as the main clinical manifestations. There is no unified and effective standard treatment plan for this disease at present. In addition to breast cancer, non-lactational mastitis is also becoming a presenting complaint in an increasing number of outpatients at the authors' clinic. This case report summarises the treatment and management of a 35-year-old female patient with NLM complicated with multiple sinus wounds after surgery. METHOD: The patient was treated as follows, with: timely debridement according to the local condition of the wound, with manual compression to drain exudate from the sinus wound; selected wound dressings according to their performance and characteristics to fill the sinus tract for drainage and infection control; psychological care of the patient and their family to ensure that patients actively participate in the treatment; family support to the patient to deal with negative emotions; integrated traditional Chinese and Western medicine to prevent/manage infection; dietary care and control; posture management and health education to facilitate the patient's wound healing process. RESULTS: After local management with systemic treatment and management using integrated traditional Chinese and Western medicine, the wound healed after 46 days, with no recurrence during a follow-up period of one year. CONCLUSION: As shown in this case report, the wound should be cut and drained as soon as possible in order to prevent obstruction of the sinus drainage. Modern wound dressings are selected for the 'external' treatment of local wounds. Integrated traditional Chinese and Western medicine may help in systemic therapy of the whole patient.

General practitioners' management of mastitis in breastfeeding women: a mixed method study in Australia.

BACKGROUND: Mastitis is a common reason new mothers visit their general practitioner (GP). In Australia, the Therapeutic Guidelines: Antibiotic provides practical advice to GPs managing a range of infections, including mastitis. It is not known if Australian GPs prescribe antibiotics and order investigations as recommended for the management of mastitis. METHODS: A convergent mixed methods design integrated quantitative analysis of a general practice dataset with analysis of interviews with GPs. Using the large-scale primary care dataset, MedicineInsight, (2021-2022), antibiotics prescribed and investigations ordered for mastitis encounters were extracted. Mastitis encounters were identified by searching 'Encounter reason', 'Test reason' and 'Prescription reason' free text field for the term 'mastitis'; 'granulomatous mastitis' was excluded. Clinical encounters for mastitis occurring within 14 days of a previous mastitis encounter were defined as belonging to the same treatment episode. Semi-structured interviews were conducted with 14 Australian GPs using Zoom or telephone in 2021-2022, and analysed thematically. The Pillar Integration Process was used to develop a joint display table; qualitative codes and themes were matched with the quantitative items to illustrate similarities/contrasts in findings. RESULTS: During an encounter for mastitis, 3122 (91.7%) women received a prescription for an oral antibiotic; most commonly di/flucloxacillin ([59.4%]) or cefalexin (937 [27.5%]). Investigations recorded ultrasound in 303 (8.9%), blood tests (full blood examination [FBE]: 170 [5.0%]; C-reactive protein [CRP]: 71 [2.1%]; erythrocyte sedimentation rate [ESR]: 34 [1.0%]) and breast milk or nipple swab cultures in approximately 1% of encounters. Analysis using pillar integration showed consistency between quantitative and qualitative data regarding mastitis management. The following themes were identified: - GPs support continued breastfeeding. - Antibiotics are central to GPs' management. - Antibiotics are mostly prescribed according to Therapeutic Guidelines. - Analgesia is a gap in the Therapeutic Guidelines. - Low use of breast milk culture. CONCLUSIONS: Prescribing antibiotics for mastitis remains central to Australian GPs' management of mastitis. Interview data clarified that GPs were aware that antibiotics might not be needed in all cases of mastitis and that delayed prescribing was not uncommon. Overall, GPs followed principles of antibiotic stewardship, however there is a need to train GPs about when to consider ordering investigations.

Stepwise transvenous lead extraction due to pacemaker pocket infection following lactational mastitis complicated with breast abscess.

BACKGROUND: Lactational mastitis is a common painful and debilitating inflammation of breast tissue, generally treated conservatively or with pus puncture in case of breast abscess. However, treating mastitis in patients with implantable surgical material located in the affected breast region can be extremely challenging. We present an unusual case of lactational mastitis complicated by pacemaker pocket infection in a breastfeeding mother. CASE PRESENTATION: A 35-year-old pacemaker-dependent female developed lactational mastitis seven weeks postpartum. Initially, the condition was treated conservatively with analgesics and antibiotics. After abscess formation, pus was aspirated using fine-needle aspiration technique. Four weeks after mastitis resolution, pacemaker pocket infection developed. According to current cardiovascular implantable electronic device infection treatment guidelines a complete surgical extraction of the entire electronic system, followed by targeted antibiotic treatment and reimplantation of a new device after infection resolution, was recommended. However, after thorough discussion with the young woman and her family and after detailed review of surgery-related risks, she declined a potentially high-risk surgical procedure. Thus, only the pulse generator was explanted; pacing leads positioned in the sub-pectoral pocket; new pacemaker implanted on the contralateral side and broad-spectrum antibiotic therapy continued for six weeks. After breastfeeding cessation, and with chronic fistula development at the primary pacemaker implantation site, the possibility of delayed surgical intervention including complete extraction of retained pacemaker leads was again thoroughly discussed with her. After thoughtful consideration the woman consented to the proposed treatment strategy. A surgical procedure including transvenous lead extraction through the primary implantation venous entry site, using hand-powered bidirectional rotational sheaths, was successfully performed, removing all retained leads through the left subclavian venous entry site, and leaving the fully functional and clinically uninfected pacemaker on the contralateral site intact. CONCLUSION: Although patients' decisions for delayed extraction in a case of cardiovascular implantable electronic device infection should be discouraged by attending physicians and members of interdisciplinary teams, our case shows that a stepwise treatment strategy may be successful as a bailout clinical scenario in patients with specific requests, demands and / or clinical needs.

'I don't want to be a guinea pig' - Swedish women's experiences of breast abscess treatment.

BACKGROUND: It is well known that breastfeeding plays an important role in the health of women and children. However, women are not always given optimal support and most do not reach their breastfeeding goals. About one in five, breastfeeding women report mastitis and a small proportion of these develop a breast abscess. Our aim was to describe the experiences of a group of Swedish breastfeeding women who developed a breast abscess. METHODS: A qualitative cross-sectional study with 18 study participants was undertaken in Sweden in 2017-2018. Potential participants were identified through electronic medical records at a university hospital and invited to participate in audio-recorded telephone interviews. Women were between 2 and 24 months postpartum at the time of the interview, on average 8 months. We conducted a thematic analysis in six steps according to Braun and Clark. RESULTS: Our analysis identified two themes: 1) Seeking care and receiving treatment was long and unpleasant, and 2) Importance of adequate professional care. Women who experienced a breast abscess were uncertain about where to ask for professional help. They often had a long wait for the right time to undergo the unpleasant and painful procedure of draining their breast abscess. The women felt it was important to receive professional care with respectful communication, continuity of care, and to receive adequate information, but they did not always receive this level of care. CONCLUSIONS: Women with puerperal breast abscesses often fall between medical specialty areas. No longer under the care of obstetricians and maternity services, their problem is too complicated for general practitioners or emergency departments, but not regarded as serious by breast surgeons. Healthcare professionals urgently need adequate training in order to deal with breastfeeding problems and be able to offer women-centred care.

Lactobacillus reuteri inhibits Staphylococcus aureus-induced mastitis by regulating oxytocin releasing and gut microbiota in mice.

Mastitis is the most frequent disease of cows and has well-recognized detrimental effects on animal wellbeing and dairy farm profitability. With the advent of the postantibiotic era, alternative antibiotic agents, especially probiotics, have received increasing attention in the treatment of mastitis. Based on research showing that Lactobacillus reuteri (L. reuteri) has anti-inflammatory effects, this study explored the protective effects and mechanisms of L. reuteri against mastitis induced by Staphylococcus aureus (S. aureus) in mice. First, mice with S. aureus-induced mastitis were orally administered L. reuteri, and the inflammatory response in the mammary gland was observed. The results showed that L. reuteri significantly inhibited S. aureus-induced mastitis. Moreover, the concentration of oxytocin (OT) and protein expression of oxytocin receptor (OTR) were measured, and inhibition of OTR or vagotomy reversed the protective effect of L. reuteri or its culture supernatant (LCS) on S. aureus-induced mastitis. In addition, in mouse mammary epithelial cells (MMECs), OT inhibited the inflammation induced by S. aureus by inhibiting the protein expression of OTR. It was suggested that L. reuteri protected against S. aureus-induced mastitis by releasing OT. Furthermore, microbiological analysis showed that the composition of the microbiota was altered, and the relative abundance of Lactobacillus was significantly increased in gut and mammary gland after treatment with L. reuteri or LCS. In conclusion, our study found the L. reuteri inhibited the mastitis-induced by S. aureus via promoting the release of OT, and treatment with L. reuteri increased the abundance of Lactobacillus in both gut and mammary gland.

Antimicrobial activity of propolis extract fractions against Staphylococcus spp. isolated from goat mastitis / Atividade antimicrobiana de frações do extrato de própolis frente à Staphylococcus spp. isolados de mastite caprina

The indiscriminate use of antibiotics in the treatment of caprine mastitis causes the appearance of resistant microorganisms, besides leaving residues in milk, putting at risk to human health. In this way, propolis is an alternative in the treatment of diseases because it has antimicrobial activity, mainly because of the presence of flavonoids in its composition. The aim of this study was to evaluate the antimicrobial potential of propolis to Staphylococcus spp. Isolated from cases of goat mastitis and qualify the crude ethanoic extract by high performance liquid chromatography (HPLC). In this study, the minimum bactericidal concentration values of propolis extracts in ethanol, ethyl acetate and hexane showed that the best concentrations capable of promoting the highest mortality of the isolates of Staphylococcus spp. from mastitis in goats, were 6250, 3125 and 1562.5µg/mL, respectively. By the microplate adherence test, it was found that 20.78% isolates were not able to form biofilm, 14.70% were classified as moderate and 64.70% were weak and none as a strong biofilm producer. Propolis in its different diluents was able to affect the formation of biofilm and showed a pronounced marked antimicrobial activity against Staphylococcus spp. strains and may be indicated for use in in vivo studies.(AU)

O uso indiscriminado de antibióticos no tratamento de mastite caprina leva ao desenvolvimento de micro-organismos resistentes que poderão estar presentes em alimentos, colocando em risco a saúde humana. Dessa forma, a própolis surge como uma alternativa para o tratamento de doenças por possuir uma ação antimicrobiana, principalmente pela presença de flavonoides em sua composição. O objetivo desse estudo foi avaliar o potencial antimicrobiano da própolis frente à Staphylococcus spp. isolados de casos de mastite caprina e qualificar o extrato etanoico bruto por cromatografia líquida de alta eficiência (CLAE-DAD). Neste estudo, os valores de concentração bactericida mínima (CBM) dos extratos de própolis em álcool etílico, acetato de etila e hexano nos isolados foram de 6250, 3125 e 1562,5µg/mL, respectivamente. Pelo teste de aderência à microplacas, observou-se que 20,78% dos microorganismos, não foram capazes de formar biofilme, 14,70% foram classificados como moderados, 64,70% em fracos e nenhum como forte produtor de biofilme. A própolis em seus diferentes diluentes foi capaz de afetar a formação de biofilme e apresentou significativa atividade antimicrobiana frente a cepas de Staphylococcus spp., podendo ser indicada para utilização em estudos "in vivo".(AU)

Evaluación del efecto antimicrobiano de Aloe barbadensis Miller asociado a ceftiofur sobre cepas de Escherichia coli / Evaluation of the antimicrobial effect of Aloe barbadensis Miller associated with ceftiofur on strains of Escherichia coli

El uso indiscriminado de antimicrobianos en animales de producción es la principal causa del aumento de la resistencia bacteriana, por lo que organizaciones intergubernamentales solicitan disminuir el uso excesivo de estos fármacos. La mastitis es causada principalmente por Escherichia coli en la zona central de Chile y, debido a que su tratamiento se concentra en el uso de antimicrobianos, se ha estudiado Aloe barbadensis Miller (Aloe vera) como una alternativa terapéutica por su efecto antimicrobiano. El objetivo de este trabajo fue evaluar el efecto inhibitorio "in vitro" de A. vera asociado a Ceftiofur en concentraciones menores a su Concentración Mínima Inhibitoria (CMI), frente a E. coli ATCC 25922 y en cepas aisladas de vacas con mastitis clínica. Se utilizó el Método de Macrodilución en Caldo. La CMI fue determinada mediante turbidez y confirmada por recuento de UFC/mL y por espectrofotometría UV-visible. Las cepas de campo fueron sometidas a un estudio de sensibilidad (Kirby Bauer) frente a un panel de antimicrobianos antes de analizar el efecto inhibitorio de A. vera. La CMI de A. vera se determinó en 60 mg/mL. La asociación de A. vera/Ceftiofur no inhibió el crecimiento de E. coli ATCC 25922. Todas las cepas de campo presentaron sensibilidad intermedia o resistencia a al menos un antimicrobiano, pero fueron inhibidas por A. vera. Esto sugiere que A. vera es más efectiva en la inhibición del crecimiento de E. coli en comparación a la asociación y podría presentarse como una alternativa terapéutica frente a mastitis clínicas causadas por E. coli.

Processos inflamatórios da mama: caracterização e manejo terapêutico / Inflammatory processes of breast: characterization and therapeutic management

Hiperemia, calor e dor na mama podem relacionar-se a um grande número de causas. Processos inflamatórios da mama geralmente estão relacionados ao ciclo grávido-puerperal e suas modificaçöes, principalmente as formas agudas. Este trabalho tem por objetivo a caracterização dos diferentes processos inflamatórios da mama e seu adequado manejo.

Redness, heat, and breast pain may be related to a number of causes. Inflammatory conditions of the breast are usually related to the pregnancy-puerperal cycle and its modifications, mainly acute forms. This work aims to characterize the different inflammatory breast conditions and its adequate management.

Estudo dos métodos de rotina diagnóstica de mastite no leite de éguas / Study of routine diagnosis methods of mastitis in mares

Routine diagnosis methods used in bovine mastitis were studied in 55 mares in lactation. The findings of strip cup test, California Mastitis Test-CMT, electronic somatic cell count-CCS, microbiological culture, and in vitro antimicrobial susceptibility profile of isolates were discussed. Streptococcus spp., Staphylococcus spp, and enterobacteria were the most common microorganisms isolated in health and CMT-positive mammary glands. Staphylococcus aureus and Arcanobacterium pyogenes were identified in two mares presenting clinical mastitis. Mean somatic cell count of eight mares without presence of microorganisms in milk was 247.57x10³/mL and 1.621,86x10³/mL in 47 mares with positive microbiological culture. Moderate concordance (63.8 percent) between positive reactions in CMT (1 to 3+) and microbiological culture was observed. Amicacin (78.9 percent), ceftiofur (74.7 percent), sulpha-trimetoprim (69,0 percent) and norfloxacin (69.0 percent), were the most effective drugs, while resistance of isolates was mainly observed against penicillin (64.8 percent), gentamycin (35.2 percent), azithromycin (35.2 percent), enrofloxacin (28.2 percent), and florfenicol (28.2 percent).

Mastitis granulomatosa idiopática y mastitis de células plasmáticas: experiencia de tres años / Granulomatous mastitis and plasmatic cell mastitis: three-year experience

Se evaluó el manejo de 13 pacientes con mastitis granulomatosa idiopática y mastitis de células plasmáticas, tratadas en el Hospital Félix Bulnes, por un período de tres años. Se estudió la relación con la edad, anticoncepción, embarazo, lactancia y la atopia. Se evaluaron las limitaciones de la mamografía y de la ecotomografía mamaria y el uso de la biopsia trucut. Se compararon los resultados del tratamiento médico y quirúrgico.

Procesos inflamatorios benignos de la mama / Benign inflammatory disorders of the breast

Los procesos inflamatorios benignos de la mama representan un capítulo importante en la patología de esta glándula. Afectan preferentemente a mujeres en edad fértil y el diagnóstico de algunas de estas lesiones puede resultar sencillo y su tratamiento no ofrecer dificultades, sin embargo en otros casos existen serios problemas, tanto para identificar el tipo de lesión como para determinar su adecuada conducta terapéutica. Afortunadamente, la mayoría de las lesiones inflamatorias mamarias finalmente demostrarán ser benignas. No obstante, el médico debe estar vigilante excluyendo en cualquier lesión la posibilidad de cáncer mamario. Cuando se enfrenta clínicamente una lesión sospechosa y su estudio no resulta totalmente clarificador, no debe postergarse la realización de una biopsia. En este artículo se revisan algunos conceptos sobre los procesos inflamatorios benignos más habituales de la mama, con especial énfasis en las bases del diagnóstico y las principales tendencias en su manejo y tratamiento

Processos inflamatórios da mama / Breast inflammatory process

Os processos inflamatórios da mama (PIM) constituem situaçöes clínicas muito importantes na prática do ginecologista e mastologista, tanto pela sua alta freqüência, como pela diversidade de etiologias, que geralmente necessitam tratamento específico e diagnóstico diferencial com câncer. Os PIM geralmente estäo relacionados ao ciclo grávido-puerperal e suas modificaçöes, principalmente as formas agudas. No entanto, o tecido mamário pode hospedar qualquer agente infeccioso e manifestar formas clínicas de evoluçäo lenta e recorrente. Classificamos os processos inflamatórios da mama em agudos e crônicos, de acordo com suas histórias naturais. As mastites crônicas foram divididas em infecciosas ou näo-infecciosas, dependendo da existência de um agente infeccioso específico em sua etiopatogenia.

Mastitis periductal: a propósito de 20 observaciones / Periductal mastitis: apropos of 20 cases

La mastitis periductal (MP) es una afección benigna de la mama, que adopta formas clínicas variadas: secreción por el pezón, tumefacción subareolar con o sin componente inflamatorio, abscesos y fistulización.Estos diversos aspectos se intrincan entre sí y, en su marcha crónica, tienden a agravarse progresivamente, evolucionando por crisis recidivantes.A propósito de una serie de 20 observaciones, revisamos la patología y formulamos consideraciones clínicas y terapéuticas.Destacamos la posibilidad cierta de una semejanza clínica con el cáncer mamario y la necesidad de estar advertido para prevenir el error diagnóstico.En su tratamiento nos inclinamos por la cirugía de resección total de los galactóforos, para evitar las recidivas, y describimos la técnica aplicada a tal fin