Journal of human lactation : official journal of International Lactation Consultant Association · 2025
Management of Mastitis in the Hospital Setting: An International Audit Study.
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Amir Lisa H, Coca Kelly P, Mello Da Silva Marcia Juliana, Okada Marcia Massumi, Onat Demir Güliz, Duran Busra, Kargin Süleyman, Güllü Kübra, Delic Lara, Dragicevic Magdalena, Rosenbauer Maria, Ngan Mee-Har Michelle, Jeong Wirawan, Saha Moni Rani, Zakarija-Grkovic Irena
Аннотация
BACKGROUND: Breastfeeding is strongly promoted by health authorities, but there is little research on whether health professionals provide best-practice care for women experiencing mastitis/breast abscess.
RESEARCH AIM: To explore management of mastitis/breast abscess in hospital emergency departments (EDs).
METHODS: Medical records of patients presented to hospital EDs in Australia, Brazil, Croatia, Germany and Türkiye with lactational mastitis/abscess between 2017 and 2023 were reviewed. Demographic and clinical information (including symptoms, management, and investigations) was extracted and analyzed.
RESULTS: A total of 580 women with mastitis/breast abscess (646 Emergency Department presentations, mostly in the first 8 weeks postpartum) were identified during the study period. The majority of the women had symptoms of mastitis/breast abscess (breast pain, lump, and inflammation) for > 48 hours before presenting in the Emergency Department. In Australia, culture and sensitivity testing of milk was available for 44% (146/331) of presentations. S. aureus was the most common bacteria isolated (33%, n = 48), of which 6% (n = 3) were methicillin-resistant. The use of diagnostic ultrasound varied between sites, from 5% (3/65) in Croatia to 82% (40/49) in Germany. Breast abscesses were mostly managed by ultrasound-guided aspiration in Australia, whereas incision and drainage was standard care in Germany. Amoxicillin/clavulanate was most commonly prescribed in Croatia (57%, 31/54) and Türkiye (69%, 28/42), whereas flucloxacillin, cephalexin, or cefuroxime was primarily used in Australia (86%, 272/322), Brazil (62%, 66/106), or Germany (80%, 33/41), respectively.
CONCLUSIONS: The management of mastitis/breast abscess varied considerably between countries. International evidence-based guidelines for the management of lactational mastitis are urgently needed.
RESEARCH AIM: To explore management of mastitis/breast abscess in hospital emergency departments (EDs).
METHODS: Medical records of patients presented to hospital EDs in Australia, Brazil, Croatia, Germany and Türkiye with lactational mastitis/abscess between 2017 and 2023 were reviewed. Demographic and clinical information (including symptoms, management, and investigations) was extracted and analyzed.
RESULTS: A total of 580 women with mastitis/breast abscess (646 Emergency Department presentations, mostly in the first 8 weeks postpartum) were identified during the study period. The majority of the women had symptoms of mastitis/breast abscess (breast pain, lump, and inflammation) for > 48 hours before presenting in the Emergency Department. In Australia, culture and sensitivity testing of milk was available for 44% (146/331) of presentations. S. aureus was the most common bacteria isolated (33%, n = 48), of which 6% (n = 3) were methicillin-resistant. The use of diagnostic ultrasound varied between sites, from 5% (3/65) in Croatia to 82% (40/49) in Germany. Breast abscesses were mostly managed by ultrasound-guided aspiration in Australia, whereas incision and drainage was standard care in Germany. Amoxicillin/clavulanate was most commonly prescribed in Croatia (57%, 31/54) and Türkiye (69%, 28/42), whereas flucloxacillin, cephalexin, or cefuroxime was primarily used in Australia (86%, 272/322), Brazil (62%, 66/106), or Germany (80%, 33/41), respectively.
CONCLUSIONS: The management of mastitis/breast abscess varied considerably between countries. International evidence-based guidelines for the management of lactational mastitis are urgently needed.