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Fri, 7 Nov 2008 20:26:04 -0500 |
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My search of the archives turned up no posts more recent than 2005. I was
hoping someone could give me updated information on treatment
recommendations for breastfeeding women with MRSA breast infection and
their babies.
Patient is an otherwise healthy 33 yr old who is 8 wks pp. She had been
exclusively breastfeeding her term, healthy infant up until 6 wks pp when her
employer abruptly told her she either needed to return to work or lose her job.
She went back to work and weaned her baby, thinking it was her only option.
She experienced some breast engorgement and pain and she did do some
pumping while she was at home (employer would not provide space or time to
pump at work) and bottle fed the infant a combination of formula and
breastmilk. Baby is doing fine but mother developed a small infection on the
skin of her right breast. It was very superficial, consisting of a 1 cm pustular
lesion with a small amount of surrounding erythema. She had a mild fever.
There was no deep inflammation or induration of the breast and no deep
abscess. The superficial lesion opened and drained spontaneously and
consisted of a 1 cm very shallow ulcer at the time she presented to the clinic.
She was started on dicloxicillin but did not have significant improvement, so
she returned to the clinic several days later. When I saw her, she had the 1
cm shallow ulcer with a small amount of purulent and fibrinous exudate and 1
cm surrounding erythema. No mass or inflammation was palpable within the
breast tissue. The infection appeared to be confined to the skin. Mom was
still pumping and occasionally breastfeeding her baby at nighttime. She had
been told it was OK to breastfeed through the infection and she was
distressed about having to wean and regretting it. She wanted to resume
breastfeeding at least part-time. I did a wound culture and began clindamycin
for treatment of presumed MRSA. I encouraged her to continue breastfeeding
and pumping.
Her cultures came back positive for MRSA, sensitive to the clindamycin. She
returned tonight for followup. She had been scheduled earlier in the week for
a followup but she had to miss that appt for work. So she's been on the
clindamycin for 6 days and her breast lesion is improving. She continues her
efforts at pumping to rebuild her milk supply and putting her baby to breast
once or twice a day, usually mornings and bedtime. Baby has been well
throughout this time. The clinic has contacted her regarding our MRSA
treatment and followup protocol.
The questions remaining are:
1) Is there any reason to discard potentially contaminated pumped
breastmilk? (I saw references to this in 2005 posts, but the babies in question
were preemies in NICU, not healthy 8 wk olds.)
2) Can she continue to breastfeed ad lib? (This is a healthy baby thus far
unaffected and obviously has already been exposed for some time already, so
it would seem the baby has most likely already been colonized.)
3) Does the infant require testing and/or follow up? (Do colonized infants
receive antibiotics and follow-up cultures as well?)
4) The standard MRSA protocol here involves treatment and follow-up cultures
of the nares. Is there any reason her breastmilk should be cultured when she
comes for followups?
Thank you for your input,
Catharine Decker, MD
Family Medicine/Urgent Care
Luther Midelfort/Mayo Health Systems
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