Hi all,

In women with chronic breast pain (breast pain lasting more than one week,
with no visible signs of inflammation), according to the literature one of
the possible reasons is an infection, usually by S aureus, according to
some authors also to Candida albicans (

*Betzold CM Results of microbial testing exploring the etiology of deep
breast pain during lactation: a systematic review and meta-analysis of
nonrandomized trials.J Midwifery Womens Health. 2012 Jul-Aug;57(4):353-64).*
*So here is my question. Once I´ve ruled out other causes of chronic/deep
breast pain ( such as *referred pain from nipple trauma secondary to an
inadequate latch, pectoral/cervicothorathic muscle contraction secondary to
strain or unergonomic breastfeeding positions, or emotional cause), I ask
for a milk culture. However, I have trouble with the results. According to
the most popular lab in Spain, any single colony of S aureus is
pathological, and for other microorganisms anything beyond 700 CFU is also
considered pathological. This, by all acounts and all I´ve read, is a very
very low limit, meaning we are looking at normal milk, not infected milk
(and it also means that a lot of women are getting antibiotic treatment for
no reason).

On the other hand, the NICE Clinical Guideline CG93 revised in 2014, states
that milk for donation is considered contaminated if the counts are
above 100.000
CFU/ml of total microorganisms, 10.000 CFU/ml of Enterobacteriaceae or
10.000 CFU/ml of S aureus.


In my practice when I decide to treat a mom I go by the NICE numbers and
the clinical symptoms, but the NICE numbers are really about what milk
should look like for donation, not about chronic breast pain.


So I ask you all, what microbiological limits do you use to consider a
mother has an infection?


Warmly (veeery warmly) from Spain,

Kika


-- 
Dra. Carmela Baeza
Médico de Familia
Consultora Certificada en Lactancia Materna IBCLC
www.centroraices.com
http://www.facebook.com/Consulta.Lactancia.Raices
<http://www.facebook.com/pages/Centro-de-Atenci%C3%B3n-a-la-Familia-Ra%C3%ADces/274415189309122>

Autora de "Amar con los Brazos Abiertos"
http://www.amazon.es/Amar-con-los-brazos-abiertos/dp/8426904688/ref=sr_1_1?s=books&ie=UTF8&qid=1420813499&sr=1-1&keywords=amar+con+los+brazos+abiertos
<http://www.ediciones-encuentro.es/libro/amar-con-los-brazos-abiertos.html>

Comprometida con el Derecho a Vivir
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