tammy
here are some of my notes from a talk i am giving:
"Bacterial culture (and sensitivity) can be of value; if normal skin flora
the outcome is often good; consider mgmt with frequent breast emptying and
rest.
Cell counts and bacterial colony counts may be useful - bacteria greater
than 10(3) /ml of milk, leukocytes greater than suggest 10(6) /ml of milk
suggest infectious mastitis [the numbers in parentheses are exponents - like
10 to the 3rd, 10 to the 6th].
Pathogens are most often coagulase positive staph aureus, may be E. coli,
more rarely beta-hemolytic strep - poorer outcomes - also assoc with sore
nipples and early onset after delivery (poor bf technique?
hospital-acquired?); require antibiotic therapy in addition to frequent
emptying and rest; review sensitivities of staph organisms for your region
[in case you don't get a culture and sensitivity or does't grow out one].
Ibuprofen is often helpful too."
So...there are several things to consider (also I give several refs below)
1. is it bacterial? is it being treated w/ right abx and for long enough
duration of tx 10-14 days?
2. is it an abscess? may need ultrasound or other dx to ascertain
3. if recurs in same place, may be breast cancer - refer to breast
specialist, breast surgeon
4. if fungal, usually doesn't grow in culture
tammy,
some authors differentiate between inflammation and infection. if recurrent
breast inflammation, this is usually from milk stasis and there are lots of
factors to look for to improve this. you need to read some good mastitis
refs as it is too  much for me to go into here. While you are reading, you
will learn a great deal, so it will be very worthwhile for you, this client,
and future ones. Good luck., I hope you can get these refs.
Amir, L., Harris, H., and Andriske, L. An audit of mastitis in the emergency
department. Journal of Human Lactation 1999, 15:221-224.
Fetherston, C. Risk factors for lactation mastitis. Journal of Human
Lactation 1998, 14:101-109.
Hale, T. Clinical Therapy in breastfeeding patients.  Amarillo TX:
Pharmasoft Medical Publishing, 1999.
Heinig, M., Francis, J., and Pappagiianis, D. Mammary candidosis in
lactating women. Journal of Human Lactation 1999, 15:281-288.
Inch. S., and von Xylander, S. Mastitis: Causes and management. WHO Dept of
Child and Adolescent Health and Development, Geneva, 2000.
Osterman, K., and Rahm, V. Lactation mastitis: Bacterial cultivation of
breast milk, symptoms, treatment, and outcome. Journal of Human Lactation
2000, 16:297-302.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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