While most mastitis (the infection) is caused by Staph aureus, other nasty bugs can be involved too, especially if mastitis is bilateral (think Strep) or does not abate after 24-48 hours of antibiotic treatment. We have seen not only Strep but Klebsiella and some other not-so-common organisms. My concern with mastitis that does not respond very well to antibiotics is that the mother may be taking the wrong drug for the wrong bug, especially if no culture and sensitivity testing has been done. Also, with the increase in community acquired MRSA (methicillin resistant Staph aureus) we should keep this in the back of our minds as a possibility. 

Marsha Walker, RN, IBCLC
Weston, MA



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