I need information from those of you who have performed milk cultures.

My understanding of obtaining a clean catch is to have patient wash hands,
wash breast/nipple, use sterile collection cup, discard first 5mL then
collect next few mLs. Now my colleagues (physicians, lab tech) bring up the
following concerns: (1) blood cultures require site to be washed with
betadyne and sterile gloves are used --shouldn't there be this sort of
cleaning for the nipple? (I assured them NOT but come on folks--help me
argue this!) (2) should sterile gloves be used?  (3) how does one keep
expressed milk from staph contamination? My argument is that urine clean
catches sure aren't all that fastidious...(those of you with lab backgrounds
will likely hoist me by my own petard on that!)

This came up because I have a patient who has what I think is sub-clinical
case of mastitis in duct within nipple structure. She had mastitis at 1 week
pp treated with Diclox. She is prone to plugged ducts (only on the one
breast), with stringy plugs that come from the affected nipple. Now she is 7
wks pp and her nipple is swollen (slightly) and mildly reddened, no dermal
damage but entire nipple is "uncomfortable". Exam and palpation of nipple
area revealed nothing unusual. Treatment with topical antifungal (mom and
baby) made no difference at all (I had her follow the entire
protocol--boiling, washing, etc.) There are no other symptoms of yeast in
her or baby. BTW: as I recall, stringy milk is a symptom of mastitis in
dairy cows and goats (you know how I am :-)  )

She did not breastfeed her first baby, but did pump for several weeks. She
noticed that the same nipple did not spray milk as well as the other; also,
she says the nipple "felt tense." My theory is that there is an anatomical
kink, now harboring a mild infection. I cultured her milk and it grew out
staph aureus--which is common organism in mastitis. (My colleagues argue
staph is only a contaminant). Gynecologist is willing to treat with suitable
antibiotics (organism is sensitive to erythromycin, augmentin and Bactrim).
I presented several references on culturing milk in mastitis--but none of
the articles I have go into detail on collection. In future I will need this
back up...so, h-e-l-p!

You can e-mail me privately, although I think postings on this topic would
benefit all of us. Until I dug out my journal articles the HCPs I work with
claimed there was nothing to be gained by milk culture since "its impossible
to collect an uncontaminated sample." My understanding is that culture is
helpful in cases of recurring mastitis (for sensitivities) and some fungal
infections.

Margery Wilson, IBCLC
wishing she had taken microbiology
Massachusetts Institute of Technology
[log in to unmask]