Hi!   I would like to see if anyone out there has seen a similar problem.  A
mom was referred to me by her midwife for bilateral green nipple discharge.
She is a seventh time mom and, needless to say, an experienced breastfeeder.
However, since this baby has been born (6 weeks ago), she has been
experiencing severe latch on pain and burning ductal pain after nursing.
She was delivered at a birth center, and therefore did not get any routine
antibiotics during labor.  She had been treated with adequate courses of
both oral diflucan and dicloxacillan without much change. She also did not
have a high milk supply (it was always great before), so the pediatrician,
of course, suggested formula. Also, her ductal opening was enlarged
(possible ductal ectasia, but that shouldn't hurt).

I was able to culture acetinobactor baumannii from a milk sample of one
breast. (Both cytology smears - for cancer - were negative).  She has no
breast lumps or hot red spots.   I started her on rocephin IM and bactrim
twice a day.  The only other drugs that this bug was sensitive to were
either IV meds or quinilones (cipro, etc.) that are not the best during
breastfeeding.

I will see her Monday for her 2nd rocephin shot, and will be able to see if
she is responding to this treatment.

The problem is that this bug does not often cause infection except in ICU
patients.  It can also be a skin contaminant.  So I want to be sure I'm not
missing anything. Has anyone seen a problem like this?  Could I be barking
up the wrong tree?   Any NPs, Midwifes, or Docs out there who have treated
for this?  I repeated the cultures, but I'm not sure they're going to come
out because of retreatment with diclox.

Has anyone seen anything like this?

Kay Sophar, MSN, CFNP

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