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 _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html