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1 Evidence Tables for Mastitis, Abscess and Related Conditions And

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1 Evidence Tables for Mastitis, Abscess and Related Conditions And Evidence tables for mastitis, abscess and related conditions and issues Tabulation of studies on mastitis illustrates the heterogeneity of study design, definition of mastitis, and factors investigated. Recent studies on mastitis in Western populations have been included, with some older studies of particular interest. List of tables: Table A: Incidence and treatment of Mastitis Table B: Reviews of the literature Table B1: Core Reviews Table B2: Other review sources Table B3: Further reviews Table C: Women’s experience of mastitis Tables D: Abscess Table D1: Incidence of abscess Table D2: Interventions for abscess Table E: Overabundant milk supply Table F: Chronic breast pain Table G: Mastitis and breast augmentation Table H: Alternative treatments for mastitis Table I: Physiology of mastitis during lactation Table J: Role of specific pathogens Table J1: Role of Staphylococcus aureus in mastitis Table J2: Mastitis and MRSA Table J3: MRSA mastitis and abscess case study Table J4: Role of Corynebacterium Table K: Effects on the baby Table K1: Effects of mastitis on the baby Table K2: Antibiotic treatment of women during lactation – effects on the infant Table K3: Maternal Strep B infections and effects on the baby through breastfeeding. Table L: Prevention 1 Table A: Incidence and treatment of Mastitis: Factors associated with incidence (possible risk factors); also studies of treatment experienced by women with mastitis: Author Type of Definition of Outcomes measured Results Comments date study mastitis Scott 2008 Prospective Red, tender, hot, Incidence of mastitis, 18% (95% CI 14%, 21%) had at least one 72% of women longitudinal swollen area of the reoccurrence, timing of episode of mastitis invited to take UK cohort study breast accompanied by episodes. 68% of those with mastitis reported only one part participated. one or more of: Duration of breastfeeding episode, 23 reported two episodes and 9% 95% follow up 420 • Temperature ≥38°C after mastitis reported three or more episodes. rate. breastfeeding • One or more of body Type of care received from women in aches, headaches health professionals 53% of initial episodes and 43% of all Glasgow, chills episodes occurred during the first four weeks Authors comment followed up at • Diagnosis of mastitis postpartum that almost half of 3,8,18 and 26 from medical women in study weeks were practitioner Women who had had mastitis were were continuing to asked about significantly more likely to be breastfeeding at breastfeed at 26 cases of 26 weeks than those who did not have weeks, while mastitis they mastitis (Log-rank test χ2 = 8.81, df = 1, national average had p=0.003) for Scotland is experienced 25%. 37% of women managed their first episode of mastitis without consulting a health professional. Those seeking help consulted GP (37%); Community MW (32%) and HV Of the women who (21%). 21% consulted more than one could recall the professional. antibiotic they were prescribed (20 78% of women consulting a HP were women), 9 were prescribed an antibiotic. This was 53% of prescribed an women with mastitis antibiotic “that was not consistent with 6out of the 57 women with mastitis (one in current practice ten) were inappropriately advised to either guidelines” (p5). stop breastfeeding from the affected breast, or altogether Kvist 2008 Descriptive Any mixture of Relationship between Five main bacterial species identified: These results 2 study. erythema (redness), bacteriological content of coagulase negative staphylococci (CNS); suggest that Sweden Breast milk from increased breast milk samples, clinical viridians streptococci, Staph aureus; group B division of 192 women with tension not relieved by symptoms, occurrence of streptococci (GBS) and Enterococcus mastitis into mastitis and breastfeeding, fever, abscess and recurring faecalis. CNS was identified significantly infective and non- 466 healthy pain and breast lumps symptoms more often in the milk of healthy controls, OR infective may not controls was = 0.60 (95% CI: 0.35, 0.91). Others more be feasible. examined. likely in cases were: viridans streptococci Using the WHO (OR: 1.43, 95% CI 1.02, 2.01); S aureus (OR: criteria (based on Data was 1.81, 95% CI: 1.29, 2.60); GBS (OR: 2.40, Thomsen) would collected during 95% CI 1.50, 3.71). have resulted in the RCT higher levels of described in GBS in breast milk was associated with antibiotic usage. other Kvist significant increase in number of contact days papers (see with clinic (=duration of symptoms) (t= -2.44, Authors suggest below) p = 0.02). Presence of other bacteria did not that daily contact affect contact days. with women is required to No significant correlation between bacterial ensure that counts of these 5 main species and maternal appropriate temperature, breast erythema, breast tension, antibiotic pain or severity at first contact. prescribing takes place. “It is 15% of case women received antibiotic important, in our therapy: there was no significant difference in opinion, that bacterial counts with other women with symptoms mastitis who did not receive antibiotics or improve within 24 between those with and without abscess. to 48 hours after initiation of care Many women with potential pathogens in their interventions.” breastmilk recovered spontaneously from (p6 of 7) mastitis or did not have any symptoms (control women). Increasing bacterial counts did not influence the clinical manifestation of mastitis. Amir, et al Descriptive At least two breast Incidence of mastitis in the 17.3% women in study experienced mastitis High rate of 2007 cohort study: symptoms (pain, first 6 months in first 6 months. breastfeeding 1193 women redness, lump) AND at (retrospective) • 15% in public hospital continuation in the Australia (primips) least one of fever or flu- Comparison of mastitis in • 23/24% in birth centre & private study sample (and like symptoms different segments of hospital Australia has Combination of population higher rates than data collected (only asked about NI). 3 during an RCT symptoms and did not 54% of episodes occurred in first 4 weeks, Hard to equate of breastfeeding ask about mastitis 71% in first 2 months and 83% in first three effect of different education, and directly) months. birthing venues a survey of two Factors associated with with NI/UK different birthing mastitis Nipple damage (pain and cracks) associated situation. venues with mastitis – may predict mastitis (OR 1.92, 95% CI 1.29, 2.86) (Nipple thrush Retrospective associated with phone follow up 2.9% of women taking antibiotics for mastitis mastitis – could be at 6 months – developed an abscess reverse causality single interview and not a predictive factor.) Kvist 2007 205 women Any mixture of Incidence estimated Estimated incidence of mastitis (taking who were in an erythema (redness), records of births locally and numbers of Sweden RCT of increased breast women referred for mastitis symptoms) treatment types tension not relieved by approx 6% (see table z) breastfeeding, fever, Associated factors 58.6% of cases experienced in first 4 weeks were also sent pain and breast lumps pp. a questionnaire No association between length of recovery More favourable time and initial fever outcome = ≤ 5 days symptoms; 36% of women with mastitis had damaged less favourable nipples. More women in ‘less favourable outcome = ≥6 days outcome group’ had damaged nipples OR = 2.70 (95% CI 1.40, 5.14) Use bottle / pacifier Use of nipple shield increased risk of may be marker for unfavourable outcome nipple trauma. NO association between mastitis and use of dummy/pacifier Potter 2005 Retrospective Any of: Incidence of mastitis Cumulative incidence 40% (95% CI, 25%, High incidence (at 6 months) • Temperature 37%) (higher than other UK population >38% 15% were sure they had had mastitis, 11% studies) explained survey (273 • Throbbing pain not sure as symptoms were not severe.. as not all women women) + follow in breast 7 out of 10 women managed an episode of sought help from up interviews • Breast painful Reasons for some women mastitis without consulting health care HPs. (10 out of 56 to touch being unsure if they had professionals. women who Wedge -shaped hot red mastitis, even if reported were willing) area of breast symptoms Peaks of incidence at 4 week and 12 weeks postpartum Wambach Descriptive Medical diagnosis Onset time Diagnosis any time from 1-36 weeks pp, Anticipatory 4 2003 study of 31 (scale of symptoms median of 3.5 weeks guidance about women developed by Symptoms Most localised symptoms in upper-outer, length of symptoms USA diagnosed with Fetherston used during Self-care lower-outer and upper-inner breast when women mastitis the study) quadrants. combine antibiotic Breast pain peaked in severity on days 1 and therapy with self- Daily phone All but one woman 2, breast warmth on days 1-3, redness days 2 help measures. calls until 7 received antibiotic & 3. 71% reported no pain by day 7. days post- therapy (and one Treatment (All but 1 received antibiotics) mastitis, then at woman received IV Continued breastfeeding most commonly 2 & 6 weeks antibiotics). Burden of mastitis (see followed advice – rated as most useful. Also after onset table Q) advised and found useful: analgesia, breast massage, hot packs, increased oral fluids, Most women extra rest, pumping, increasing breastfeeding completed 16% at 2 weeks and 19% at 6 weeks antibiotic course, Symptom reoccurrence experienced reoccurrence so reoccurrence 13% experienced symptoms for more than 7 not connected with complications days non-compliance. 10% had candidia infections (vaginal/breast) 5 Foxman 2002 Prospective: Self report of mastitis Incidence (to 12 weeks) Overall incidence = 9.5 % Authors say no 946 diagnosed by health • 8.1% one case difference in USA breastfeeding care provider • 1.3% two cases incidence if using women • 0.1% three cases symptoms to Lawrence (described symptoms: Highest in first few weeks, then fell. define. 2002 provides -breast tender 98% Describe treatment a - fever 82% Almost half changed breastfeeding practices Duration of commentary - malaise 87% 88% received medications (antibiotics, breastfeeding was on this study - chills 78% analgesics) not associated with - redness 78% mastitis.
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