1 INTRODUCTION
Acute mastitis is a common problem during breastfeeding, and it is
estimated that approximately one in five breastfeeding women has
experienced acute mastitis.1-3 Mastitis episodes are
often characterized by rapid progression with local redness and breast
pain and are accompanied by systemic symptoms, including fever,
headache, nausea, vomiting, etc. Unlike mastitis sufferers abroad who
get medical help from community, mastitis sufferers in mainland China
often receive medical help from physicians in the hospital, and most of
them have to go to the emergency department (ED) because of high fever,
intolerable pain and fear of breastfeeding cessation.
The underlying causes of acute mastitis include stress, over nutrition,
overreliance on breast pumps, and a lack of breastfeeding experience.
Two direct causes of acute mastitis, milk stasis and bacterial
infection, are important and determine the treatment
strategies.4,5 Conservative treatments, the purpose of
which is to relieve milk stasis and that include hot or cold compresses,
acupuncture and the application of cabbage leaves, have been
demonstrated to be inconclusive for managing milk
stasis.6 Numeroud literature showed that therapeutic
breast massage was helpful for emptying the breast and relieving milk
stasis.7-9 Antibiotic targeting pathogenic organism is
theoretically useful for eliminating inflammation and decreasing abscess
formation. However, in some situations, acute mastitis is just an
inflammatory condition, and there is no pathogenic bacterial infection.
Therefore, conservative treatments seem adequate, and the additional use
of antibiotics may be unnecessary in such situations.
In practice, although the role of conservative treatments for relieving
milk stasis is inconclusive, the following treatments are still
important for acute mastitis: breast massage for emptying the breast,
ibuprofen for analgesia, a hot compress applied prior to breastfeeding
for stimulating milk flow, and a cool compress applied after
breastfeeding for reducing swelling and pain. In addition, oral or
intravenous flucloxacillin is preferred for mastitis episodes that need
antibiotics, and clindamycin is chosen for the patient who is allergic
to penicillin. If the signs and symptoms improve within 24-48 hours in
patients who are prescribed antibiotics, a total duration of five to
seven days is encouraged; if the signs and symptoms are not improved or
are even worse, antibiotics with different mechanisms are started
immediately, and human milk is collected for cultivation and sensitivity
tests.4
Two inflammatory markers, serum leukocyte counts (SLCs) and C-reactive
protein (CRP), are widely used in acute inflammatory diseases, such as
acute appendicitis and cholecystitis. However, the associations between
these two inflammatory markers and infectious diseases are complex, and
few studies focusing on these two inflammatory markers and acute
mastitis have been reported. Osterman K et al. conducted a prospective
study to compare serum SLCs and CRP among 41 episodes of lactation
mastitis.10 Bacterial cultivation of breast milk was
performed in all patients, and patients were classified into two groups
based on the presence of potentially pathogenic bacteria: group A
without potentially pathogenic bacteria and group B with potentially
pathogenic bacteria. They found that the mean SLCs were significantly
higher in group B than in group A; however, although the levels of CRP
in both groups were elevated, there was no significant difference
between the two groups.10
A positive relationship between higher SLCs and the presence of
potentially pathogenic bacteria indicates that mastitis with higher SLCs
is more likely to be infectious disease and should be treated with the
addition of antibiotics as well as conservative treatments. However, no
relative study has been performed since then. Therefore, the purpose of
our study was to describe the clinical characteristics, treatment
regimens and treatment outcomes of acute mastitis in breastfeeding women
and to further explore the value of SLCs for initial antibiotic use in
breastfeeding women with acute mastitis in mainland China.