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Puerperal mastitis in the past decade: results of a single institution analysis
J Lukassek1,2, A Ignatov3, J Faerber4
1Department of Obstetrics and Gynaecology, Otto-von-Guericke University, Magdeburg, Germany. Julia.lukassek@gmx.de.
Purpose:
Although puerperal mastitis is a common disease, published data are poor. Increasing rates of community-acquired MRSA (CA-MRSA) cases are reported in the USA. However, information about common pathogens and CA-MRSA in Germany is still insufficient. The aim of this study was to investigate the most common pathogens of puerperal mastitis in the last decade, its therapy, resistance rate and the effectiveness of the current treatment strategies.
Methods:
The pathogens, the respective antibiograms and the treatment strategies of patients treated for puerperal mastits at the University Clinic Magdeburg (Germany) between 2006 and 2016 were retrospectively reviewed. Statistical analysis was performed using SPSS Version 21.
Results:
In our series, 59 cases with puerperal mastitis were reviewed, 26 (44.1%) of these developed a breast abscess. In 37 of 59 (67.3%) cases the symptoms occurred in the first 8 weeks postpartum. The most common pathogens were Staphylococcus aureus (64.9%) and Coagulase-negative Staphylococcus (13.5%). Methicillin-resistant Staphylococcus aureus (MRSA) was found in one case. Of the 19 cases with Staphylococcus aureus, 17 were resistant to Penicillin. Conservative management was mainly performed with Flucloxacillin (60%), which was successful in most cases. Sixteen of 26 (61.5%) women with abscesses underwent ultrasound (US)-guided needle aspiration.
Conclusion:
In this cohort, MRSA was not a main pathogen responsible for breast abscesses. Conservative treatment strategies remained constant during the observed period and Flucloxacillin was the most frequent antibiotic used. The analysis of the courses of diseases leads to the conclusion that surgical incision is progressively replaced by US-guided needle aspiration.
Insights
Puerperal mastitis in Germany is primarily caused by Staphylococcus aureus, with limited MRSA presence. Conservative treatment with Flucloxacillin is effective, and ultrasound-guided aspiration is replacing surgical incision for abscesses.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Clinical Microbiology
Background:
- Puerperal mastitis is a common postpartum complication with limited published data, especially regarding causative pathogens and antibiotic resistance in Germany.
- Increasing rates of community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) in the USA highlight the need for local data.
Purpose of the Study:
- To identify common pathogens causing puerperal mastitis over a decade in Germany.
- To analyze antibiotic resistance patterns and evaluate the effectiveness of current treatment strategies.
- To investigate the prevalence of CA-MRSA in puerperal mastitis cases.
Main Methods:
- Retrospective review of 59 puerperal mastitis cases treated at University Clinic Magdeburg (2006-2016).
- Analysis of pathogens, antibiograms, and treatment strategies.
- Statistical analysis using SPSS Version 21.
Main Results:
- Staphylococcus aureus (64.9%) and Coagulase-negative Staphylococcus (13.5%) were the most frequent pathogens.
- Methicillin-resistant Staphylococcus aureus (MRSA) was identified in only one case.
- Conservative management with Flucloxacillin was successful in most cases; ultrasound-guided needle aspiration was increasingly used for abscesses.
Conclusions:
- MRSA was not a primary pathogen in this cohort of puerperal mastitis.
- Conservative treatment with Flucloxacillin remains a consistent and effective strategy.
- Ultrasound-guided needle aspiration is progressively replacing surgical incision for breast abscesses.
