Management of Mastitis in the Hospital Setting: An International Audit Study

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Public Health

Background:

• Breastfeeding is widely promoted by health authorities.
• Limited research exists on best-practice care for mastitis/breast abscess provided by health professionals.
• Understanding emergency department (ED) management is crucial for maternal health.

Purpose of the Study:

• To explore the management of mastitis and breast abscess in hospital emergency departments (EDs).
• To identify variations in diagnostic and treatment approaches across different countries.
• To highlight areas for improvement in lactational mastitis care.

Main Methods:

• Retrospective review of medical records from ED presentations in Australia, Brazil, Croatia, Germany, and Türkiye (2017-2023).
• Extraction and analysis of demographic, clinical, and management data for lactational mastitis/breast abscess.
• Comparison of diagnostic investigations (e.g., milk culture, ultrasound) and treatment strategies.

Main Results:

• 580 women with mastitis/breast abscess (646 ED presentations) were identified, primarily within 8 weeks postpartum.
• Most women experienced symptoms for over 48 hours before ED presentation.
• Significant international variation observed in milk culture use (44% in Australia), ultrasound use (5% in Croatia to 82% in Germany), and antibiotic prescribing patterns.

Conclusions:

• Management of mastitis/breast abscess in EDs shows considerable international variation.
• Current practices deviate significantly between countries, indicating a need for standardized care.
• Urgent development of international evidence-based guidelines for lactational mastitis management is required.