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Staphylococcus aureus and sore nipples
V H Livingstone1, C E Willis, J Berkowitz
1Department of Family Practice, University of British Columbia, USA.
Objective:
To correlate clinical symptoms and signs of sore nipples with the presence of Staphylococcus aureus and to determine the probability of mothers having S aureus-infected nipples when these local symptoms and signs are found.
Design:
Two cohorts of consecutive patients were enrolled regardless of presenting complaint. A questionnaire was administered to determine the presence and severity of sore nipples. Objective findings on breast examination were documented. A nipple swab was taken for culture and sensitivity.
Setting:
Breastfeeding clinic serving patients referred by family physicians, pediatricians, and community health nurses.
Patients:
A sample of 227 breastfeeding mothers was collected in two cohorts.
Main Outcome Measures:
Answers to questions about sore nipples, objective findings from physical examination, and results from nipple swabs.
Results:
Most subjects (51%) had sore nipples, and 45% of subjects had objective findings on examination; 23% of subjects had a positive nipple swab culture; 15% grew S aureus on culture. The risk of having S aureus colonization was 4.8 times greater if nipple pain was moderate or severe rather than mild. A break in nipple integument associated with cracks, fissures, ulcers, or pus gave a 35% chance of having S aureus colonization, five times greater than when the integument was intact.
Conclusions:
The study showed that mothers with infants younger than 1 month who complained of moderate to severe nipple pain and who had cracks, fissures, ulcers, or exudates had a 64% chance of having positive skin cultures and a 54% chance of having S aureus colonization.