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

Abstract

Background: Breastfeeding is strongly promoted by health authorities, but there is little research on whether health professionals provide best-practice care for women experiencing mastitis/breast abscess.

Research aim: To explore management of mastitis/breast abscess in hospital emergency departments (EDs).

Methods: Medical records of patients presented to hospital EDs in Australia, Brazil, Croatia, Germany and Türkiye with lactational mastitis/abscess between 2017 and 2023 were reviewed. Demographic and clinical information (including symptoms, management, and investigations) was extracted and analyzed.

Results: A total of 580 women with mastitis/breast abscess (646 Emergency Department presentations, mostly in the first 8 weeks postpartum) were identified during the study period. The majority of the women had symptoms of mastitis/breast abscess (breast pain, lump, and inflammation) for > 48 hours before presenting in the Emergency Department. In Australia, culture and sensitivity testing of milk was available for 44% (146/331) of presentations. S. aureus was the most common bacteria isolated (33%, n = 48), of which 6% (n = 3) were methicillin-resistant. The use of diagnostic ultrasound varied between sites, from 5% (3/65) in Croatia to 82% (40/49) in Germany. Breast abscesses were mostly managed by ultrasound-guided aspiration in Australia, whereas incision and drainage was standard care in Germany. Amoxicillin/clavulanate was most commonly prescribed in Croatia (57%, 31/54) and Türkiye (69%, 28/42), whereas flucloxacillin, cephalexin, or cefuroxime was primarily used in Australia (86%, 272/322), Brazil (62%, 66/106), or Germany (80%, 33/41), respectively.

Conclusions: The management of mastitis/breast abscess varied considerably between countries. International evidence-based guidelines for the management of lactational mastitis are urgently needed.