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Infection may be due to entry of disease-producing germs through cracks in the nipple. Most commonly, the offending microorganism is Staphylococcus aureus. Other predisposing factors include blocked milk ducts (from a tight bra or prolonged intervals between breastfeedings) and an incomplete let-down reflex (possibly related to emotional trauma). Infection begins in one lobule but may extend to other areas.
The woman complains of breast swelling and tenderness and shooting pains during and between feedings, in addition to fever, headache, and malaise. A triangular flush underneath the affected breast is an early sign. Abnormal vital signs include fever and tachycardia.
Heat should be applied locally; appropriate antibiotics, such as beta-lactamase–stable penicillins, are prescribed; and analgesics are given for discomfort. Although symptoms usually are relieved after 2 to 3 days of antibiotic therapy, treatment should be continued for 10 days. Frank abscesses require incision and drainage; pumping the breasts may be recommended to avoid engorgement and maintain lactation.
Health care professionals should encourage mothers to get adequate rest and hydration. Patient teaching emphasizes personal hygiene, breast care, wearing a supportive bra, and feeding the infant frequently to empty the breast. The mother is taught to recognize early signs of potential infection such as nipple redness and cracking. The patient and infant should be isolated from other nursing mothers and other infants to prevent spreading the infection, and the mother taught always to wash her hands before touching her breast and after feeding. The mother should be reassured that breast-feeding during mastitis will not harm her infant. The affected breast should be offered first to promote complete emptying and prevent clogged ducts. If an open abscess necessitates not feeding from this breast, it should be pumped until the abscess heals, while the mother continues feeding from the unaffected breast. The application of warm, wet towels to the affected breast or taking a warm shower should be suggested. Adequate fluid intake and rest should be encouraged. See: breastfeeding