Bacteriological findings and clinical symptoms in relation to clinical outcome in puerperal mastitis.

Clinical symptoms, bacterial content in breast milk and treatment were recorded in 43 women in Oslo with puerperal mastitis. Patients with a favorable (n = 35) and unfavorable outcome (n = 8) (defined as abscess formation and/or symptom relief after more than 7 days) were compared. The group with unfavorable outcome was characterized by increased delay between symptoms and time for consultation, higher score of clinical symptoms and higher frequency of Staphylococcus aureus. A higher frequency of S. aureus was found in the affected breasts than in the unaffected breasts. There was no difference concerning the frequency of coagulase-negative staphylococci and overall bacterial counts, either between milk from affected and non-affected breasts, or between milk from non-affected breasts and milk from healthy donors. The present investigation indicates that penicillin treatment is questionable when considering that untreated cases healed almost as quickly as treated ones, and that 70% of the S. aureus strains were resistant to phenoxymethylpenicillin. It is concluded that present bacterial examinations in breast milk are of limited help in deciding who needs antibiotic treatment.