The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment.
The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment.
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DOI：
10.1186/1746-4358-3-6
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发表时间：
2008-04-07
影响因子：
3.5
通讯作者：
Schalén C
中科院分区：
文献类型：
--
作者：
Kvist LJ;Larsson BW;Hall-Lord ML;Steen A;Schalén C
细菌病原体在哺乳期乳腺炎中的作用尚不清楚。本研究的目的是比较乳腺炎女性和健康母乳捐献者母乳中的细菌种类，并评价抗生素治疗的使用、乳腺炎症状、医疗保健接触次数、乳房脓肿发生率、乳头受损和复发症状与细菌计数的关系。在这项描述性研究中，对192名乳腺炎妇女（称为病例）和466名母乳捐献者（称为对照）的母乳进行了细菌学检查，并使用分析统计进行了比较。还进行了统计分析，以测试细菌含量和临床症状之间的关系，如量表、抗生素处方、护理接触次数、乳房脓肿发生率和复发症状。在病例组和对照组中均发现5种主要细菌：凝固酶阴性葡萄球菌（CNS）、草绿色链球菌、金黄色葡萄球菌（S。金黄色葡萄球菌）、B族链球菌（GBS）和粪肠球菌。乳腺炎患者中，S。健康妇女乳汁中金黄色葡萄球菌和GBS的检出率为31%，金黄色葡萄球菌和10%有GBS。有没有显着的相关性之间的细菌计数和乳腺炎的症状，衡量规模。开药和未开药的患者或有和没有乳腺脓肿的患者的细菌计数没有差异。母乳中的GBS与医疗保健接触增加相关（p = 0.02）。母乳中CNS或草绿色链球菌≥ 107 cfu/L的女性乳头受损的几率增加（p = 0.003）。许多健康的母乳喂养妇女在母乳中有潜在的致病细菌。细菌计数增加并不影响乳腺炎的临床表现;因此，母乳中的细菌计数在决定使用抗生素治疗时可能价值有限，因为母乳细菌培养的结果可能难以解释。这些结果表明，将乳腺炎分为感染性或非感染性形式实际上可能不可行。每日随访以测量症状的消退可以帮助发现那些需要抗生素的人。
The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts. In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms. Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 107 cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003). Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.