Can mastitis lead to sepsis?

Mastitis Can Progress to Sepsis in Severe Cases

Yes, mastitis can progress to sepsis if left untreated or if treatment is inadequate, particularly in cases with bacterial infection that spreads systemically. Mastitis represents a spectrum of inflammatory conditions of the breast that can potentially lead to serious complications including sepsis.

Understanding Mastitis and Its Progression

Mastitis is an inflammatory condition of the breast that occurs in approximately 10% of breastfeeding women, typically within the first three months postpartum 1. The condition presents with:

• Focal breast tenderness
• Overlying skin erythema or hyperpigmentation
• Systemic symptoms (fever, malaise)
• Swollen, red, hot, and painful breast

Pathophysiology of Progression to Sepsis

Mastitis can progress along a continuum:

1. Initial inflammation: Often begins as milk stasis and inflammation
2. Bacterial infection: Commonly caused by Staphylococcus aureus or Streptococcus species
3. Localized infection: Confined to breast tissue
4. Systemic infection: When bacteria enter the bloodstream (bacteremia)
5. Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection 2

Risk Factors for Progression to Sepsis

Several factors increase the risk of mastitis progressing to sepsis:

• Delayed or inadequate treatment
• Immunocompromised status
• Virulent bacterial strains (including methicillin-resistant S. aureus)
• Formation of breast abscess
• Continued milk stasis without proper drainage

Clinical Signs of Mastitis Progressing to Sepsis

Watch for these warning signs that mastitis may be progressing to sepsis:

• Persistent high fever (>38.5°C/101.3°F)
• Severe systemic symptoms (extreme fatigue, confusion)
• Hypotension
• Tachycardia
• Tachypnea
• Signs of organ dysfunction

Management to Prevent Sepsis

Early Treatment of Mastitis

• Conservative measures (first 24-48 hours):
  • Continue breastfeeding (safe and recommended by the American Academy of Pediatrics) 3
  • NSAIDs for pain and inflammation
  • Ice application
  • Feeding directly from the affected breast
  • Minimize excessive pumping 1

Antibiotic Therapy

• If no improvement after 24-48 hours of conservative measures, antibiotics should be started
• Target common skin flora:
  • First-line: Dicloxacillin or cephalexin (effective against S. aureus) 4
  • Consider coverage for methicillin-resistant S. aureus if prevalent in the community

Monitoring Response

• Improvement should be seen within 48 hours of starting antibiotics
• If symptoms worsen or do not improve:
  • Consider ultrasound to rule out abscess
  • Obtain milk culture to guide antibiotic selection
  • Consider hospitalization for intravenous antibiotics 3

When to Hospitalize

Hospitalization with intravenous antibiotics should be considered when:

• Signs of sepsis are present
• Oral antibiotics fail
• Patient is immunocompromised
• Severe symptoms prevent adequate oral intake
• Breast abscess requiring drainage is present

Complications of Untreated Mastitis

• Breast abscess: Most common complication, requiring surgical drainage or needle aspiration 4
• Sepsis: Life-threatening condition requiring immediate medical attention
• Recurrent mastitis: Due to inadequate initial treatment

Prevention Strategies

• Proper breastfeeding technique with good infant latch
• Frequent, complete emptying of the breast
• Avoid excessive pumping and aggressive breast massage
• Prompt treatment of sore nipples (which can precipitate mastitis) 4
• Physiologic breastfeeding rather than pumping when possible 1

Key Takeaways

1. Mastitis is primarily an inflammatory condition but can involve bacterial infection
2. Without proper treatment, mastitis can progress to sepsis
3. Early recognition and appropriate treatment are essential to prevent complications
4. Continued breastfeeding during treatment is recommended and safe for the infant
5. Prompt medical attention for worsening symptoms can prevent progression to sepsis

Remember that while most cases of mastitis can be managed as outpatients with oral antibiotics, deterioration of symptoms or signs of sepsis require immediate medical attention and likely hospitalization for intravenous antibiotics and supportive care.