Is Mastitis a Puerperal Infection?
Yes, mastitis is classified as a puerperal infection when it occurs during the postpartum/breastfeeding period, though the term "puerperal mastitis" specifically refers to lactational mastitis occurring after delivery.
Definition and Classification
- Puerperal mastitis is defined as a staphylococcal infection of the lactating breast that typically peaks during the third and fourth week after delivery 1
- The condition represents a spectrum of inflammatory conditions, with lactational mastitis being the most common form, affecting approximately 10% of breastfeeding women in the United States 2
- Most cases occur within the first 3 months postpartum, with the highest concentration of risk in the early postpartum period 3, 2
Infectious Etiology
- The primary causative organism is Staphylococcus aureus, which is why first-line antibiotic therapy targets this pathogen 4, 5
- Less commonly, Streptococcus pyogenes can cause severe puerperal mastitis with invasive disease and abscess formation 6
- The infection typically occurs via bacterial transmission through the infant's nasopharynx to the nipple and milk ducts 1
Clinical Context as a Puerperal Complication
- Puerperal mastitis is three times more common after hospital delivery than home delivery, reflecting bacterial hospitalism patterns 1
- The cumulative incidence in the first seven weeks postpartum is approximately 2.9% to 11.1 episodes per 1,000 breastfeeding weeks 3, 7
- When fever and chills are present, this indicates systemic involvement and warrants close monitoring, with hospitalization considered for worsening symptoms or concern for sepsis 4
Important Distinction
- While puerperal mastitis occurs during the postpartum period, mastitis can also occur antepartum (during pregnancy), though this is uncommon 8
- Mastitis rarely occurs in non-nursing women, further establishing its connection to the puerperal/lactation state 1
Treatment Approach Specific to Puerperal Context
- The American Academy of Pediatrics recommends continued breastfeeding or milk expression, appropriate antibiotic therapy targeting Staphylococcus aureus, and drainage of any abscesses for inpatient treatment of puerperal mastitis 4
- Approximately 10% of mastitis cases progress to breast abscesses requiring drainage 4
- Discontinuing breastfeeding during treatment can worsen the condition and increase abscess risk 5