Prevalence of and Factors Associated With Lactational Mastitis in Eastern and Southern Africa: An Exploratory Analysis of Community-Based Household Surveys

BackgroundLactational mastitis is an extremely painful and distressing inflammation of the breast, which can seriously disrupt breastfeeding. Most of the evidence on the frequency of this condition and its risk factors is from high-income countries. Thus, there is a crucial need for more information on lactational mastitis and its associated factors in Sub-Saharan Africa (SSA).MethodsWe used data from representative, community-based cross-sectional household surveys conducted with 3,315 women from four countries (Ethiopia, Kenya, Malawi, and Tanzania) who reported ever-breastfeeding their last child born in the two years before the survey. We first estimated country-specific and pooled prevalence of self-reported lactational mastitis and examined mastitis-related breastfeeding discontinuation. Additionally, we examined factors associated with reporting mastitis in the pooled sample using bivariate and multivariable logistic regression accounting for clustering at the country level and post-stratification weights.ResultsThe prevalence of self-reported lactational mastitis ranged from 3.1% in Ethiopia to 12.0% in Kenya. Close to 17.0% of women who experienced mastitis stopped breastfeeding because of mastitis. The adjusted odds of self-reported lactational mastitis were approximately two-fold higher among women who completed at least some primary school compared to women who had no formal education. Study participants who delivered by caesarean section had 1.46 times higher odds of reporting lactational mastitis than women with a vaginal birth. Despite wide confidence intervals, our models also indicate that young women (15 – 24 years) and women who practiced prelacteal feeding had higher odds of experiencing lactational mastitis than older women (25+ years) and women who did not give prelacteal feed to their newborn. ConclusionThe prevalence of lactational mastitis in four countries of SSA might be somewhat lower than estimates reported from other settings. We found that lactational mastitis may result in breastfeeding discontinuation in approximately 1 in 5 woman-infant dyads affected by the condition. Factors such as younger age, higher education, caesarean section, and prelacteal feeding may be associated with experiencing mastitis. Further studies should explore the risk and protective factors for lactational mastitis in African contexts and address the negative consequences on breastfeeding.

Skin and soft tissue infection caused by Streptococcus pneumoniae: report of 15 cases

Background. Streptococcus pneumoniae is a very rare cause of skin and soft tissue infections (SSTI). The aim of this study was to determine the clinical and microbiological characteristics of these infections. Material and methods. The medical records of patients with SSTIs due to S. pneumoniae diagnosed at the University Hospital of Guadalajara between January 2012 and December 2020 were retrospectively reviewed. Microbiological identification was performed using conventional procedures. Antimicrobial sensitivity was performed using the MicroScan WalkAway-96 plus automatic system and E-test strips following the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Results. Fifteen cases of SSTIs were diagnosed. 73,3% of the cases presented underlying diseases, neoplasias being the most frequent. 60% of the cases presented predisposing factors, immunosuppression being the most common. The clinical presentations were: abscesses in different locations, ulcers, surgical wounds, lactational mastitis and necrotizing fasciitis. Polymicrobial infections were detected in 73.3% and the etiology was nosocomial in 6.6%. The clinical course was favorable in 90.9% of the cases. The antibiotics with the highest percentages of sensitivity against S. pneumoniae were cefotaxime, levofloxacin, vancomycin, linezolid and rifampicin. Conclusions. S. pneumoniae should be kept in mind as a possible causative agent of SSTIs, especially in patients with neoplasias and immunosuppression. Its involvement in infections such as lactational mastitis and necrotizing fasciitis should be highlighted. The clinical evolution is favorable in most patients, but it is important to pay special attention to cases of necrotizing fasciitis due to the severity of these infections.

ROLE OF MINI-INVASIVE SURGERY IN TREATMENT OF LACTATION MASTITIS

Introduction. Lactation mastitis is not a rear pathology. It is observed at every tenth parturient woman, mainly in the case of premature termination of breastfeeding. When analyzing the structure of postpartum purulent-inflammatory complications, most researchers report about high frequency lactational mastitis (in 26-67% cases). The technique of conducting wide incisions to drain the breast abscess and drug cessation of lactation was adopted to treat lactational abscess.Purpose. Specify the location for minimally invasive surgical techniques (puncture and drainage of the nidus of infection under ultrasound guidance) in the complex treatment of lactational abscesses of the mammary glands.Materials and methods. 64 parturient women suffering from verified lactation abscesses were observed. Average age of patients was 24,9±4,5 years (from 21 to 44). The research was carried out during 3 years: from 2018 to 2020. All patients were on outpatient treatment and under observation. Conservative and surgical (minimally invasive) methods of breast abscess treatment were applied. Puncture of the lactation abscess was carried out with a thick needle (18g «pink»), at the greatest distance from the areola, after expressing / feeding.Results. 41% of breast abscesses occurred during lactation up to 1 month, while in 34% of cases, the period of lactation was in the range from 1 to 3 months. In 16% of patients, an abscess formed during lactation from 3 to 7 months, in 7% of cases - from 7 to 18 months. Duration of breastfeeding was investigated at the 3rd day, 3rd week and 12th week after surgery. Breastfeeding was interrupted on women’s request. As a result we found out, that minimally invasive (puncture, drainage) surgical methods for treating breast abscesses should be prioritized at complex treatment programs for lactational mastitis.

O81: MAMMA: MASTITIS AND MAMMARY ABSCESS MANAGEMENT AUDIT

Presenting Author Email: [email protected] Research question Is there significant variation in the management of mastitis and breast abscesses between different hospitals in the UK and Ireland? Background and Aim Lactational mastitis affects a third of breastfeeding women, 11% of whom develop breast abscesses. Non-lactational mastitis affects 5-9% of women. Management of mastitis includes alleviation of milk stasis and antibiotics. Ultrasound-guided needle aspiration is the recommended method of treatment for breast abscesses. Despite guideline recommendations, there is evidence suggesting significant variation in practice, particularly concerning antibiotic prescribing, rates of incision and drainage and length of inpatient treatment. Considering that the majority of breast surgeons are no longer participating in the on-call roster and the acute presentation of primary breast infections, we hypothesise that such variation in practice indeed exists across the UK and Ireland, where patients are treated by non-breast specialist general surgeons. The aim of the MAMMA study is to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland and to provide recommendations for best practice. Design Patients: Inclusion criteria: all female patients over the age of 16 with symptoms of mastitis or breast abscess. Exclusion criteria: 1) male patients, 2) underlying breast cancer, 3) breast surgery within 90 days of presentation, 4) breast implant in situ on the ipsilateral side. Intervention / Comparator (or main explanatory variable in an observational study): The following guidelines will be used as audit standards: 1) WHO Mastitis Guidelines 2000, 2) GAIN Guidelines on the Treatment, Management & Prevention of Mastitis 2008, 3) ABM Clinical Protocol #4: Mastitis 2014, 4) NICE Clinical Knowledge Summaries: Mastitis and Breast Abscess MAMMA: Mastitis And Mammary abscess Management Audit Outcomes: Phase 1 will increase our understanding of the patient treatment pathways and ease of access to specialist breast services for patients with mastitis and breast abscesses. Phase 2 will collect prospective, real-time data on the management of mastitis and breast abscesses nationwide. Specifically, MAMMA will enable us to gather precise evidence on antibiotic prescribing, rate of operative versus radiological management, waiting time to ultrasound scan, rate of inpatient versus outpatient treatment, length of hospital stay and the rate of follow-up by breast surgeons. This highquality data will be instrumental in updating guidelines and help to standardise the management of mastitis and breast abscess across the UK and Ireland. Study design The study will be carried out in 3 phases with the support of a national trainee collaborative: 1) national practice survey, 2) prospective audit, 3) prospective re-audit. All acute hospitals that manage patients with mastitis and breast abscess will be invited to participate. All participating centres will be required to register this audit as per local protocol. All study data will be collected and managed using REDCap electronic data capture tool. Team and Infrastructure MAMMA National trainee collaborative will be established with the assistance of the Mammary Fold Academic and Research Committee and other regional research collaboratives. It will be the driving force behind this project. The trainee collaborative will be overseen by the MAMMA Steering Committee, convened from key stake-holders from a variety of medical and surgical specialties, allied health care professionals and patient representatives, who are directly involved in the management of patients with breast infections. MAMMA Study Management Group (SMG) will be responsible for audit management, data analysis, dissemination of results and drafting of publication. Regional trainee leads will represent each HEE region in the UK and Ireland and will be responsible for recruitment and coordination of local collaboratives; they will be directly accountable to the SMG. Local trainee collaboratives will consist of a local lead, maximum of two collaborators and one data validator. Further information is available on www.mammastudy.com.