Archives of Gynecology and Obstetrics

, Volume 300, Issue 6, pp 1637–1644 | Cite as

Puerperal mastitis in the past decade: results of a single institution analysis

  • J. LukassekEmail author
  • A. Ignatov
  • J. Faerber
  • S. D. Costa
  • H. Eggemann
General Gynecology



Although puerperal mastitis is a common disease, published data are poor. Increasing rates of community-acquired MRSA (CA-MRSA) cases are reported in the USA. However, information about common pathogens and CA-MRSA in Germany is still insufficient. The aim of this study was to investigate the most common pathogens of puerperal mastitis in the last decade, its therapy, resistance rate and the effectiveness of the current treatment strategies.


The pathogens, the respective antibiograms and the treatment strategies of patients treated for puerperal mastits at the University Clinic Magdeburg (Germany) between 2006 and 2016 were retrospectively reviewed. Statistical analysis was performed using SPSS Version 21.


In our series, 59 cases with puerperal mastitis were reviewed, 26 (44.1%) of these developed a breast abscess. In 37 of 59 (67.3%) cases the symptoms occurred in the first 8 weeks postpartum. The most common pathogens were Staphylococcus aureus (64.9%) and Coagulase-negative Staphylococcus (13.5%). Methicillin-resistant Staphylococcus aureus (MRSA) was found in one case. Of the 19 cases with Staphylococcus aureus, 17 were resistant to Penicillin. Conservative management was mainly performed with Flucloxacillin (60%), which was successful in most cases. Sixteen of 26 (61.5%) women with abscesses underwent ultrasound (US)-guided needle aspiration.


In this cohort, MRSA was not a main pathogen responsible for breast abscesses. Conservative treatment strategies remained constant during the observed period and Flucloxacillin was the most frequent antibiotic used. The analysis of the courses of diseases leads to the conclusion that surgical incision is progressively replaced by US-guided needle aspiration.


Lactational breast abscess MRSA Puerperal mastitis Ultrasound-guided needle aspiration 


Author contribution

J. Lukassek: data collection, statistical analysis, manuscript writing. A.Ignatov: data management, manuscript writing and editing.J. Faerber: data management, manuscript editing.S.D. Costa: manuscript editing. H. Eggemann: protocol development, data management, manuscript writing and editing.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest.

Ethical approval

Due to the retrospective design of the study ethical approval is not applicable.

Informed consent

Due to the retrospective design of the study an informed consent is not applicable.


  1. 1.
    World Health Organization (2000) Mastitis Causes and Management: 1–44Google Scholar
  2. 2.
    Amir LH, Della Forster A, Lumley J et al (2007) A descriptive study of mastitis in Australian breastfeeding women: incidence and determinants. BMC Public Health 7:62. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Stafford I, Hernandez J, Laibl V et al (2008) Community-acquired methicillin-resistant Staphylococcus aureus among patients with puerperal mastitis requiring hospitalization. Obstet Gynecol 112(3):533–537. CrossRefPubMedGoogle Scholar
  4. 4.
    Amir LH, Della Forster, McLachlan H et al. (2004) Incidence of breast abscess in lactating women: Report from an Australian cohort. BJOG: An Internal Journal of Obs Gyn 111(12): 1378–1381. CrossRefGoogle Scholar
  5. 5.
    Lee I-W, Kang L, Hsu H-P et al (2010) Puerperal mastitis requiring hospitalization during a nine-year period. Am J Obstet Gynecol 203(4):332.e1–332.e6. CrossRefGoogle Scholar
  6. 6.
    Cullinane M, Amir LH, Donath SM et al (2015) Determinants of mastitis in women in the CASTLE study: a cohort study. BMC Fam Pract 16:181. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Mediano P, Fernandez L, Rodriguez JM et al. (2014) Case-control study of risk factors for infectious mastitis in Spanish breastfeeding women. BMC Pregnancy ChildbirthGoogle Scholar
  8. 8.
    Betzold CM (2007) An update on the recognition and management of lactational breast inflammation. J Midwifery Womens Health 52(6):595–605. CrossRefPubMedGoogle Scholar
  9. 9.
    Yokoe DS, Christiansen CL, Johnson R et al (2001) Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis 7(5):837–841. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kvist LJ, Larsson BW, Hall-Lord ML et al (2008) The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment. Int Breastfeed J 3:6. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Branch-Elliman W, Lee GM, Golen TH et al (2013) Health and economic burden of post-partum Staphylococcus aureus breast abscess. PLoS ONE 8(9):e73155. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Reddy P, Qi C, Zembower T et al (2007) Postpartum mastitis and community-acquired methicillin-resistant Staphoylococcus aureus. Emerg Infect Dis 13(2):299–301CrossRefGoogle Scholar
  13. 13.
    Bodmann KF, Grabein B, Kresken M et al. S2 k Leitlinie Kalkulierte parenterale Initialtherapie bakterieller Erkrankungen bei Erwachsenen- Update 2018. Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG): 1–446Google Scholar
  14. 14.
    Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe S3 Therapie entzündlicher Bursterkrankungen in der StillzeitGoogle Scholar
  15. 15.
    Schwarz RJ, Shrestha R (2001) Needle aspiration of breast abscesses. Am J Surg 182(2):117–119. CrossRefPubMedGoogle Scholar
  16. 16.
    Ozseker B, Ozcan UA, Rasa K et al (2008) Treatment of breast abscesses with ultrasound-guided aspiration and irrigation in the emergency setting. Emerg Radiol 15(2):105–108. CrossRefPubMedGoogle Scholar
  17. 17.
    Ulitzsch D, Nyman MKG, Carlson RA (2004) Breast abscess in lactating women: uS-guided treatment. Radiology 232(3):904–909. CrossRefPubMedGoogle Scholar
  18. 18.
    O’Hara RJ, Dexter SPL (1996) Fox JN Conservative management of infective mastitis and breast abscesses after ultrasonographic assessment. Br J Surg 83:1413–1414CrossRefGoogle Scholar
  19. 19.
    Lee I-W, Kang L, Kuo P-L et al (2011) Puerperal breast abscess caused by oxacillin-resistant Staphylococcus aureus successfully treated by aspiration and antimicrobial therapy. Taiwan J Obstet Gynecol 50(2):233–235. CrossRefPubMedGoogle Scholar
  20. 20.
    Kataria K, Srivastava A, Dhar A (2013) Management of lactational mastitis and breast abscesses: review of current knowledge and practice. Indian J Surg 75(6):430–435CrossRefGoogle Scholar
  21. 21.
    Imperiale A, Zandrino F, Calabrese M, Parodi G, Massa T (2001) Abscesses of the breast US-guided serial percutaneous aspiration and local antibiotic therapy after unsuccessful systemic antibiotic therapy. Acta Radiologica. 42(2):161–165PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyOtto-von-Guericke UniversityMagdeburgGermany
  2. 2.Department of Medical Microbiology and Hospital Hygiene, Otto-von-Guericke UniversityMagdeburgGermany
  3. 3.NoerdlingenGermany

Personalised recommendations