Mastitis puerperal

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Óscar Alejandro Bonilla Sepúlveda

Resumen

La mastitis puerperal es un problema de salud importante en el posparto, la incidencia varía del 2% al 33%. Se define como la inflamación de los lóbulos glandulares, siendo la infección la etiología más frecuente y el puerperio, en las primeras semanas, el periodo de mayor prevalencia. La mayoría de las mujeres experimentan algún grado de congestión mamaria, al preparar la glándula para la eyección láctea durante el amamantamiento, pero cuando la técnica es inadecuada y lleva a fisuras del pezón, se genera riesgo de colonización bacteriana de los ductos mamarios con sobreinfección e, incluso, formación de abscesos, que van a requerir manejo hospitalario, antibioticoterapia e intervenciones quirúrgicas. Es esta la causa más importante de suspensión de la lactancia y su repercusión en la alimentación y desarrollo del recién nacido. No hay uniformidad en los criterios y el diagnóstico sigue siendo fundamentalmente clínico. El microrganismo más implicado es el estafilococo, su confirmación microbiológica se hace a partir del Gram y cultivo del drenaje de abscesos o de cultivos de leche, siendo estos, pocas veces realizados, a menos que el cuadro se complique con repercusión sistémica (sepsis) o no haya respuesta a la antibioticoterapia empírica. El tratamiento fundamental es el drenaje del seno, por lo que debe mantenerse la lactancia.

Palabras clave:
mastitis, breast, infection, abscess mastitis, mama, absceso mastite, mama, abscesso

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Referencias

OMS. Mastitis: causas y manejo. Ginebra: WHO/FCH/CAH; 2000. [Acceso: 26 de julio de 2016]. Disponible en:http://apps.who.int/iris/bitstream/10665/66925/1/WHO_FCH_CAH_00.13_spa.pdf.

Amir L. Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #4: mastitis. Breastfeed Med 2014;9(5):239-243.

Amir LH, Forster DA, Lumley J, McLachlan H. A descriptive study of mastitis in Australian breastfeeding women: Incidence and determinants. BMC Public Health. 2007;7:62.

Foxman B, D’Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: Occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol. 2002;155(2):103-114.

Mediano P, Fernández L, Rodríguez JM, Marín M. Case control study of risk factors for infectious mastitis in Spanish breastfeeding women. BMC Pregnancy Childbirth. 2014;14:195.

Barbosa-Cesnik C, Schwartz K, Fozman B. Lactation mastitis. JAMA 2003;289(13):1609-1612.

Scott JA, Robertson M, Fitzpatrick J, Knight C, Mulholland S. Occurrence of lactational mastitis and medical management: A prospective cohort study in Glasgow. Int Breastfeed J. 2008;25:3-21.

Michie C, Lockie F, Lynn W. The challenge of mastitis. Arch Dis Child. 2003;88(9):818-821.

Lawrence RA, Lawrence RM. Protocolo 4: Mastitis. En: Lawrence RA, Lawrence RM, eds. Lactancia materna, una guía para la profesión médica. 6 ed. Madrid: Elsevier; 2007:1142-1146.

Jiménez E, Fernández L, Maldonado A, Martín R, Olivares M, Xaus J, et al. Oral administration of Lactobacillus strains isolated from breast milk as an alternative for the treatment of infectious mastitis during lactation. Appl Environ Microbiol. 2008;74(15):4650-4655.

Civardi E, Garofoli F, Tzialla C, Paolillo P, Bollani L, Stronati M. Microorganisms in human milk: Lights and shadows. J Matern Fetal Neonatal Med. 2013;26(Suppl 2):30-34.

Jonsson S, Pulkkinen MO. Mastitis today: Incidence, prevention and treatment. Ann Chir Gynaecol. 1994;Suppl 208:84-87.

Betzold CM. An update on the recognition and management of lactational breast inflammation. J Midwifery Womens Health. 2007;52(6):595-605.

Spencer JP. Management of mastitis in breastfeeding women. Am Fam Phys. 2008;78(6):727-731.

Delgado S, Arroyo R, Jiménez E, Marín ML, del Campo R, Fernández L, et al. Staphylococcus epidermidis strains isolated from breast milk of women suffering infectious mastitis: Potential virulence traits and resistance to antibiotics. BMC Microbiol 2009;9:82-93.

Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Cochrane Database Syst Rev 2013;2:CD005458.

Contreras GA, Rodríguez JM. Mastitis: Comparative etiology and epidemiology. J Mammary Gland Biol Neoplasia. 2011;16(4):339-356.

Amir LH, Forster D, McLachlan H, Lumley J. Incidence of breast abscess in lactating women: Report from an Australian cohort. Br J Obstet Gynaecol. 2004;111:1378-1381.

Lawrence RA, Lawrence RM. Complicaciones médicas en la madre. En: Lawrence RA, Lawrence RM eds. Lactancia maternal, una guía para la profesión médica. 6 ed. Madrid: Elsevier; 2007:615-692.

Moazzez A, Kelso RL, Towfigh S, Sohn H, Berne TV, Mason RJ. Breast abscess bacteriologic features in the era of community- acquired methicillin-resistant Staphylococcus aureus epidemics. Arch Surg. 2007;142:881-884.

Fernández L, Arroyo R, Espinosa I, Marín M, Jiménez E, Rodríguez JM. Probiotics for human lactational mastitis. Benef Microb. 2014;5(2):169-183.

Tratado de obstetricia y ginecología SEGO. 13ª ed. Barcelona: Panamericana; 2013.

DNPAO. National Center for Chronic Disease Prevention and Health Promotion. Infant Feeding Practices Survey II: Results. Centers for Disease Control and Prevention. 2009. Disponible en: http://www.cdc.gov/ifps/results/ch2/table2-37.htm.

McClellan HL, Hepworth AR, Garbin CP, Rowan MK, Deacon J, Hartmann PE, et al. Nipple pain during breastfeeding with or without visible trauma. J Hum Lact. 2012;28:511-521.

Fetherston C. Risk factors for lactation mastitis. J Hum Lact. 1998;14:101-109.

World Health Organization. Mastitis: Causes and management. Geneva: World Health Organization; 2000.

Mediano P, Fernández L, Rodríguez JM, Marín M. Case-control study of risk factors for infectious mastitis in Spanish breastfeeding women. BMC Pregnancy Childbirth. 2014;14:195.

Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-490.

West PA, Hewitt JH, Murphy OM. The influence of methods of collection and storage on the bacteriology of human milk. J Appl Microbiol. 1979;46(2):269-277.

Patel SH, Vaidya YH, Patel RJ, Pandit RJ, Joshi CG, Kunjadiya AP. Culture independent assessment of human milk microboal community in lactational mastitis. Sci Rep. 2017;7:7804.

Heikkila MP, Saris PE. Inhibition of Staphylococcus aureus by the commensal bacteria of human milk. J Appl Microbiol. 2003;95(3):471-478.

Murphy K, Curley D, O’Callaghan TF, O’Shea C-A, Dempsey EM, O’Toole PW et al. The Composition of human milk and infant faecal microbiota over the first three months of life: A pilot study. Sci Rep. 2017;7:40597.

Serafini AB, André MC, Rodrigues MA, Kipnis A, Carvalho CO, Campos MR, et al. Qualidade microbiológica de leite humano obtido em banco de leite. Rev Saúde Pública. 2003;37:775-779.

Martín R, Jiménez E, Heilig H, Fernández L, Marín ML, Zoetendal EG, et al. Isolation of bifidobacteria from breast milk and assessment of the bifidobacterial population by PCRdenaturing gradient gel electrophoresis and quantitative real-time PCR. Appl Environ Microbiol. 2009;75:965-969.

Martín V, Maldonado-Barragán A, Moles L, Rodríguez-Banõs M, del Campo R, Fernández L, et al. Sharing of bacterial strains between breast milk and infant feces. J Hum Lact. 2012;28:36-44.

Jost T, Lacroix C, Braegger CP, Rochat F, Chassard C. Vertical mother-neonate transfer of maternal gut bacteria via breastfeeding. Environ Microbio. 2014;16(9):2891-2904.

Latuga MS, Stuebe A, Seed PC. A review of the source and function of microbiota in breast milk. Semin Reprod Med. 2014;32:68-73.

Fernandez L, Langa S, Martın V, et al. The human milk microbiota: Origin and potential roles in health and disease. Pharmacol Res. 2013;69:1-10.

Department of Child and Adolescent Health and Development. Mastitis: Causes and management. Geneva, Switzerland: World Health Organization; 2000. http:// whqlibdoc.who. int/hq/2000/WHO_FCH_CAH_00.13. pdf. Accessed June 15, 2008.

Wambach KA. Lactation mastitis: A descriptive study of the experience. J Hum Lact. 2003;19(1):24-34.

Osterman KL, Rahm VA. Lactation mastitis: Bacterial cultivation of breast milk, symptoms, treatment, and outcome. J Hum Lact. 2000;16(4):297-302.

Arroyo R, Mediano P, Jiménez E, Delgado S, Fernández L, Marín M, et al. Diagnóstico etiológico de las mastitis infecciosas: propuesta de protocolo para el cultivo de muestras de leche humana. Acta Pediatr Esp. 2011;69:276-281.

Delgado S, Arroyo R, Jiménez E, Fernández L, Rodríguez JM. Mastitis infecciosas durante la lactancia: un problema infravalorado (I). Acta Pediatr Esp. 2009;67:77-84.

Jiménez E, Delgado S, Arroyo R, Fernández L, Rodríguez JM. Mastitis infecciosas durante la lactancia: un problema infravalorado (II). Acta Pediatr Esp. 2009;67:125-132.

Kayıran PG, Can F, Kayıran SM, Ergonul O, Gürakan B. Transmission of methicillin-sensitive Staphylococcus aureus to a preterm infant through breast milk. J Matern Fetal Neonatal Med. 2014;27(5):527-529.

Jawa G, Hussain Z, Da Silva O. Recurrent late-onsetgroup B Streptococcus sepsis in a preterm infant acquired by expressed breastmilk transmission: A case report. Breastfeed Med. 2013;8(1):134-136.

Aldea-Mansilla C, García de Viedma D, Cercenado E, Martin- Rabadán P, Marín M, Bouza E. Comparison of phenotypic with genotypic procedures for confirmation of coagulase-negative Staphylococcus catheter-related blood-stream infections. J Clin Microbiol. 2006;44:3529-3532.

Trop I, Dugas A, David J, El Khoury M, Boileau JF, Larouche N, et al. Breast abscesses: Evidencebased algorithms for diagnosis, management, and follow-up. Radiographics. 2011;31:1683-1699.

Hook GW, Ikeda DM. Treatment of breast abscesses with US-guided percutaneous needle drainage withoutind welling catheter placement. Radiology. 1999;213:579-582.

Ulitzsch D, Nyman MK, Carlson RA. Breast abscess in lactating women: US-guided treatment. Radiology. 2004;232:904-909.

Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L. Reasons for earlier than desired cessation of breastfeeding. Pediatrics. 2013;131:e726-e732.

Dennis CL, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database Syst Rev. 2014;12:CD007366.

Mangesi L, Dowswell T. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev. 2010;8:CD006946.

Arroyo R, Martín V, Maldonado A, Jiménez E, Fernández L, Rodríguez JM. Treatment of infectious mastitis during lactation: antibiotics versus oral administration of lactobacilli isolated from breast milk. Clin Infect Dis 2010;50:1551-1558.

Brockway M, Benzies K, Hayden KA. Interventions to improve breastfeeding self-efficacy and resultant breastfeeding rates: A systematic review and meta-analysis. J Hum Lact. 2017;33(3):486-499.

Betzold C. Results of microbial testing exploring the etiology of deep breast pain during lactation: A systematic review and meta-analysis of nonrandomized trials. J Midwifery Womens Health. 2012;57(4):353-364.

Betzold C. An update on the recognition and management of lactational breast inflammation. J Midwifery Womens Health. 2007;52(6):595-605.

Cusack L, Brennan M. Lactational mastitis and breast abscess, diagnosis and management in general practice. Aus Fam Physician. 2011;40(12):976-979.

Kataria K, Srivastava A, Dhar A. Management of lactational mastitis and breast abscesses: Review of current knowledge and practice. Indian J Surg. 2013;75(6):430-435.

Montalto M, Lui B. MRSA as a cause of postpartum breast abscess in infant and mother. J Hum Lact. 2009;25(4):448-450.

Barbosa-Cesnik C, Schwartz K, Foxman B. Lactation mastitis. JAMA 2003;289:1609-1612.

Ozseker B, Ozcan UA, Rasa K, Cizmeli OM. Treatment of breast abscesses with ultrasound-guided aspiration and irrigation in the emergency setting. Emerg Radiol. 2008;15(2):105-108.