Neonatal Mastitis and Concurrent Serious Bacterial Infection

Abstract

OBJECTIVES Describe the clinical presentation, prevalence, and outcomes of concurrent serious bacterial infection (SBI) among infants with mastitis. METHODS Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants aged ≤90 days with mastitis who were seen in the emergency department between January 1, 2008, and December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized. RESULTS Among 657 infants (median age 21 days), 641 (98%) were well appearing, 138 (21%) had history of fever at home or in the emergency department, and 63 (10%) had reported fussiness or poor feeding. Blood, urine, and cerebrospinal fluid cultures were collected in 581 (88%), 274 (42%), and 216 (33%) infants, respectively. Pathogens grew in 0.3% (95% confidence interval [CI] 0.04–1.2) of blood, 1.1% (95% CI 0.2–3.2) of urine, and 0.4% (95% CI 0.01–2.5) of cerebrospinal fluid cultures. Cultures from the site of infection were obtained in 335 (51%) infants, with 77% (95% CI 72–81) growing a pathogen, most commonly methicillin-resistant Staphylococcus aureus (54%), followed by methicillin-susceptible S aureus (29%), and unspecified S aureus (8%). A total of 591 (90%) infants were admitted to the hospital, with 22 (3.7%) admitted to an ICU. Overall, 10 (1.5% [95% CI 0.7–2.8]) had sepsis or shock, and 2 (0.3% [95% CI 0.04–1.1]) had severe cellulitis or necrotizing soft tissue infection. None received vasopressors or endotracheal intubation. There were no deaths. CONCLUSIONS In this multicenter cohort, mild localized disease was typical of neonatal mastitis. SBI and adverse outcomes were rare. Evaluation for SBI is likely unnecessary in most afebrile, well-appearing infants with mastitis.

La mastite neonatale

“…Non è raccomandata la spremitura manuale che può essere un ulteriore fattore di rischio per l'ascessualizzazione del processo infettivo [1]. Raramente la mastite si associa a sintomi sistemici o a gravi complicanze (cellulite, fascite necrotizzante, osteomielite, sepsi e ascesso cerebrale) [7]. Nel sospetto di una mastite in un neonato in buone condizioni generali, anche se febbrile, non è indicata l'esecuzione dell'emocoltura e della rachicentesi che risultano, nella gran parte dei casi, negative.…”

“…Nel sospetto di una mastite in un neonato in buone condizioni generali, anche se febbrile, non è indicata l'esecuzione dell'emocoltura e della rachicentesi che risultano, nella gran parte dei casi, negative. Queste indagini saranno riservate ai pazienti che presentino sintomi e segni di interessamento sistemico suggestivi per sepsi e/o meningoencefalite [2,5,7]. La sensazione tattile di un'area di fluttuazione non richiede necessariamente ulteriori indagini ecografiche, non aggiungendo generalmente informazioni tali da modificare il percorso diagnostico e terapeutico.…”