STAPHYLOCOCCUS-AUREUS AND SORE NIPPLES

OBJECTIVE To correlate clinical symptoms and signs of sore nipples wit h the presence of Staphylococcus aureus and to determine the probabili ty of mothers having S aureus-infected nipples when these local sympto ms and signs are found. DESIGN Two cohorts of consecutive patients wer e enrolled regardless of presenting complaint. A questionnaire was adm inistered to determine the presence and severity of sore nipples. Obje ctive findings on breast examination were documented. A nipple swab wa s taken for culture and sensitivity SETTING Breastfeeding clinic servi ng patients referred by family physicians, pediatricians, and communit y health nurses. PATIENTS A sample of 227 breastfeeding mothers tvas c ollected in two cohorts. MAIN OUTCOME MEASURES Answers to questions ab out sore nipples, objective findings from physical examination, and re sults from nipple swabs. RESULTS Most subjects (51%) had sore nipples, and 45% of subjects had objective findings on examination 23% of subj ects had a positive nipple swab culture; 15% grew S aureus on culture. The risk of having S aureus colonization was 4.8 times greater if nip ple pain was moderate or severe rather than mild. A break in nipple in tegument associated with cracks, fissures, ulcers, or pus gave a 35% c hance of having S aureus colonization, five limes greater than when th e integument was intact. CONCLUSIONS The study showed that mothers wit h infants younger than 1 month who complained of moderate to severe ni pple pain and who had cracks, fissures, ulcers, or exudates had a 64% chance of having positive skin cultures and a 54% chance of having S a ureus colonization.