The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol.

Lisa H Amir,Jane Rw Fisher,Suzanne M Garland,Meabh Cullinane,Susan M Donath,Catherine M Bennett,Sepehr N Tabrizi,Amanda R Cooklin,Matthew S Payne

doi:10.1186/1471-2393-11-54

Abstract

BackgroundThe CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study will investigate the micro-organisms involved in the development of mastitis and "breast thrush" among breastfeeding women. To date, the organism(s) associated with the development of breast thrush have not been identified. The CASTLE study will also investigate the impact of physical health problems and breastfeeding problems on maternal psychological health in the early postpartum period.Methods/DesignThe CASTLE study is a longitudinal descriptive study designed to investigate the role of Staphylococcus spp (species) and Candida spp in breast pain and infection among lactating women, and to describe the transmission dynamics of S. aureus and Candida spp between mother and infant. The relationship between breastfeeding and postpartum health problems as well as maternal psychological well-being is also being investigated. A prospective cohort of four hundred nulliparous women who are at least thirty six weeks gestation pregnant are being recruited from two hospitals in Melbourne, Australia (November 2009 to June 2011). At recruitment, nasal, nipple (both breasts) and vaginal swabs are taken and participants complete a questionnaire asking about previous known staphylococcal and candidal infections. Following the birth, participants are followed-up six times: in hospital and then at home weekly until four weeks postpartum. Participants complete a questionnaire at each time points to collect information about breastfeeding problems and postpartum health problems. Nasal and nipple swabs and breast milk samples are collected from the mother. Oral and nasal swabs are collected from the baby. A telephone interview is conducted at eight weeks postpartum to collect information about postpartum health problems and breastfeeding problems, such as mastitis and nipple and breast pain.DiscussionThis study is the first longitudinal study of the role of both staphylococcal and candidal colonisation in breast infections and will help to resolve the current controversy about which is the primary organism in the condition known as breast thrush. This study will also document transmission dynamics of S. aureus and Candida spp between mother and infant. In addition, CASTLE will investigate the impact of common maternal physical health symptoms and the effect of breastfeeding problems on maternal psychological well-being.

Highlights

The CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study will investigate the micro-organisms involved in the development of mastitis and “breast thrush” among breastfeeding women
Breastfeeding women may experience burning nipple/breast pain known as breast thrush which occurs in about 10% of breastfeeding women [9,10]
Specific aims of the study are: 1. To determine whether S. aureus and/or Candida spp are involved in burning nipple/breast pain in lactating women - the condition known as breast thrush using a longitudinal study for the first time; 2

Summary

Introduction

The CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study will investigate the micro-organisms involved in the development of mastitis and “breast thrush” among breastfeeding women. The World Health Organization and Australian authorities recommend that babies are exclusively breastfed for the first six months of life [1,2] During this time, and especially in the early weeks, breastfeeding women can experience a range of breastfeeding problems, in particular breast and nipple pain, or breast infections such as mastitis or “breast thrush”. Seventy five percent of mastitis episodes occur in the first seven weeks following birth [4] It is a painful, distressing condition which may require hospitalisation or lead to development of a breast abscess [5]. The suggestion that CNS such as S. epidermidis may be involved in infective mastitis highlights that, S. aureus is certainly one cause of mastitis, commensal skin flora which have previously been thought of as nonpathogenic, may be responsible for this illness in a proportion of breastfeeding women [7]

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