In the XX century. , before the use of antibiotics and in the early years of penicillin, the main causative agents of acute lactational mastitis were equally streptococcus and staphylococcus aureus. In the 1960s, streptococcus became the dominant cause of this disease (60.0-70.0% of cases), staphylococcus already caused the development of mastitis in approximately 25.0% of patients.
Later, as a result of known causes, antibiotic-resistant strains of staphylococcus and other microflora. The most important feature of staphylococcus was its fastest ability to produce an enzyme penicillinase (P-lactamase), which neutralizes penicillin. Soon this ability manifested itself in many other antibiotics. In the 70-80s, pathogenic staphylococcus was sown from a purulent focus with lactational mastitis in 95-100%, and in 90-98% of cases in the form of monoculture and much less often - in association with another flora: Pseudomonas aeruginosa and Escherichia coli, streptococcus, proteus and etc.
In the study of pus of 872 patients obtained during the operation, we isolated S. aureus in monoculture in 90.8% of cases, and in association with another microflora in 2.5% of cases.
In addition to staphylococcus, purulent mastitis can sometimes cause opportunistic gram-negative bacteria, the role of which has significantly increased in recent years. Staphylococci, which cause purulent mastitis, almost 100% of cases were insensitive to penicillin, streptomycin, tetracycline, levomycetin and many other antibacterial drugs. Moreover, this microbe is characterized by multidrug resistance to 3-6 antibiotics, including those currently used in wide clinical practice. It should also be added that in the vast majority of cases, staphylococci have all the signs of pronounced pathogenicity, and some of its components (protein A, teichoic acid) have a significant immunodepressive effect.
Most authors believe that the immediate source of infection of the breast is a newborn that transmits a mother infection when applied to the breast. The child is infected from medical personnel, care items, linen. A cross-infection is possible: the transfer of pathogenic staphylococci from mother to child and then again to the mother.
It is believed that the entrance gates of an infection that causes lactational mastitis can be the mouth of the milk ducts, cracks and excoriation of the nipples, various lesions of the skin of the breast or genitals. Depending on the source of infection, it is spread by galactogenic, lymphogenic and hematogenous pathways. When a significant contamination of the mammary glands is combined with pathogenic and opportunistic flora with some other unfavorable factors, the threat of mastitis. Such adverse factors are lactostasis, pathology of pregnancy, childbirth, the postpartum period, various concomitant diseases.
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