title: Staphylococcus aureus and sore nipples.
abstract: OBJECTIVE
  To correlate clinical symptoms and signs of sore nipples with the presence of Staphylococcus aureus and to determine the probability of mothers having S aureus-infected nipples when these local symptoms and signs are found.
  
  
  METHODS
  Two cohorts of consecutive patients were enrolled regardless of presenting complaint. A questionnaire was administered to determine the presence and severity of sore nipples. Objective findings on breast examination were documented. A nipple swab was taken for culture and sensitivity.
  
  
  METHODS
  Breastfeeding clinic serving patients referred by family physicians, pediatricians, and community health nurses.
  
  
  METHODS
  A sample of 227 breastfeeding mothers was collected in two cohorts.
  
  
  METHODS
  Answers to questions about sore nipples, objective findings from physical examination, and results from nipple swabs.
  
  
  RESULTS
  Most subjects (51%) had sore nipples, and 45% of subjects had objective findings on examination; 23% of subjects 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 nipple pain was moderate or severe rather than mild. A break in nipple integument associated with cracks, fissures, ulcers, or pus gave a 35% chance of having S aureus colonization, five times greater than when the integument was intact.
  
  
  CONCLUSIONS
  The study showed that mothers with infants younger than 1 month who complained of moderate to severe nipple 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 aureus colonization.
authors.affiliation: Department of Family Practice, University of British Columbia, USA.
authors.forename: V H
authors.initials: VH
authors.lastname: Livingstone
authors.forename: C E
authors.initials: CE
authors.lastname: Willis
authors.forename: J
authors.initials: J
authors.lastname: Berkowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D009558:Nipples / Q000382:microbiology*; D010146:Pain / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013207:Staphylococcal Skin Infections / Q000150:complications* / Q000382:microbiology; D013211:Staphylococcus aureus; D011795:Surveys and Questionnaires