What are the key clinical features to differentiate between infectious and non-infectious mastitis in breastfeeding women?

Key clinical features differentiating infectious from non-infectious mastitis in breastfeeding women include:

• Infectious mastitis typically presents with localized breast pain, redness, swelling, and systemic symptoms such as fever and chills, indicating an active infection. The affected area may be warm and tender to touch. Symptoms usually respond to antibiotic treatment within 48 hours.
• Non-infectious mastitis may present with breast pain and inflammation but lacks systemic signs of infection such as fever or chills. It may be associated with nipple damage, skin conditions (e.g., eczema, psoriasis), or mechanical factors like poor infant attachment rather than bacterial infection.
• Failure to improve after appropriate antibiotic therapy suggests a non-infectious cause or alternative diagnosis such as breast abscess or malignancy, warranting further investigation and referral.
• Infectious mastitis is often associated with bacterial entry through nipple damage or skin lesions, whereas non-infectious mastitis may be related to milk stasis or inflammatory conditions without bacterial infection.

Therefore, the presence of systemic infection signs, response to antibiotics, and local signs of infection help differentiate infectious mastitis from non-infectious causes in breastfeeding women.

References: NICE CKS, NICE CKS, NICE CKS