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Journal of Human Lactation : Official... Nov 2020Lactational mastitis is a maternal morbidity that affects the wellbeing of women and their babies, including through breastfeeding discontinuation.
BACKGROUND
Lactational mastitis is a maternal morbidity that affects the wellbeing of women and their babies, including through breastfeeding discontinuation.
RESEARCH AIM
To systematically review the available global literature on the frequency of lactational mastitis, and to summarize the evidence on risk factors for lactational mastitis. We also describe gaps in the evidence and identify priority areas for future research.
METHODS
We systematically searched and screened 6 databases and included 26 articles, conducted meta-analysis of disease frequency, and narratively synthesized evidence on risk factors.
RESULTS
In 11 (42%) articles researchers reported a measure of disease frequency; 5 (19%) reported risk factors, and 10 (39%) included both. Overall, the quality of studies was low, related to suboptimal measurement of disease frequency, high risk of bias, reverse causality, and incomplete adjustment for confounding. Meta-analysis was based on 3 studies (pooled incidence between birth and Week 25 postpartum: 11.1 episodes per 1,000 breastfeeding weeks; 95% CI [10.2-12.0]); with high heterogeneity across contexts and highest incidence in the first four weeks postpartum. Researchers assessed 42 potential risk factors; nipple damage was the most frequently studied and strongly associated with mastitis. There was a scarcity of studies from low-resource settings.
CONCLUSIONS
Lactational mastitis is a common condition, but the wide variability in incidence across contexts suggested that a substantial portion of this burden might be preventable. Provision of care to breastfeeding women at risk for or affected by mastitis is currently constrained due to a critical lack of high quality epidemiological evidence about its incidence and risk factors.
Topics: Adult; Breast Feeding; Female; Humans; Incidence; Infant; Lactation; Mastitis; Mothers; Risk Factors
PubMed: 32286139
DOI: 10.1177/0890334420907898 -
Frontiers in Veterinary Science 2020The literature contains an extensive panel of studies focusing on the costs of animal diseases. The losses of an agriculture holding can be influenced by many factors...
The literature contains an extensive panel of studies focusing on the costs of animal diseases. The losses of an agriculture holding can be influenced by many factors since farming is a complex system and diseases are closely interrelated. Meta-analysis can be used to detect effects (i.e., change in clinical mastitis losses here) across studies and to identify factors that may influence those effects. This includes the external validity of the published study results with regard to the input parameters and the internal validity of the study, particularly how other diseases related to the target disease were accounted for. Mixed-effect meta-regressions were performed to estimate the mean clinical mastitis losses per case across the literature and to elucidate to what extent clinical mastitis losses are influenced by (i) general factors, such as etiology; (ii) the types of losses that contribute to the total mastitis losses; and (iii) prices. In total, 82 observations from nine studies were included in the meta-analysis to assess mean clinical mastitis losses per case. The multivariate meta-regression showed that etiology significantly influenced the clinical mastitis loss per case. The mean loss was determined to be €224 per case for all published etiologies. In detail, mean losses equalled €457 and €101 per case of clinical mastitis due to gram-negative and gram-positive bacteria, respectively, and €428 and €74 per case of clinical mastitis due to and , respectively. Additionally, the mean loss obtained depended on whether diagnostic costs and reduced feed intake in cases of mastitis were included in the clinical mastitis loss calculation. The monetary values of labor cost, drug cost and culling cost, as well as treatment price (all included), significantly influenced the clinical mastitis losses per case. All other tested moderators were not associated with mastitis losses, highlighting the need for more standardized economic studies, for both methods and ways results are presented, and suggesting that the mastitis losses assessed in the literature cannot be extrapolated (limited external validity). Although meta-analyses are useful to overview the burden of diseases across studies, their ability to summarize extensive literature with various economic assessments is limited. These limitations in loss assessments also suggest the need to focus on management strategies rather than on pure monetary estimations of disease costs, at least for production diseases at the farm level.
PubMed: 32258070
DOI: 10.3389/fvets.2020.00149 -
Breast Care (Basel, Switzerland) Feb 2020Granulomatous lobular mastitis (GLM) is infrequently diagnosed. This study aimed to evaluate the efficacy and safety of managements for GLM in the nonlactation period.
OBJECTIVE
Granulomatous lobular mastitis (GLM) is infrequently diagnosed. This study aimed to evaluate the efficacy and safety of managements for GLM in the nonlactation period.
METHODS
Publications were retrieved from PubMed, EMBASE, and the Cochrane library on September 10, 2018. We pooled and compared the outcome parameters and complete remission (CR) rates between different treatments using a meta-analysis.
RESULTS
Twenty-one publications including 970 patients treated with surgical excision, steroids, abscess drainage, antibiotics, and observation were included. Surgery significantly improved CR rate compared with steroids ( = 0.0003). There was no difference in the CR rate in patients treated with surgery alone or combined with steroids ( = 0.28). Surgery showed borderline significant efficacy in the CR rate compared with antibiotics ( = 0.06) and abscess drainage ( = 0.06). No difference was observed in effectiveness between observation and surgical management in patients diagnosed with early GLM and mild symptoms.
CONCLUSIONS
Although surgery was the ideal management for GLM, steroids and antibiotics might be ideal managements for GLM patients who are worried about surgical scars. Observation was an impressive alternative for patients with early GLM.
PubMed: 32231499
DOI: 10.1159/000501498 -
Animal Health Research Reviews Dec 2019A systematic review and network meta-analysis were conducted to assess the relative efficacy of internal or external teat sealants given at dry-off in dairy cattle.... (Meta-Analysis)
Meta-Analysis
A systematic review and network meta-analysis were conducted to assess the relative efficacy of internal or external teat sealants given at dry-off in dairy cattle. Controlled trials were eligible if they assessed the use of internal or external teat sealants, with or without concurrent antimicrobial therapy, compared to no treatment or an alternative treatment, and measured one or more of the following outcomes: incidence of intramammary infection (IMI) at calving, IMI during the first 30 days in milk (DIM), or clinical mastitis during the first 30 DIM. Risk of bias was based on the Cochrane Risk of Bias 2.0 tool with modified signaling questions. From 2280 initially identified records, 32 trials had data extracted for one or more outcomes. Network meta-analysis was conducted for IMI at calving. Use of an internal teat sealant (bismuth subnitrate) significantly reduced the risk of new IMI at calving compared to non-treated controls (RR = 0.36, 95% CI 0.25-0.72). For comparisons between antimicrobial and teat sealant groups, concerns regarding precision were seen. Synthesis of the primary research identified important challenges related to the comparability of outcomes, replication and connection of interventions, and quality of reporting of study conduct.
Topics: Animals; Antacids; Anti-Bacterial Agents; Bismuth; Cattle; Female; Mammary Glands, Animal; Mastitis, Bovine; Network Meta-Analysis
PubMed: 32081124
DOI: 10.1017/S1466252319000276 -
Animal Health Research Reviews Dec 2019A systematic review and network meta-analysis were conducted to assess the relative efficacy of antimicrobial therapy for clinical mastitis in lactating dairy cattle.... (Meta-Analysis)
Meta-Analysis
A systematic review and network meta-analysis were conducted to assess the relative efficacy of antimicrobial therapy for clinical mastitis in lactating dairy cattle. Controlled trials in lactating dairy cattle with natural disease exposure were eligible if they compared an antimicrobial treatment to a non-treated control, placebo, or a different antimicrobial, for the treatment of clinical mastitis, and assessed clinical or bacteriologic cure. Potential for bias was assessed using a modified Cochrane Risk of Bias 2.0 tool. From 14775 initially identified records, 54 trials were assessed as eligible. Networks were established for bacteriologic cure by bacterial species group, and clinical cure. Disparate networks among bacteriologic cures precluded meta-analysis. Network meta-analysis was conducted for trials assessing clinical cure, but lack of precision of point estimates resulted in wide credibility intervals for all treatments, with no definitive conclusions regarding relative efficacy. Consideration of network geometry can inform future research to increase the utility of current and previous work. Replication of intervention arms and consideration of connection to existing networks would improve the future ability to determine relative efficacy. Challenges in the evaluation of bias in primary research stemmed from a lack of reporting. Consideration of reporting guidelines would also improve the utility of future research.
Topics: Animals; Anti-Bacterial Agents; Cattle; Female; Lactation; Mastitis, Bovine; Network Meta-Analysis
PubMed: 32081123
DOI: 10.1017/S1466252319000318 -
Animal Health Research Reviews Dec 2019A systematic review and network meta-analysis were conducted to assess the relative efficacy of antimicrobial therapy given to dairy cows at dry-off. Eligible studies... (Meta-Analysis)
Meta-Analysis
Comparative efficacy of antimicrobial treatments in dairy cows at dry-off to prevent new intramammary infections during the dry period or clinical mastitis during early lactation: a systematic review and network meta-analysis.
A systematic review and network meta-analysis were conducted to assess the relative efficacy of antimicrobial therapy given to dairy cows at dry-off. Eligible studies were controlled trials assessing the use of antimicrobials compared to no treatment or an alternative treatment, and assessed one or more of the following outcomes: incidence of intramammary infection (IMI) at calving, incidence of IMI during the first 30 days in milk (DIM), or incidence of clinical mastitis during the first 30 DIM. Databases and conference proceedings were searched for relevant articles. The potential for bias was assessed using the Cochrane Risk of Bias 2.0 algorithm. From 3480 initially identified records, 45 trials had data extracted for one or more outcomes. Network meta-analysis was conducted for IMI at calving. The use of cephalosporins, cloxacillin, or penicillin with aminoglycoside significantly reduced the risk of new IMI at calving compared to non-treated controls (cephalosporins, RR = 0.37, 95% CI 0.23-0.65; cloxacillin, RR = 0.55, 95% CI 0.38-0.79; penicillin with aminoglycoside, RR = 0.42, 95% CI 0.26-0.72). Synthesis revealed challenges with a comparability of outcomes, replication of interventions, definitions of outcomes, and quality of reporting. The use of reporting guidelines, replication among interventions, and standardization of outcome definitions would increase the utility of primary research in this area.
Topics: Animals; Anti-Bacterial Agents; Cattle; Female; Infections; Lactation; Mastitis, Bovine; Network Meta-Analysis
PubMed: 32081120
DOI: 10.1017/S1466252319000239 -
Animal Health Research Reviews Dec 2019A systematic review and meta-analysis were conducted to determine the efficacy of selective dry-cow antimicrobial therapy compared to blanket therapy (all quarters/all... (Meta-Analysis)
Meta-Analysis
A systematic review and meta-analysis were conducted to determine the efficacy of selective dry-cow antimicrobial therapy compared to blanket therapy (all quarters/all cows). Controlled trials were eligible if any of the following were assessed: incidence of clinical mastitis during the first 30 DIM, frequency of intramammary infection (IMI) at calving, or frequency of IMI during the first 30 DIM. From 3480 identified records, nine trials were data extracted for IMI at calving. There was an insufficient number of trials to conduct meta-analysis for the other outcomes. Risk of IMI at calving in selectively treated cows was higher than blanket therapy (RR = 1.34, 95% CI = 1.13, 1.16), but substantial heterogeneity was present (I2 = 58%). Subgroup analysis showed that, for trials using internal teat sealants, there was no difference in IMI risk at calving between groups, and no heterogeneity was present. For trials not using internal teat sealants, there was an increased risk in cows assigned to a selective dry-cow therapy protocol, compared to blanket treatment, with substantial heterogeneity in this subgroup. However, the small number of trials and heterogeneity in the subgroup without internal teat sealants suggests that the relative risk between treatments may differ from the determined point estimates based on other unmeasured factors.
Topics: Animals; Anti-Bacterial Agents; Cattle; Female; Lactation; Mammary Glands, Animal; Mastitis, Bovine
PubMed: 32081118
DOI: 10.1017/S1466252319000306 -
Animal Health Research Reviews Jun 2019Use of antimicrobial approaches at drying-off for preventing new intramammary infections (IMI) during the dry period in dairy cows could be replaced by non-antimicrobial... (Meta-Analysis)
Meta-Analysis
Non-antimicrobial approaches at drying-off for treating and preventing intramammary infections in dairy cows. Part 1. Meta-analyses of efficacy of using an internal teat sealant without a concomitant antimicrobial treatment.
Use of antimicrobial approaches at drying-off for preventing new intramammary infections (IMI) during the dry period in dairy cows could be replaced by non-antimicrobial approaches. Such approaches would be of interest not only for organic but also for conventional dairy producers. The objective of the current review was to quantify the effect of non-antimicrobial internal teat sealant (ITS)-based approaches at drying-off for treating and preventing IMI, when compared with no treatment or with an antimicrobial-based approach. The protocol for this review was published before initiating the review. A total of 18 trials from 16 articles could be used to investigate the effect of an ITS-based approach. With the available results, we conclude with a high level of confidence that non-antimicrobial ITS-based dry-off approaches are efficient for preventing new IMI during the dry period when compared with no treatment, and would reduce risk of new IMI by 52%. Moreover, we are relatively confident that a bismuth subnitrate-based ITS performed better than an antimicrobial for preventing new IMI during the dry period (a risk reduction of 23%). Similarly, we are relatively confident that an ITS-based approach would only slightly or not at all reduce the prevalence of IMI at calving compared with untreated quarters.
Topics: Animals; Antacids; Anti-Bacterial Agents; Bismuth; Cattle; Female; Lactation; Mammary Glands, Animal; Mastitis, Bovine
PubMed: 31895023
DOI: 10.1017/S1466252319000070 -
Journal of Dairy Science Feb 2020A systematic review was conducted to elucidate the role of teat-end hyperkeratosis (THK) as a risk factor for clinical mastitis (CM) or subclinical mastitis (SCM)....
A systematic review was conducted to elucidate the role of teat-end hyperkeratosis (THK) as a risk factor for clinical mastitis (CM) or subclinical mastitis (SCM). Scientific papers on the subject were identified by means of a database search. All types of peer-reviewed analytical studies, observational or experimental and published in English, could be included in the review, regardless of publication year. Of 152 identified records, 18 articles were selected, of which 8 were prospective cohort studies, 9 were cross-sectional, and 1 was a hybrid case-control study. Internal validity of studies was assessed using a score system ranging from 0 to 6, based on design, risk of bias, and statistical methods. The most frequent study limitation was improper use of statistical methods to avoid confounding of associations between THK and CM or SCM. The 3 studies that used CM as outcome (all with high validity scores) showed positive associations with THK (especially severe), although the magnitude and statistical significance of the estimates differed among them. Most studies that used SCM as the primary outcome (based on microbiological examination of milk) reported that only severe THK was associated with SCM. Two studies with high validity scores reported moderate to strong associations between severe THK and incidence or prevalence of Staphylococcus aureus intramammary infection. Two studies with high validity scores reported that only severe THK was associated with the risk of somatic cell count (SCC) ≥200,000 cells/mL and increased mean SCC, respectively. Although 4 cross-sectional studies reported positive associations between THK and SCC, these associations were possibly spurious because confounding factors, such as parity, were not considered in the analyses. Results of the reviewed studies suggest that severe THK is a risk factor for both CM and SCM, as defined by microbiological examination of milk, SCC thresholds, or mean SCC. The effect of severe THK on both contagious (especially Staphylococcus aureus) and environmental CM or SCM emphasizes the importance of teat health for mastitis control. Four studies demonstrated that quarters with mild THK had lower prevalence of intramammary infection or lower mean SCC than quarters with no THK, suggesting that development of mild THK, as a physiological response to milking, can have a protective effect. Dairy consultants should focus on monitoring and minimizing occurrence of severe THK to prevent CM and SCM.
Topics: Animals; Callosities; Case-Control Studies; Cattle; Cell Count; Cross-Sectional Studies; Dairying; Female; Keratosis; Mammary Glands, Animal; Mastitis, Bovine; Milk; Pregnancy; Prevalence; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus
PubMed: 31759610
DOI: 10.3168/jds.2019-16811 -
The Breast Journal Nov 2019Idiopathic granulomatous mastitis is a rare benign breast disease. A systematic review was designed. Clinical and therapeutic characteristics were analyzed. Human...
Idiopathic granulomatous mastitis is a rare benign breast disease. A systematic review was designed. Clinical and therapeutic characteristics were analyzed. Human Development Index (HDI) was used to define two groups of study: group A (very high and high HDI) and group B (medium and low HDI). Corticosteroid therapy was done in 69% group A and 78% group B. Surgery was done in 63% in group A and 83% in group B. Antibiotics were used in 68% group A and 88% group B. There is no consensus about optimal treatment for granulomatous mastitis.
Topics: Female; Granulomatous Mastitis; Humans; Patient Care Management; Treatment Outcome
PubMed: 31273861
DOI: 10.1111/tbj.13446