{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:28:12Z","timestamp":1786418892831,"version":"build-2736575974"},"reference-count":28,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2013,6,21]],"date-time":"2013-06-21T00:00:00Z","timestamp":1371772800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Breastfeeding Medicine"],"published-print":{"date-parts":[[2014,1,1]]},"abstract":"Abstract<\/jats:title>\n \n Background:<\/jats:title>\n \n An infectious etiology for chronic breast pain in breastfeeding women continues to be debated. Although recent data suggest that\n Staphylococcus aureus<\/jats:italic>\n and coagulase-negative\n Staphylococcus<\/jats:italic>\n (CNS) may cause chronic breast pain, no studies have used quantitative cultures to address this question. In this study we compared bacterial species and colony counts between breastfeeding women with (cases) and without (controls) chronic pain.\n <\/jats:p>\n <\/jats:sec>\n \n Subjects and Methods:<\/jats:title>\n \n We enrolled 114 breastfeeding women in a prospective cohort study. Cases (\n n<\/jats:italic>\n =61), breastfeeding women with breast pain for >1 week and no signs of acute infection, were matched with controls (\n n<\/jats:italic>\n =53) by weeks postpartum and parity.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n More cases had a history of mastitis (14% vs. 2%,\n p<\/jats:italic>\n =0.036), cracked nipples (64% vs. 17%,\n p<\/jats:italic>\n =0.001), and other breastfeeding difficulties.\n Enterobacter<\/jats:italic>\n species growth was less likely in cases (0% vs. 7.5%,\n p<\/jats:italic>\n =0.029). Cases had a significantly higher growth of\n S. aureus<\/jats:italic>\n (19.7% vs. 1.9%,\n p<\/jats:italic>\n =0.003). CNS frequency was similar between groups (75% vs. 79%,\n p<\/jats:italic>\n =0.626), but median colony count growth was significantly lower in cases (900 colony-forming units\/mL vs. 5,000 colony-forming units\/ml,\n p<\/jats:italic>\n =0.003). Growth of CNS and\n S. aureus<\/jats:italic>\n was negatively correlated (\n r<\/jats:italic>\n =\u20130.265,\n p<\/jats:italic>\n =0.004).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n Higher\n S. aureus<\/jats:italic>\n growth in cases supports a pathogenic role for\n S. aureus<\/jats:italic>\n and reinforces the need for future antibiotic treatment studies in breastfeeding women with chronic pain. In contrast, similar CNS frequency between groups, lower CNS colony counts in cases, and a negative correlation between\n S. aureus<\/jats:italic>\n and CNS growth suggest that neither CNS, nor its overgrowth, causes chronic breast pain.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1089\/bfm.2013.0012","type":"journal-article","created":{"date-parts":[[2013,6,21]],"date-time":"2013-06-21T09:40:37Z","timestamp":1371807637000},"page":"29-34","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":29,"title":["A Case Control Study of Bacterial Species and Colony Count in Milk of Breastfeeding Women with Chronic Pain"],"prefix":"10.1177","volume":"9","author":[{"given":"Ann","family":"Witt","sequence":"first","affiliation":[{"name":"Case Western Reserve University"},{"name":"Breastfeeding Medicine of Northeast Ohio"},{"name":"Senders Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Jane","family":"Mason","sequence":"additional","affiliation":[{"name":"Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Burgess","sequence":"additional","affiliation":[{"name":"Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Flocke","sequence":"additional","affiliation":[{"name":"Case Western Reserve University"},{"name":"Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Zyzanski","sequence":"additional","affiliation":[{"name":"Case Western Reserve University"},{"name":"Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2013,6,21]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-3552"},{"key":"e_1_3_3_3_2","unstructured":"AAFP breastfeeding policy statement. 2012. www.aafp.org\/online\/en\/home\/policy\/policies\/b\/breastfeedingpolicy.html (accessed December18 2012)."},{"key":"e_1_3_3_4_2","unstructured":"World Health Organization. Breastfeeding. www.who.int\/topics\/breastfeeding\/en\/ (accessed December18 2012)."},{"key":"e_1_3_3_5_2","first-page":"439","article-title":"Factors associated with weaning in the first 3 months postpartum","volume":"51","author":"Schwartz K","year":"2002","unstructured":"Schwartz K, , D'Arcy H, , Gillespie B, et al. Factors associated with weaning in the first 3 months postpartum. 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Can Fam Physician, 1996; 42:654\u2013659.","journal-title":"Can Fam Physician"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/089033449901500315"},{"key":"e_1_3_3_14_2","first-page":"191","article-title":"Bacterial pathogens isolated from nipple wounds: A four-year prospective study [abstract 34]","volume":"2","author":"Saenz R","year":"2007","unstructured":"Saenz R. Bacterial pathogens isolated from nipple wounds: A four-year prospective study [abstract 34]. Breastfeed Med, 2007; 2:191.","journal-title":"Breastfeed Med"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2008.9993"},{"key":"e_1_3_3_16_2","volume-title":"Mastitis: Causes and management","author":"World Health Organization","year":"2000","unstructured":"World Health Organization. Mastitis: Causes and management. Publication number WHO\/FCH\/CAH\/100.13. World Health Organization, Geneva, 2000."},{"key":"e_1_3_3_17_2","first-page":"570","article-title":"Painful nipples in nursing mothers: Fungal or staphylococal?: A preliminary study","volume":"32","author":"Graves S","year":"2003","unstructured":"Graves S, , Wright W, , Harman R, et al. Painful nipples in nursing mothers: Fungal or staphylococal?: A preliminary study. Aust Fam Physician, 2003; 32:570\u2013571.","journal-title":"Aust Fam Physician"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1542-2011.2011.00136.x"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/1746-4358-3-6"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2011.13"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.97.4.492"},{"key":"e_1_3_3_22_2","first-page":"550","article-title":"Patterns of bacterial colonization of human milk","volume":"53","author":"Eidelman A","year":"1979","unstructured":"Eidelman A, , Szilagyi G. 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