CASTLE

CASTLE logo

Candida and Staph Transmission: Longitudinal Evaluation

about

What is the study about?

The CASTLE study was initiated to investigate the roles played by Candida and Staphylococcus aureus in nipple and breast pain among breastfeeding women.

Most women who are breastfeeding do not experience any breast infections. However about one woman in five will develop a breast infection, such as mastitis. At present, it is not known whether burning nipple pain associated with radiating breast pain is caused by a fungal infection (Candida albicans, known as "thrush") or a bacterial infection (Staphylococcus aureus, known as "Golden Staph"). Therefore the aim of the CASTLE study is to investigate the role of these micro-organisms in nipple and breast pain among breastfeeding women.

How are we doing this?

We recruited women who are planning to breastfeed at the Royal Women's Hospital and Frances Perry House. Women were recruited in late pregnancy and we obtained two swabs from the woman at this time point to get an indication of Candida and S. aureus colonisation before the birth. We followed the woman through until eight weeks after birth, taking nasal and nipple swabs and breast milk samples at five defined time points. We also obtained nasal and oral swabs from her baby. These swabs are used to detect the presence of Candida or Staphylococcus and allow us to track these microorganisms over time. We carried out this microbiological analysis in conjunction with questionnaires at each time point. These questionnaires ask specific questions relating to mothers' health and breastfeeding problems. Therefore we are using all of this information to address the role played by these microorganisms in nipple and breast pain.

researchers

Who are the researchers?

The Principal Investigator is Dr Lisa Amir, a General Practitioner, Lactation Consultant and Senior Research Fellow at Mother & Child Health Research, La Trobe University.

The Associate Investigators involved in CASTLE are Prof Suzanne Garland and A/Prof Sepehr Tabrizi from the Royal Women's Hospital, Prof Catherine Bennett from Deakin University and A/Prof Susan Donath from the Clinical Epidemiology and Biostatistics Unit (CEBU) at the Royal Children's Hospital.

Dr Matthew Payne was employed as the scientist for the CASTLE study. He is supervising the microbiological and molecular investigations associated with the project.

The CASTLE study is being co-ordinated at the Royal Women's Hospital and Frances Perry House by Dr Meabh Cullinane.

Publications

Amir LH, Cullinane M, Garland SM, Tabrizi SN, Donath SM, Bennett CM, Cooklin AR, Fisher JR, Payne MS. The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol. BMC Pregnancy Childbirth 2011; 11: 54. [This article is available online through the open access journal BMC Pregnancy and Childbirth]

Amir LH, Donath SM, Garland SM, Tabrizi SN, Bennett CM, Cullinane M, Payne MS. Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia. BMJ Open 2013; 3(3): e002351. [This article is available online through the open access journal BMJ Open.]

Buck M, Amir LH, Cullinane M, Donath SM, CASTLE study team. Nipple pain, damage and vasospasm in the first eight weeks postpartum. Breastfeed Medicine 2014; 9(1):56-62. Available from: http://online.liebertpub.com/doi/abs/10.1089/bfm.2013.0106?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Cooklin AR, Amir LH, Jarman J, Cullinane M, Donath SM, The CASTLE Study Team. Maternal physical health symptoms in the first 8 weeks postpartum among primiparous Australian women. Birth 2015; 42(3):254-60. Available from: http://dx.doi.org/10.1111/birt.12168

Buck ML, Amir LH, Donath SM. Topical treatments used by breastfeeding women to treat sore and damaged nipples. Clinical Lactation 2015; 6(1):16-23. Available from: http://dx.doi.org/10.1891/2158-0782.6.1.16

Payne MS, Cullinane M, Garland SM, Tabrizi SN, Donath SM, Bennett CM, Amir LH. Detection of Candida spp. in the vagina of a cohort of nulliparous pregnant women by culture and molecular methods: Is there an association between maternal vaginal and infant oral colonisation? Aust NZJ Obstet Gynaecol 2016; 56(2):179-84. Available from: http://dx.doi.org/10.1111/ajo.12409

Also a La Trobe University press release of March 2013 is available online.

more information

Who is funding the study?

This is an eighteen month project funded by the National Health and Medical Research Council of Australia (NHMRC).

Privacy and access to information

Information collected is kept confidential and the data will be used only for the purposes of this study. We have research ethics approval to conduct the CASTLE project.

For more information about the CASTLE study, please contact Dr Lisa Amir (l.amir@latrobe.edu.au) or Dr Meabh Cullinane (m.cullinane@latrobe.edu.au).