Download PDF
Am J Perinatol 2013; 30(02): 125-130
DOI: 10.1055/s-0032-1333134
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Methicillin-Resistant Staphylococcus aureus in Obstetrics

Jeanne S. Sheffield
1   Division, Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations
Further Information

Publication History

16 August 2012

09 November 2012

Publication Date:
04 January 2013 (online)

    Permissions and Reprints

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the major multiple antibiotic-resistant bacterial pathogens causing serious community-associated and health care-associated infections. It is now pervasive in the obstetric population associated with skin and soft tissue infections, mastitis, episiotomy, and cesarean wound infections and urinary tract infections. This review addresses the epidemiology, definitions, microbiology, and pathogenesis as well as common clinical presentations. A discussion of the 2011 Infectious Diseases Society of America MRSA treatment guidelines details available antibiotics, invasive and noninvasive MRSA management, and specific factors related to obstetrics. Finally, prevention strategies including decolonization are discussed.

Keywords

MRSA - methicillin resistance - antibiotic resistance - CA-MRSA
 

  • References

  • 1 von Eiff C, Becker K, Machka K, Stammer H, Peters G. Study Group. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001; 344: 11-16
    CrossrefPubMedGoogle Scholar
  • 2 Kluytmans JA, Wertheim HF. Nasal carriage of Staphylococcus aureus and prevention of nosocomial infections. Infection 2005; 33: 3-8
    PubMedGoogle Scholar
  • 3 Simor AE. Staphylococcal decolonisation: an effective strategy for prevention of infection?. Lancet Infect Dis 2011; 11: 952-962
    CrossrefPubMedGoogle Scholar
  • 4 Wertheim HFL, Verveer J, Boelens HAM, van Belkum A, Verbrugh HA, Vos MC. Effect of mupirocin treatment on nasal, pharyngeal, and perineal carriage of Staphylococcus aureus in healthy adults. Antimicrob Agents Chemother 2005; 49: 1465-1467
    CrossrefPubMedGoogle Scholar
  • 5 Gorwitz RJ, Kruszon-Moran D, McAllister SK , et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001–2004. J Infect Dis 2008; 197: 1226-1234
    CrossrefPubMedGoogle Scholar
  • 6 Klevens RM, Morrison MA, Nadle J , et al; Active Bacterial Core surveillance (ABCs) MRSA Investigators. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298: 1763-1771
    CrossrefPubMedGoogle Scholar
  • 7 Butterly A, Schmidt U, Wiener-Kronish J. Methicillin-resistant Staphylococcus aureus colonization, its relationship to nosocomial infection, and efficacy of control methods. Anesthesiology 2010; 113: 1453-1459
    CrossrefPubMedGoogle Scholar
  • 8 Cosgrove SE, Qi Y, Kaye KS, Harbarth S, Karchmer AW, Carmeli Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005; 26: 166-174
    CrossrefPubMedGoogle Scholar
  • 9 de Kraker ME, Wolkewitz M, Davey PG , et al; BURDEN Study Group. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother 2011; 55: 1598-1605
    CrossrefPubMedGoogle Scholar
  • 10 David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010; 23: 616-687
    CrossrefPubMedGoogle Scholar
  • 11 Chua T, Moore CL, Perri MB , et al. Molecular epidemiology of methicillin-resistant Staphylococcus aureus bloodstream isolates in urban Detroit. J Clin Microbiol 2008; 46: 2345-2352
    CrossrefPubMedGoogle Scholar
  • 12 Seybold U, Kourbatova EV, Johnson JG , et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006; 42: 647-656
    CrossrefPubMedGoogle Scholar
  • 13 Stefani S, Chung DR, Lindsay JA , et al. Meticillin-resistant Staphylococcus aureus (MRSA): global epidemiology and harmonisation of typing methods. Int J Antimicrob Agents 2012; 39: 273-282
    CrossrefPubMedGoogle Scholar
  • 14 Moran GJ, Krishnadasan A, Gorwitz RJ , et al; EMERGEncy ID Net Study Group. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006; 355: 666-674
    CrossrefPubMedGoogle Scholar
  • 15 Tong SYC, Chen LF, Fowler Jr VG. Colonization, pathogenicity, host susceptibility, and therapeutics for Staphylococcus aureus: what is the clinical relevance?. Semin Immunopathol 2012; 34: 185-200
    CrossrefPubMedGoogle Scholar
  • 16 Top KA, Huard RC, Fox Z , et al. Trends in methicillin-resistant Staphylococcus aureus anovaginal colonization in pregnant women in 2005 versus 2009. J Clin Microbiol 2010; 48: 3675-3680
    CrossrefPubMedGoogle Scholar
  • 17 Andrews WW, Schelonka R, Waites K, Stamm A, Cliver SP, Moser S. Genital tract methicillin-resistant Staphylococcus aureus: risk of vertical transmission in pregnant women. Obstet Gynecol 2008; 111: 113-118
    CrossrefPubMedGoogle Scholar
  • 18 Creech CB, Litzner B, Talbot TR, Schaffner W. Frequency of detection of methicillin-resistant Staphylococcus aureus from rectovaginal swabs in pregnant women. Am J Infect Control 2010; 38: 72-74
    CrossrefPubMedGoogle Scholar
  • 19 Beigi RH. Clinical implications of methicillin-resistant Staphylococcus aureus in pregnancy. Curr Opin Obstet Gynecol 2011; 23: 82-86
    CrossrefPubMedGoogle Scholar
  • 20 Chen KT, Huard RC, Della-Latta P, Saiman L. Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol 2006; 108 (3 Pt 1) 482-487
    CrossrefPubMedGoogle Scholar
  • 21 Liu C, Bayer A, Cosgrove SE , et al; Infectious Diseases Society of America. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52: e18-e55
    CrossrefPubMedGoogle Scholar
  • 22 Laibl VR, Sheffield JS, Roberts S, McIntire DD, Trevino S, Wendel Jr GD. Clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy. Obstet Gynecol 2005; 106: 461-465
    CrossrefPubMedGoogle Scholar
  • 23 Moazzez A, Kelso RL, Towfigh S, Sohn H, Berne TV, Mason RJ. Breast abscess bacteriologic features in the era of community-acquired methicillin-resistant Staphylococcus aureus epidemics. Arch Surg 2007; 142 (9) 881-884
    CrossrefPubMedGoogle Scholar
  • 24 Lee IW, Kang L, Hsu HP, Kuo PL, Chang CM. Puerperal mastitis requiring hospitalization during a nine-year period. Am J Obstet Gynecol 2010; 203: e1-e6
    PubMedGoogle Scholar
  • 25 Reddy P, Qi C, Zembower T, Noskin GA, Bolon M. Postpartum mastitis and community-acquired methicillin-resistant Staphylococcus aureus . Emerg Infect Dis 2007; 13: 298-301
    CrossrefPubMedGoogle Scholar
  • 26 Thurman AR, Satterfield TM, Soper DE. Methicillin-resistant Staphylococcus aureus as a common cause of vulvar abscesses. Obstet Gynecol 2008; 112: 538-544
    CrossrefPubMedGoogle Scholar
  • 27 Lareau SM, Meyn L, Beigi RH. Methicillin-resistant Staphylococcus aureus as the most common cause of perineal abscesses. Infectious Diseases in Clinical Practice 2010; 18: 258-260
    CrossrefPubMedGoogle Scholar
  • 28 Pimentel JD, Meier FA, Samuel LP. Chorioamnionitis and neonatal sepsis from community-associated MRSA. Emerg Infect Dis 2009; 15: 2069-2071
    CrossrefPubMedGoogle Scholar
  • 29 Rotas M, McCalla S, Liu C, Minkoff H. Methicillin-resistant Staphylococcus aureus necrotizing pneumonia arising from an infected episiotomy site. Obstet Gynecol 2007; 109 (2 Pt2) 533-536
    CrossrefPubMedGoogle Scholar
  • 30 Beigi RH, Bunge K, Song Y, Lee BY. Epidemiologic and economic effect of methicillin-resistant Staphylococcus aureus in obstetrics. Obstet Gynecol 2009; 113: 983-991
    CrossrefPubMedGoogle Scholar
  • 31 Carey AJ, Della-Latta P, Huard R , et al. Changes in the molecular epidemiological characteristics of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2010; 31: 613-619
    CrossrefPubMedGoogle Scholar
  • 32 Healy CM, Hulten KG, Palazzi DL, Campbell JR, Baker CJ. Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clin Infect Dis 2004; 39: 1460-1466
    CrossrefPubMedGoogle Scholar
  • 33 James L, Gorwitz RJ, Jones RC , et al. Methicillin-resistant Staphylococcus aureus infections among healthy full-term newborns. Arch Dis Child Fetal Neonatal Ed 2008; 93: F40-F44
    CrossrefPubMedGoogle Scholar
  • 34 Fortunov RM, Hulten KG, Hammerman WA, Mason Jr EO, Kaplan SL. Community-acquired Staphylococcus aureus infections in term and near-term previously healthy neonates. Pediatrics 2006; 118: 874-881
    CrossrefPubMedGoogle Scholar
  • 35 Saunders A, Panaro L, McGeer A , et al. A nosocomial outbreak of community-associated methicillin-resistant Staphylococcus aureus among healthy newborns and postpartum mothers. Can J Infect Dis Med Microbiol 2007; 18: 128-132
    PubMedGoogle Scholar
  • 36 Gastelum DT, Dassey D, Mascola L, Yasuda LM. Transmission of community-associated methicillin-resistant Staphylococcus aureus from breast milk in the neonatal intensive care unit. Pediatr Infect Dis J 2005; 24: 1122-1124
    CrossrefPubMedGoogle Scholar
  • 37 Huang YC, Chao AS, Chang SD , et al. Association of Staphylococcus aureus colonization in parturient mothers and their babies. Pediatr Infect Dis J 2009; 28: 742-744
    PubMedGoogle Scholar
  • 38 Jimenez-Truque N, Tedeschi S, Saye EJ , et al. Relationship between maternal and neonatal Staphylococcus aureus colonization. Pediatrics 2012; 129: e1252-e1259
    CrossrefPubMedGoogle Scholar
  • 39 Pinter DM, Mandel J, Hulten KG, Minkoff H, Tosi MF. Maternal-infant perinatal transmission of methicillin-resistant and methicillin-sensitive Staphylococcus aureus . Am J Perinatol 2009; 26: 145-151
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Gray J, Patwardhan SC, Martin W. Meticillin-resistant Staphylococcus aureus screening in obstetrics: a review. J Hosp Infect 2010; 75: 89-92
    CrossrefPubMedGoogle Scholar
  • 41 Fridkin SK, Hageman JC, Morrison M , et al; Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005; 352: 1436-1444
    CrossrefPubMedGoogle Scholar
  • 42 Lee MC, Rios AM, Aten MF , et al. Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus . Pediatr Infect Dis J 2004; 23: 123-127
    PubMedGoogle Scholar
  • 43 Rajendran PM, Young D, Maurer T , et al. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007; 51: 4044-4048
    CrossrefPubMedGoogle Scholar
  • 44 Forcade NA, Wiederhold NP, Ryan L, Talbert RL, Frei CR. Antibacterials as adjuncts to incision and drainage for adults with purulent methicillin-resistant Staphylococcus aureus (MRSA) skin infections. Drugs 2012; 72: 339-351
    CrossrefPubMedGoogle Scholar
  • 45 Huang SS, Yokoe DS, Hinrichsen VL , et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006; 43: 971-978
    CrossrefPubMedGoogle Scholar
  • 46 Loveday HP, Pellowe CM, Jones SRL, Pratt RJ. A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A). J Hosp Infect 2006; 63 (Suppl. 01) S45-S70
    CrossrefPubMedGoogle Scholar
  • 47 Huskins WC, Huckabee CM, O'Grady NP , et al; STAR*ICU Trial Investigators. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011; 364: 1407-1418
    CrossrefPubMedGoogle Scholar
  • 48 Harbarth S, Fankhauser C, Schrenzel J , et al. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008; 299: 1149-1157
    CrossrefPubMedGoogle Scholar