Predictors and Outcomes for Pregnant Women with Vaginal-Rectal Carriage of Community-Associated Methicillin-Resistant Staphylococcus aureus

Katherine T. Chen; Holly Campbell; Luisa N. Borrell; Richard C. Huard; Lisa Saiman; Phyllis Della-Latta

doi:10.1055/s-2007-976551

American Journal of Perinatology, Table of Contents

Am J Perinatol 2007; 24(4): 235-240
DOI: 10.1055/s-2007-976551

Predictors and Outcomes for Pregnant Women with Vaginal-Rectal Carriage of Community-Associated Methicillin-Resistant Staphylococcus aureus

Katherine T. Chen¹ ^, ² , Holly Campbell¹ , Luisa N. Borrell² , Richard C. Huard³ , Lisa Saiman⁴ , Phyllis Della-Latta³

¹Department of Obstetrics and Gynecology, Columbia University, New York, New York
²Department of Epidemiology, Columbia University, New York, New York
³Department of Pathology, Columbia University, New York, New York
⁴Department of Pediatrics, Columbia University, New York, New York

Abstract

ABSTRACT

The purpose of this study was to determine the predictors and outcomes of pregnant women with vaginal-rectal carriage of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). We performed an unmatched 1:4 case-control study with two control groups (13 CA-MRSA cases, 52 methicillin-sensitive S. aureus (MSSA) controls, and 52 S. aureus-negative controls) via a retrospective medical record review. We found that CA-MRSA cases were 12.5 times significantly less likely to be colonized with group B streptococci (GBS) compared with MSSA controls in multivariable analyses. When we compared MSSA patients with S. aureus-negative patients, we found that MSSA patients were 4.5 times significantly more likely to be colonized with GBS and 11 times significantly more likely to have a postpartum fever ≥ 100.4°F in multivariable analyses. Traditional risk factors for hospital-associated MRSA do not appear to predict vaginal-rectal CA-MRSA carriage in pregnant women. Instead, CA-MRSA carriage is significantly associated with lack of GBS carriage. Additional microbiologic studies and epidemiologic studies are needed to clarify the relationship between S. aureus and GBS, given that these two colonizing organisms have the potential to become pathogens.

KEYWORDS

Staphylococcus aureus - methicillin-resistant S. aureus (MRSA) - community-associated MRSA - group B streptococci (GBS) - antibiotic resistance

Full Text

References

REFERENCES

1 Moellering Jr R C. The growing menace of community-acquired methicillin-resistant Staphylococcus aureus . Ann Intern Med. 2006; 144 368-370
2 Weber J T. Community-associated methicillin-resistant Staphylococcus aureus. . Clin Infect Dis. 2005; 41(suppl 4) S269-S272
3 Naimi T S, LeDell K H, Como-Sabetti K et al.. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003; 290 2976-2984
4 Charlebois E D, Perdreau-Remington F, Kreiswirth B et al.. Origins of community strains of methicillin-resistant Staphylococcus aureus . Clin Infect Dis. 2004; 39 47-54
5 Zhang K, McClure J A, Elsayed S, Louie T, Conly J M. Novel multiplex PCR assay for characterization and concomitant subtyping of staphylococcal cassette chromosome mec types I to V in methicillin-resistant Staphylococcus aureus . J Clin Microbiol. 2005; 43 5026-5033
6 McDougal L K, Steward C D, Killgore G E, Chaitram J M, McAllister S K, Tenover F C. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol. 2003; 41 5113-5120
7 Tenover F C, McDougal L K, Goering R V et al.. Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States. J Clin Microbiol. 2006; 44 108-118
8 Chambers H F. Community-associated MRSA-resistance and virulence converge. N Engl J Med. 2005; 352 1485-1487
9 Centers for Disease Control and Prevention . Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus-Minnesota and North Dakota, 1997-1999. JAMA. 1999; 282 1123-1125
10 Herold B C, Immergluck L C, Maranan M C et al.. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA. 1998; 279 593-598
11 Hussain F M, Boyle-Vavra S, Bethel C D, Daum R S. Current trends in community-acquired methicillin-resistant Staphylococcus aureus at a tertiary care pediatric facility. Pediatr Infect Dis J. 2000; 19 1163-1166
12 Purcell K, Fergie J. Epidemic of community-acquired methicillin-resistant Staphylococcus aureus infections: a 14-year study at Driscoll Children's Hospital. Arch Pediatr Adolesc Med. 2005; 159 980-985
13 Healy C M, Hulten K G, Palazzi D L, Campbell J R, Baker C J. Emergence of new strains of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Clin Infect Dis. 2004; 39 1460-1466
14 Seybold U, Ray S M, Halvosa S J, Voris V, White N, Blumberg H M. Emergence of methicillin-resistant Staphylococcus aureus USA300/400 as the predominant clones in the neonatal intensive care unit. Presented at the 2006 SHEA Annual Meeting March 18-21, 2006 Chicago, IL;
15 Bratu S, Eramo A, Kopec R et al.. Community-associated methicillin-resistant Staphylococcus aureus in hospital nursery and maternity units. Emerg Infect Dis. 2005; 11 808-813
16 Community-associated methicillin-resistant Staphylococcus aureus infection among healthy newborns-Chicago and Los Angeles County, 2004. MMWR Recomm Rep. 2006; 55 329-332
17 Saiman L, O'Keefe M, Graham III P L et al.. Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women. Clin Infect Dis. 2003; 37 1313-1319
18 Laibl V R, Sheffield J S, Roberts S, McIntire D D, Trevino S, Wendel Jr G D. Clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy. Obstet Gynecol. 2005; 106 461-465
19 Wenzel R P, Perl T M. The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. J Hosp Infect. 1995; 31 13-24
20 Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev. 1997; 10 505-520
21 Yu V L, Goetz A, Wagener M et al.. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. Efficacy of antibiotic prophylaxis. N Engl J Med. 1986; 315 91-96
22 von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001; 344 11-16
23 Chen K T, Huard R C, Della-Latta P, Saiman L. Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol. 2006; 108 482-487
24 Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep. 2002; 51 1-22
25 Kuehnert M J, Kruszon-Moran D, Hill H A et al.. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis. 2006; 193 172-179
26 Graham III P L, Lin S X, Larson E LAUS. Population-based survey of Staphylococcus aureus colonization. Ann Intern Med. 2006; 144 318-325
27 Boyce J M. Methicillin-resistant Staphylococcus aureus. Detection, epidemiology, and control measures. Infect Dis Clin North Am. 1989; 3 901-913
28 Lowy F D. Staphylococcus aureus infections. N Engl J Med. 1998; 339 520-532
29 Nakamura M M, Rohling K L, Shashaty M, Lu H, Tang Y W, Edwards K M. Prevalence of methicillin-resistant Staphylococcus aureus nasal carriage in the community pediatric population. Pediatr Infect Dis J. 2002; 21 917-922
30 Creech II C B, Kernodle D S, Alsentzer A, Wilson C, Edwards K M. Increasing rates of nasal carriage of methicillin-resistant Staphylococcus aureus in healthy children. Pediatr Infect Dis J. 2005; 24 617-621
31 Prevention of perinatal group B streptococcal disease: a public health perspective. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1996; 45 1-24
32 Chaisilwattana P, Monif G RG. In vitro ability of the group B streptococci to inhibit gram-positive and gram-variable constituents of the bacterial flora of the female genital tract. Infect Dis Obstet Gynecol. 1995; 3 91-97
33 Carson H M, LaPoint P G, Monif G RG. Interrelationships within the bacterial flora of the female genital tract. Infect Dis Obstet Gynecol. 1997; 5 305-309
34 Smaill F, Hofmeyr G J. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev. 2002; 3 CD000933
35 Kopecko D. Specialized genetic recombination systems in bacteria: their involvement in gene expression and evolution. Prog Mol Subcell Biol. 1980; 7 135-243
36 Sweet L R, Gibbs R S. Clinical microbiology of the female genital tract. In: Sweet LR, Gibbs RS Infectious Diseases of the Female Genital Tract. 4th. Philadelphia, PA; Lippincott Williams and Wilkins 2002: 3-12
37 L'Heriteau F, Lucet J C, Scanvic A, Bouvet E. Community-acquired methicillin-resistant Staphylococcus aureus and familial transmission. JAMA. 1999; 282 1038-1039
38 Morel A S, Wu F, Della-Latta P, Cronquist A, Rubenstein D, Saiman L. Nosocomial transmission of methicillin-resistant Staphylococcus aureus from a mother to her preterm quadruplet infants. Am J Infect Control. 2002; 30 170-173
39 Peacock S J, Justice A, Griffiths D et al.. Determinants of acquisition and carriage of Staphylococcus aureus in infancy. J Clin Microbiol. 2003; 41 5718-5725
40 Gail M, Williams R, Byar D P, Brown C. How many controls?. J Chronic Dis. 1976; 29 723-731
41 Williams R E. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev. 1963; 27 56-71
42 Gibbs R. Emerging infections in obstetric and gynecologic practice. Obstet Gynecol. 2006; 108 480-481

Katherine T ChenDepartment of Obstetrics and Gynecology and Epidemiology

Columbia University

722 West 168th Street, New York, NY 10032