ABSTRACT
Infection with methicillin-resistant Staphylococcus aureus (MRSA) has become a worldwide problem and is no longer acquired only in a hospital
setting. Community-associated MRSA is an emerging pathogen of increasing interest
to both obstetricians and neonatologists, reported in all three trimesters of pregnancy
and postpartum, and in neonatal intensive care units, leading to severe outcomes,
including neonatal death. This case report describes a serious and potentially life-threatening
infection (including wound abscess, septicemia, septic thrombophlebitis, and septic
pulmonary emboli) that developed in an otherwise healthy postpartum woman who had
screened positive for MRSA in nares, vagina, and rectum at the time of her prior admission
in labor as part of a research study. We conclude that asymptomatic nasal, vaginal,
and rectal colonization with MRSA occurs in pregnancy and may be a risk factor for
serious systemic infection after delivery.
KEYWORDS
MRSA - methicillin-resistant Staphylococcus aureus
- CA-MRSA - community-acquired methicillin-resistant Staphylococcus aureus
- pregnancy - postpartum - infection - sepsis
REFERENCES
- 1
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
- 2
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
- 3
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
- 4
Gastelum D T, Dassey D, Mascola L, Yasuda L M.
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
- 5
Eckhardt C, Halvosa J S, Ray S M, Blumberg H M.
Transmission of methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit from a patient with community-acquired disease.
Infect Control Hosp Epidemiol.
2003;
24
460-461
- 6
Kluytmans-Vandenbergh M F, Kluytmans J A.
Community-acquired methicillin-resistant Staphylococcus aureus: current perspectives.
Clin Microbiol Infect.
2006;
12(Suppl 1)
9-15
- 7
Kollef M H, Micek S T.
Methicillin-resistant Staphylococcus aureus: a new community-acquired pathogen?.
Curr Opin Infect Dis.
2006;
19
161-168
- 8
Maltezou H C, Giamarellou H.
Community-acquired methicillin-resistant Staphylococcus aureus infections.
Int J Antimicrob Agents.
2006;
27
87-96
- 9
Cool-Foley A A, Nathan C, O'Donovan III C, Simon D.
Eradication of methicillin-resistant Staphylococcus aureus vaginitis with mupirocin.
DICP.
1991;
25
1331-1333
- 10
Mitsuda T, Arai K, Fujita S, Yokota S.
Demonstration of mother-to-infant transmission of Staphylococcus aureus by pulsed-field gel electrophoresis.
Eur J Pediatr.
1996;
155
194-199
- 11
Chen K T, Campbell H, Borrell L N, Huard R C, Saiman L, Della-Latta P.
Predictors and outcomes for pregnant women with vaginal-rectal carriage of community-associated
methicillin-resistant Staphylococcus aureus
.
Am J Perinatol.
2007;
24
235-240
- 12
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
- 13
Perl T M, Golub J E.
New approaches to reduce Staphylococcus aureus nosocomial infection rates: treating S. aureus nasal carriage.
Ann Pharmacother.
1998;
32
S7-S16
- 14
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
- 15
Perl T M, Cullen J J, Wenzel R P et al..
Mupirocin and the risk of Staphylococcus aureus study team: intranasal mupirocin to prevent postoperative Staphylococcus aureus infections.
N Engl J Med.
2002;
346
1871-1877
Paul G StumpfM.D. F.A.C.O.G.
Professor and Chair of Obstetrics and Gynecology, University of Nevada School of Medicine
2040 W. Charleston Blvd., Suite 200, Las Vegas, NV 89102
