MRSA Infection Emerging Problem in Pregnant Patients
In a new study, researchers from a university hospital in Texas describe the clinical features of pregnant women with community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection, an emerging problem at their center.
As it turns out, both the presentation and management of MRSA infection in pregnant women is not that much different from what occurs in non-pregnant women, lead author Dr. Vanessa R. Laibl, from the University of Texas Southwestern Medical Center at Dallas, told Reuters Health.
“Clinicians should look for pregnant women who come in with folliculitis, skin abscesses, or breast abscesses,” Dr. Laibl said. “The women will often attribute it to an insect bite without ever being able to identify the insect. They may report other affected family members and the lesions will tend to be recurrent. These findings should prompt the clinician to perform a culture for MRSA.”
The treatment of MRSA in pregnant women is pretty much the same as in non-pregnant women, surgical drainage of the abscess coupled with antibiotic therapy. However, “we do avoid using levofloxacin and tetracycline’s in pregnant women,” Dr. Laibl noted. “For outpatient therapy, we typically use trimethoprim-sulfamethoxazole, whereas for inpatient therapy, we give vancomycin.”
As for obstetrical outcomes, Dr. Laibl said that “pregnant women with MRSA fare just as well as women without this infection. They don’t get chorioamnionitis any more often” and other outcomes appear comparable as well.
The new findings, which appear in the September issue of Obstetrics & Gynecology, are based on a chart review of pregnant patients who were diagnosed with MRSA infection at the researchers’ center between January 1, 2000 and July 30, 2004. At total of 57 cases were identified, including 2 in 2000, 4 in 2001, 11 in 2002, 23 in 2003, and 17 through July 2004. “Although there may have been some ascertainment bias, there does seem to be a rise in cases,” Dr. Laibl commented.
Ninety-six percent of cases involved skin and soft tissue infections, most commonly in the extremities. Most patients required inpatient treatment and most patients had recurrent episodes of infection. HIV infection and asthma were common comorbid conditions, present in 13% and 11% of cases, respectively.
MRSA isolates were invariably sensitive to trimethoprim-sulfamethoxazole, vancomycin, and rifampin and were usually sensitive to gentamicin and levofloxacin.
Obstet Gynecology 2005;106:461-465
