Rupesh I. Patel, Howard K. Kaufman. Nasopharyngeal Carriage of Methicillin-Resistant Staphylococcus aureus: Incidence and Outcomes in Pregnant Women. J Am Osteopath Assoc 2011;111(6):389–395. doi: 10.7556/jaoa.2011.111.6.389.
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Context: Infections due to methicillin-resistant Staphylococcus aureus (MRSA), especially community-acquired MRSA, have increased substantially during the past decade. The optimal protocols for screening patients, particularly during pregnancy, have not been determined.
Objectives: To determine the incidence of nasopharyngeal carriage of MRSA in pregnancy as well as whether there was a correlation between positive maternal screening test results and an increased risk of adverse maternal or neonatal outcomes, including neonatal carriage of MRSA.
Methods: The authors conducted a retrospective review of medical records from Rockford Memorial Hospital in Illinois between December 14, 2007, and July 14, 2008. All patients, who were pregnant women admitted to the hospital, and their newborns had nasopharyngeal swabs collected for MRSA detection. Numbers of neonatal intensive care unit admissions and results of neonatal sepsis evaluations were noted. Maternal postoperative infections and anesthesia-related complications were noted and compared to those of control patients. Apgar scores at birth were compared with those of a control group.
Results: Of 1045 patients who were tested, 31 patients (2.9%) had positive results for MRSA. By comparison, the hospital-wide MRSA prevalence for this period was 7.9% (569 positive results of 7206 patients tested). This prevalence was substantially higher than that noted for the study population. Twenty-three of the 31 patients (74%) delivered at our institution and thus comprised the study group. A control group comprised 46 patients with negative results of MRSA screening. No positive results of neonatal MRSA screening tests were noted in either group, and no statistically significant difference between the 2 groups existed in 5-minute Apgar scores, neonatal intensive care unit admissions, or neonatal sepsis evaluations. Positive MRSA-screening test results were associated with a statistically significant decrease in the provision of regional anesthesia to the pregnant women (P=.05).
Conclusion: Maternal nasopharyngeal carriage of MRSA was not associated with adverse maternal or neonatal outcomes, including neonatal MRSA carriage. Regional anesthesia was provided less frequently to MRSA-positive individuals. Further studies in larger groups of patients are needed to help determine the optimal management of MRSA-positive patients during pregnancy.
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