Clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy.
OBJECTIVE
The objective of this study was to review the presentation and management of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in pregnant women.


METHODS
This was a chart review of pregnant patients who were diagnosed with MRSA between January 1, 2000, and July 30, 2004. Data collected included demographic characteristics, clinical presentation, culture results, and pathogen susceptibilities. Patients' pregnancy outcomes were compared with the general obstetric population during the study period.


RESULTS
Fifty-seven charts were available for review. There were 2 cases in 2000, 4 in 2001, 11 in 2002, 23 in 2003, and 17 through July of 2004. Comorbid conditions included human immunodeficiency virus and acquired immunodeficiency syndrome (13%), asthma (11%), and diabetes (9%). Diagnostic culture was most commonly obtained in the second trimester (46%); however 18% of cases occurred in the postpartum period. Skin and soft tissue infections accounted for 96% of cases. The most common site for a lesion was the extremities (44%), followed by the buttocks (25%), and breast (mastitis) (23%). Fifty-eight percent of patients had recurrent episodes. Sixty-three percent of patients required inpatient treatment. All MRSA isolates were sensitive to trimethoprim-sulfamethoxazole, vancomycin, and rifampin. Other antibiotics to which the isolates were susceptible included gentamicin (98%) and levofloxacin (84%). In comparison with the general obstetric population, patients with MRSA were more likely to be multiparous and to have had a cesarean delivery.


CONCLUSIONS
Community-acquired MRSA is an emerging problem in our obstetric population. Most commonly, it presents as a skin or soft tissue infection that involves multiple sites. Recurrent skin abscesses during pregnancy should raise prompt investigation for MRSA.


METHODS
II-3.
Laibl
Vanessa R
VR
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9032, USA. VLAIBL@parknet.pmh.org
Sheffield
Jeanne S
JS
Roberts
Scott
S
McIntire
Donald D
DD
Trevino
Sylvia
S
Wendel
George D
GD
D000328:Adult; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016106:Methicillin Resistance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000187:drug effects