Volume 13, Number 2—February 2007
Dispatch
Postpartum Mastitis and Community-acquired Methicillin-resistant Staphylococcus aureus
Pavani Reddy*
, Chao Qi*, Teresa Zembower*, Gary A. Noskin*, and Maureen Bolon*
, Chao Qi*, Teresa Zembower*, Gary A. Noskin*, and Maureen Bolon*
Table
Demographics, symptoms, interventions, and outcomes in patients with Staphylococcus aureus–associated postpartum mastitis*
| Variable | No. (%) patients | OR (95% CI) | p value* | |
|---|---|---|---|---|
| MRSA (n = 21) | MSSA (n = 27) | |||
| Demographics | ||||
| Median age, y | 32 | 32.5 | – | 0.90 |
| Multiparous | 12 (57) | 9 (33) | 2.67 (0.71–10.4) | 0.10 |
| Race† | ||||
| Caucasian | 15 (71) | 19 (79) | 0.66 (0.13–3.19) | 0.55 |
| Other | 6 (29) | 5 (21) | 1.52 (0.31–7.59) | 0.55 |
| Clinical symptoms | ||||
| Fever | 7 (33) | 10 (37) | 0.85 (0.22–3.30) | 0.79 |
| Skin changes or fissures | 6 (29) | 8 (30) | 0.95 (0.23–3.96) | 0.94 |
| Induration | 20 (95) | 21 (78) | 5.71 (0.59–275.7) | 0.09 |
| Median time from delivery to symptom onset, d | 27 | 33.5 | – | 0.60 |
| Prenatal risk factors | ||||
| Diabetes | 2 (10) | 1 (4) | 2.74 (0.13–167.56) | 0.41 |
| Group B β-hemolytic streptococcus colonization‡ | 3 (16) | 4 (16) | 0.88 (0.11–5.96) | 0.87 |
| Intrapartum risk factors | ||||
| Intrapartum treatment with antimicrobial drugs† | 9 (43) | 7 (29) | 1.82 (0.45–7.52) | 0.34 |
| Cesarean section‡ | 3 (14) | 2 (8) | 1.92 (0.19–24.89) | 0.50 |
| Artificial rupture of membranes§ | 12 (63) | 10 (44) | 2.23 (0.54–9.41) | 0.20 |
| Vaginal laceration or episiotomy§ | 18 (95) | 22 (96) | 0.82 (0.01–67.75) | 0.89 |
| Epidural anesthesia§ | 12 (63) | 18 (78) | 0.48 (0.10–2.26) | 0.28 |
| Interventions | ||||
| Aspiration | 17 (81) | 22 (82) | 0.97 (0.18–5.66) | 0.96 |
| Repeat aspiration | 7 (41) | 5 (23) | 2.38 (0.48–12.14) | 0.22 |
| Incision and drainage | 1 (6) | 9 (41) | 0.09 (0.00–0.84) | 0.01 |
| Drain placement | 3 (14) | 6 (22) | 0.58 (0.08–3.26) | 0.49 |
| Outcomes | ||||
| Hospital admission | 10 | 11 | 1.32 (0.36–4.90) | 0.63 |
| Median length of stay, d | 4 | 4 | – | 0.90 |
| Median leukocyte count, cells/μL | 12.8 | 15.3 | – | 0.21 |
| Temperature >38.1°C | 6 (60) | 2 (18) | 6.75 (0.69–88.48) | 0.05 |
| Recurrent symptoms requiring readmission | 1 (10) | 1 (9) | 1.11 (0.01–95.83) | 0.94 |
| Outpatient, later admitted | 2 (18) | 1(6) | 3.75 (0.16–235.66) | 0.29 |
| Breastfeeding discontinued¶ | 3 (16) | 5 (22) | 0.71 (0.10–4.38) | 0.67 |
*MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-susceptible S. aureus; OR, odds ratio for categorical variables using χ2 analysis or Fisher exact test where appropriate; CI, confidence interval; p values for continuous variables calculated by using the Wilcoxon test.
†Data available for 24 MSSA patients.
‡Data available for 25 MSSA patients.
§Data available for 19 MRSA and 23 MSSA patients.
¶Data available for 19 MRSA and 24 MSSA patients.
References
- Barbosa-Cesnik C, Schwartz K, Foxman B. Lactation mastitis.JAMA. 2003;289:1609–13. DOIPubMedGoogle Scholar
- Foxman B, D’Arcy H, Gillespie B, Bobo JK, Schwartz K. Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States.Am J Epidemiol. 2002;155:103–14. DOIPubMedGoogle Scholar
- Osterman KL, Rahm VA. Lactation mastitis: bacterial cultivation of breast milk, symptoms, treatment, and outcome.J Hum Lact. 2000;16:297–302. DOIPubMedGoogle Scholar
- Marshall BR, Hepper JK, Zirbel CC. Sporadic puerperal mastitis: an infection that need not interrupt lactation.JAMA. 1975;233:1377–9. DOIPubMedGoogle Scholar
- Niebyl JR, Spence MR, Parmley TH. Sporadic (non-epidemic) puerperal mastitis.J Reprod Med. 1978;20:97–100.PubMedGoogle Scholar
- Saiman L, O’Keefe M, Graham PLIII, Wu F, Said-Salim B, Kreiswirth B, Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women.Clin Infect Dis. 2003;37:1313–9. DOIPubMedGoogle Scholar
- Laibl VR, Sheffield JS, Roberts S, McIntire DD, Trevino S, Wendel GDJr. Clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy.Obstet Gynecol. 2005;106:461–5.PubMedGoogle Scholar
- Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection.JAMA. 2003;290:2976–84. DOIPubMedGoogle Scholar
- Charlebois ED, Perdreau-Remington F, Kreiswirth B, Bangsberg DR, Ciccarone D, Diep BA, Origins of community strains of methicillin-resistant Staphylococcus aureus.Clin Infect Dis. 2004;39:47–54. DOIPubMedGoogle Scholar
- Zhang K, McClure J, Elsayed S, Louie T, Conly JM. Novel multiplex PCR assay for characterization and concomitant subtyping of Staphylococcal cassette chromosome mec types I to IV in methicillin-resistant Staphylococcus aureus.J Clin Microbiol. 2005;43:5026–33. DOIPubMedGoogle Scholar
- Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposed risk.JAMA. 1998;279:593–8. DOIPubMedGoogle Scholar
- Jones TF, Creech CB, Erwin P, Baird SG, Woron AM, Schaffner W. Family outbreaks of invasive community-associated methicillin-resistant Staphylococcus aureus infection [cited 2006 Dec 26]. Clin Infect Dis [serial online]. 2006 Mar. Available from http://www.journals.uchicago.edu/CID/journal/issues/v42n9/38813/38813.web.pdf
- Lee MC, Rios AM, Aten MF, Mejias A, Cavuoti D, McCracken GHJr, Management and outcome of children with skin and soft tissue abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus.Pediatr Infect Dis J. 2004;23:123–7. DOIPubMedGoogle Scholar
- Dener C, Inan A. Breast abscesses in lactating women.World J Surg. 2003;27:130–3.PubMedGoogle Scholar
- Kawada M, Okuzumi K, Hitomi S, Sugishita C. Transmission of Staphylococcus aureus between healthy, lactating mothers and their infants by breastfeeding.J Hum Lact. 2003;19:411–7. DOIPubMedGoogle Scholar
- Behari P, Englund J, Alcasid G, Garcia-Houchins S, Weber SG. Transmission of methicillin-resistant Staphylococcus aureus to preterm infants through breast milk.Infect Control Hosp Epidemiol. 2004;25:778–80. DOIPubMedGoogle Scholar
- Loveday HP, Pellowe CM, Jones SR, Pratt RJ. A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A).J Hosp Infect. 2006;63(Suppl 1):S45–70. DOIPubMedGoogle Scholar
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