Pinter David M, Mandel Judy, Hulten Kristina G, Minkoff Howard, Tosi Michael F
Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York, USA.
Am J Perinatol. 2009 Feb;26(2):145-51. doi: 10.1055/s-0028-1095179. Epub 2008 Oct 31.
Because of the increasing importance of Staphylococcus aureus (SA), including methicillin-resistant SA (MRSA) in serious neonatal infections, we studied the contribution of perinatal maternal-infant transmission of SA to the colonization and infection of newborn infants. Cultures for SA, including MRSA, were obtained from nares and vagina of women in labor at term. Each mother's infant, if delivered vaginally, was cultured from nares and skin at delivery and again after 48 hours (at discharge). All MRSA and selected SA isolates were studied by pulsed field gel electrophoresis (PFGE). Infants were monitored after discharge for staphylococcal infection for 4 weeks. Of 304 women completing the study, 43 were colonized with SA, and 9/43 had MRSA. Of 252 evaluable infants, 25 were colonized with SA, and 9/25 had MRSA. Six of 252 mother-infant pairs were concordant for SA colonization, and one of these for MRSA. Isolates from five of these six infants were indistinguishable from their mother's isolates by PFGE, including the pair with MRSA. One SA-colonized infant and four noncolonized infants subsequently developed staphylococcal infections during the monitoring period. About 20% of SA isolates in this maternal population were MRSA. Perinatal maternal-infant transmission accounted for 20% of instances of perinatal colonization of infants with SA. Molecular confirmation of perinatal maternal-infant transmission of MRSA was first documented. In this population of term infants, most SA infections in the first 4 weeks of life appeared to result from colonization that occurred after discharge from the nursery.
由于金黄色葡萄球菌（SA），包括耐甲氧西林金黄色葡萄球菌（MRSA）在严重新生儿感染中的重要性日益增加，我们研究了围产期母婴SA传播对新生儿定植和感染的影响。对足月分娩的妇女的鼻腔和阴道进行SA培养，包括MRSA。每位母亲的婴儿，如果是经阴道分娩，在出生时从鼻腔和皮肤取样培养，48小时后（出院时）再次取样培养。所有MRSA和选定的SA分离株均通过脉冲场凝胶电泳（PFGE）进行研究。婴儿出院后接受4周的葡萄球菌感染监测。在完成研究的304名妇女中，43人被SA定植，其中9/43为MRSA。在252名可评估的婴儿中，25人被SA定植，其中9/25为MRSA。252对母婴中有6对SA定植情况一致，其中1对MRSA定植情况一致。这6名婴儿中有5名的分离株通过PFGE与母亲的分离株无法区分，包括那对MRSA定植的母婴。1名SA定植的婴儿和4名未定植的婴儿在监测期内随后发生了葡萄球菌感染。该产妇群体中约20%的SA分离株为MRSA。围产期母婴传播占婴儿SA围产期定植病例的20%。首次记录了MRSA围产期母婴传播的分子学证实情况。在这群足月婴儿中，生命最初4周内的大多数SA感染似乎是由出院后发生的定植引起的。
