The Potential Threat of Vertical Transmission in Methicillin-Resistant Staphylococcus Aureus Infection: A Systematic Review 2022

Abstract

This systematic review paper aimed to assess and analyze the prevalence of maternal colonization of Staphylococcus aureus (S. aureus) also known as methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) in the peripartum period and its significance on vertical transmission to the neonate and if it is a potential threat to the health of newborns. For this, multiple databases, such as PubMed, MEDLINE, ScienceDirect, and the database of Elsevier, were used to scout for relevant articles, and results were reported adhering to the principles set by Preferred Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines 2020. A specific medical subject headings (MeSH) criterion was designed to search for relevant publications on PubMed. A total of 26 articles were finally selected after a meticulous screening process, including detailed inclusion and exclusion criteria, manual reading of titles and abstracts, and availability of accessible full-text articles. A few articles were also selected after going through the citations section of the initially selected papers. Quality appraisal was done on the selected publications.Maternal colonization of S. aureus is determined to be highly prevalent with the hypothesis that nasal colonization had higher rates than recto-vaginal sites. Increasing maternal age, history of vaginitis, and multiparity were the most common risk factors for MRSA and MSSA colonization. Premature babies were at the highest risk of MRSA colonization. Breast milk is also a risk factor for neonatal MRSA transmission. Through this systematic review, we concluded that although the rate of vertical transmission of MRSA is lower than that of MSSA, we felt that it held significance as neonates with the bug have poor outcomes due to skin and soft tissue infections and there is spread of MRSA to other neonates in the wards and spread to siblings in cases of triplets and quadruplets and even death due to potential MRSA sepsis. Women in Africa and China had high prevalence rates of MRSA and S. aureus which can probably be attributed to a lack of access to adequate healthcare facilities. We recommend screening with regular recto-vaginal swabs and nasal swabs especially in regions with a high burden of MRSA to be performed at regular intervals after confirmation of pregnancy, as prevention and screening are effective to avoid serious complications.

Comparison of risk factors for Methicillin Resistant Staphylococcus aureus (MRSA) colonization in healthy newborns, born to mothers with and without MRSA colonization

“…Since MRSA colonization from healthcare workers or household contacts is possible, there should be identification of all environmentally and maternal derived risk factors. 8 …”

“…6 The prevalence of MRSA carriage in vaginal sites of pregnant women is 1.7% and Original Article 5.7% in anterior nares showed the neonatal incidence of MRSA carriage is 0.8%. 7,8 There are many risk factors for MRSA colonization in neonates including low birth weight, prematurity and multiple gestation. 6 Advanced maternal age and lack of access to proper healthcare facilities during pregnancy are the leading risk factors for maternal colonization.…”

“…Since MRSA colonization from healthcare workers or household contacts is possible, there should be identification of all environmentally and maternal derived risk factors. 8 This study has been designed to determine the risk factors for MRSA colonization in healthy neonates, born to mothers with and without MRSA colonization. According to our knowledge, no data is available in Pakistan on risk factors for MRSA colonization in healthy newborns.…”

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“…6 Colonization with S. aureus in peripartum patients is common and has been associated with invasive infections-such as skin and soft tissue infections, mastitis, pneumonia, and sepsis-as well as vertical transmission, and adverse neonatal outcomes. [7][8][9][10] Moreover, a prolonged course of intravenous antibiotics is often needed for patients with S. aureus bloodstream infections, including through peripherally inserted central lines, which are at increased risk of infectious and thromboembolic complications during pregnancy. 11 S. aureus infections in pregnancy have also been linked to significant healthcare utilization and subsequent economic burden.…”