Pre-pregnancy diabetes poses a triple risk for MRSA

Pre-pregnancy diabetes poses a triple risk for MRSA
Pre-pregnancy diabetes poses a triple risk for MRSA

Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a strain of staph bacteria that’s become resistant to the antibiotics commonly used to treat ordinary staph infections. Most MRSA infections occur in people who have been in hospitals or other health care settings, such as nursing homes and dialysis centers, according to the Mayo Clinic.

Patients with diabetes are known to have an elevated risk for some infections such as of the urinary tract and surgical wounds, and diabetes also raises the risk of cesarean section birth, which in turn carries infection risks.

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) infection in postpartum women is not well characterized. Because diabetes is a risk factor for some infections, the researchers sought to characterize the relationship between diabetes and invasive MRSA infections in women admitted to US hospitals for delivery of an infant, according to the study’s abstract.

Dr. Andrea M. Parroitt, MPH, PhD, and Dr. Onyebuchi A. Arah, M.D., D.Sc., M.P.H., Ph.D., Professor at the Department of Epidemiology, UCLA Fielding School of Public Health, analyzed data from the Nationwide Inpatient Sample, a representative sample of US community hospitals.

The database included 3,531,821 deliveries, with 0.8% being in women with pre-pregnancy diabetes and included; 0.1% women who had diabetes with complications, and 5.3% involved gestational diabetes.

There were 563 cases of MRSA during delivery hospitalizations, with cases increasing over the 4-year study period.

The site of infection was the skin in 30.9%, the urinary tract in 6.4%, other genitourinary locations in 5.2%, and wounds in 3%.

Septicemia also occurred in 2% of cases.

In total, there were 17 MRSA infections in women who were diabetic before pregnancy, and 26 in women with gestational diabetes.

The multivariate analysis adjusted for age, race, selected comorbidities, and expected payer, and hospital teaching status, urbanicity, bed size, geographic region, and ownership.

There was some suggestion that the risk for MRSA infection was even higher among women with complications of diabetes (OR 1.5, 95% CI 0.3-6), but this was not definitive, the researchers noted.

In their conclusion the team writes “Pre-pregnancy diabetes, but not gestational diabetes, appears to be a risk factor for invasive MRSA infection in the early postpartum period. Women with diabetic complications may be at additional risk, but estimates were imprecise.”

“Women admitted to labor and delivery are generally young and healthy and lack many of the risk factors for nosocomial MRSA infection, the large numbers of women … mean that this group may make a substantial contribution to the burden of MRSA infections, even if the risk of infection is low,” observed the team.

Dr.’s Parriott and Arah note that more research will be needed to further demonstrate the association of MRSA and diabetes in pregnant women.

The research team cautions “As we wait for further research on this topic, it might seem prudent for hospitals to be vigilant about possible MRSA risk among diabetic women in labor and delivery.”

This study appears in the American Journal of Infection Control.


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