Father‐to‐Infant Transmission of Community‐Acquired Methicillin‐Resistant Staphylococcusaureus in a Neonatal Intensive Care Unit • Author(s): Jaffar A. Al‐Tawfiq , MDSource: Infection Control and Hospital Epidemiology, Vol. 27, No. 6 (June 2006), pp. 636-637Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiologyof AmericaStable URL: http://www.jstor.org/stable/10.1086/505097 .

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infection control and hospital epidemiology june 2006, vol. 27, no. 6

c o n c i s e c o m m u n i c a t i o n

Father-to-Infant Transmissionof Community-Acquired Methicillin-Resistant Staphylococcus aureusin a Neonatal Intensive Care Unit

Jaffar A. Al-Tawfiq, MD

Methicillin-resistant Staphylococcus aureus (MRSA) is increasinglybeing recognized as a cause of community-acquired infection. Itstransmission in neonatal intensive care units (NICUs) has reportedlybeen linked to a few cases of community-acquired MRSA (CA-MRSA) infection. Here, I describe a case of CA-MRSA transmissionfrom a father to his child in a NICU. Recognition that CA-MRSAmay be transmitted in a hospital setting raises important issues forMRSA infection control and treatment options.

Infect Control Hosp Epidemiol 2006; 27:636-637

Methicillin-resistant Staphylococcus aureus (MRSA) was iden-tified at approximately the same time that semisyntheticpenicillinase–resistant penicillins were being used to treat S.aureus infection.1 Initially, MRSA was only described in hos-pitalized patients, particularly patients in the intensive careunit (ICU). Community-acquired MRSA (CA-MRSA) wassubsequently identified and reported in 1981.2 MRSA out-breaks in neonatal ICUs (NICUs) are well described.3 In suchoutbreaks, one of the most important routes of MRSA trans-mission is via the hands of healthcare workers (HCWs),4 whocan be transiently colonized with MRSA yet still be the sourceof infection in their close contacts, such as family membersor patients.5 In addition to the transmission of nosocomialMRSA strains within the hospital, community strains ofMRSA may be transmitted to hospitalized patients via familymembers. In a previous report, a strain of CA-MRSA wastransmitted from mother to infant in a NICU.6 In anotherreport, several cases of MRSA colonization were thought toresult from transmission between mothers and their babies,although molecular typing was not performed in that study.7

I report here the transmission of CA-MRSA from a father tohis child in a NICU. To my knowledge, this is the first reportof CA-MRSA transmission from a father to his child in thishospital setting.

case report

The patient, a full-term newborn female, was born at anotherhospital by normal spontaneous vaginal delivery with a breechpresentation. At birth, she had hypoxic ischemic encepha-lopathy, and her initial weight was 2.250 kg. The next day,the patient was intubated and mechanically ventilated forcardiopulmonary arrest after aspiration. She was subsequentlytransferred to the NICU at Dhahran Health Center (Dhahran,Saudi Arabia). She was given ampicillin and gentamicin for7 days and received no other antibiotics.

The infection control policy at Dhahran Health Center

requires that all patients transferred from outside hospitalsto an ICU in the hospital undergo screening for detection ofMRSA. Results of initial screening of nasal swab speci-mens and cultures of respiratory specimens were negative forMRSA. Five weeks into the patient’s hospital course, however,culture of a respiratory specimen yielded MRSA, but she hadno signs or symptoms of pneumonia.

The infant’s parents were healthy with no significant pastmedical history. The parents had not recently received med-ical treatment or undergone surgery, and they were notHCWs. According to our hospital policy, even a solitary caseof MRSA colonization or infection in the NICU is consideredan outbreak. Thus, screening of nasal swab specimens ob-tained from all 93 NICU HCWs, the other 26 patients whowere in the NICU during the preceding 5 weeks, and theparents of the neonate was performed. The neonate and herfather tested positive for MRSA; the mother, HCWs, andremaining patients tested negative for MRSA.

The 2 strains of MRSA obtained from the patient and herfather had a similar antibiogram; both strains were susceptibleto ciprofloxacin, clindamycin, erythromycin, and vancomy-cin. The strains were resistant to tetracycline, penicillin G,and oxacillin. Both strains were sent to Mayo Medical Lab-oratories (Rochester, MN) for pulsed-field gel electrophoresis(PFGE), which revealed that the 2 isolates had indistinguish-able PFGE patterns.

discussion

It is known that nosocomial MRSA infection or colonizationis usually associated with transmission from an infected orcolonized patient, a hospital source, or, occasionally, from acolonized HCW.8 In outbreaks of MRSA infection and col-onization in the NICU, HCWs were found to be transientlycolonized of MRSA, with subsequent transmission of thispathogen to their families.5,9,10 In another study from Japan,an outbreak of MRSA infection in the NICU was traced tocolonized healthcare workers.11 Familial transmission of nos-ocomial or community-acquired MRSA from patients to theirhousehold contacts has also been reported.12 Mother-to-infant transmission has been shown to occur in 4 pregnantwomen and their infants.13 In a report by Hollis et al.,8 astrain of MRSA that was initially transmitted among familymembers was subsequent transmitted to a neonate in theNICU. Antibiograms and DNA analysis confirmed that theisolates from the mother and the neonate were identical.8 Inanother report, the MRSA strain from a NICU outbreak wasderived from the mother of an infant with a low birthweight.14 In another report from a NICU, the transmissionof MRSA from a mother to 3 of her preterm quadrupletinfants occurred postnatally.15 However, it was not known

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familial transmission of ca-mrsa in a nicu 637

whether the strain from the mother was hospital-acquiredMRSA or CA-MRSA.

CA-MRSA has been described in children with and chil-dren without identifiable risk factors.16 The reported preva-lence of CA-MRSA has varied and has depended on the geo-graphic location of the study and the various definitions used.Individuals with MRSA infection or colonization may spreadthe organism within households and to other contacts in thecommunity.17 In a study from Toronto, a child infected withCA-MRSA transmitted the pathogen to others in a day carecenter.18 In another report, CA-MRSA was transmitted froma mother to her child in a NICU.6

Here, we describe the transmission of CA-MRSA from afather to his infant. We are not aware of any previous reportof such a transmission. The father had not recently undergonesurgery or received medical treatment. In addition, a nasalswab specimen from the mother tested negative for MRSA.Thus, it seems likely that the father transmitted CA-MRSAto the infant. Because the strains were indistinguishable fromeach other by PFGE, the findings confirm that the isolateswere related and that a directional transmission had occurredfrom the father to the neonate. This is further substantiatedby the fact that the mother, all 93 HCWs, and all 26 otherneonates in the NICU tested negative for MRSA.

The recognition that CA-MRSA may be transmitted in thehospital setting raises important issues for MRSA infectioncontrol. Whether routine screening of parents of neonatesshould be done is a question that remains to be answered.If further evidence links high and significant transmissionrates of CA-MRSA from parents to newborns, then screeningof family members may be indicated. Such a recommendationhas only been suggested by a single author.8 In addition,screening of family members for MRSA has been recom-mended by another author for patients undergoing contin-uous ambulatory peritoneal dialysis.19

In conclusion, the possibility of the transmission of MRSAby parents, family members, and visitors should be consideredwhen investigating a nosocomial outbreak of CA-MRSA col-onization or infection in a NICU. In addition, the health andoccupational histories of all parents need to be considered.

acknowledgments

I thank Ms. Angela J. Harwood and Mr. Daniel M. Blucker for their help inediting the manuscript, and I am grateful to the Saudi Aramco Medical ServicesOrganization facilities for the data and analysis that resulted in this article.

From the Internal Medicine Services Division, Dhahran Health Center,Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, SaudiArabia.

Address reprint requests to Jaffar A. Al-Tawfiq, MD, P. O. Box 76, RoomA-420, Building 61, Dhahran Health Center, Saudi Aramco, Dhahran 31311,Saudi Arabia (jaffar.tawfiq@aramco.com).

Received September 21, 2004; accepted January 17, 2005; electronicallypublished May 25, 2006.

� 2006 by The Society for Healthcare Epidemiology of America. All rightsreserved. 0899-823X/2006/2706-0019$15.00.

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