From the Research
Management of Staphylococcus aureus vaginal colonization during labor typically does not require specific antibiotic treatment unless the patient shows signs of active infection. For routine positive vaginal cultures without symptoms, observation is recommended as S. aureus can be part of normal vaginal flora in some women 1. If the patient has risk factors such as previous S. aureus infections or is MRSA-positive, consider intrapartum prophylaxis with vancomycin 15-20 mg/kg IV every 12 hours during labor, as guided by the most recent and highest quality study on managing S. aureus bacteremia 2.
Key Considerations
- For symptomatic infections, treatment should be guided by susceptibility testing, with options including clindamycin 600 mg IV every 8 hours or cefazolin 2 g IV every 8 hours for methicillin-sensitive strains 2.
- Neonatal monitoring is important after delivery, as vertical transmission is possible though uncommon 1.
- The main concern with S. aureus during labor is the potential for postpartum infections such as endometritis or wound infections following cesarean delivery, rather than adverse effects on the fetus.
- Good hand hygiene and standard infection control practices should be maintained throughout labor and delivery to minimize transmission risk.
Risk Factors and Transmission
- The prevalence of vaginal carriage of Staphylococcus aureus was found to be around 5.9% among pregnant women within 1 month of delivery 1.
- Delivery by caesarean section compared with the vaginal route significantly decreased the likelihood of S. aureus colonization in the newborns 1.
- Vertical transmission from mothers to infants at delivery is a likely route of MRSA acquisition by the newborn, but the consequences for newborns are generally unclear 3, 1.
Treatment Approach
- Empirical antibiotic treatment should include vancomycin or daptomycin, which are active against MRSA, as recommended by the most recent guidelines on managing S. aureus bacteremia 2.
- Once S. aureus susceptibilities are known, MSSA should be treated with cefazolin or an antistaphylococcal penicillin 2.
- Additional clinical management consists of identifying sites of metastatic infection and pursuing source control for identified foci of infection 2.