Methicillin resistant Staphylococcus aureus as a cause of chorioamnionitis

Chorioamnionitis is a leading cause of morbidity and mortality in preterm infants. Only rarely is Staphylococcus aureus implicated. A case of methicillin resistant Staphylococcus aureus causing chorioamnionitis and endometritis is presented.

A 39-year-old gravida 2 para 1 female, who previously worked as the unit clerk in the pediatric pulmonary unit of a children's hospital, was initially admitted at 22 weeks with a shortened cervix. The patient refused emergency cerclage. She was released from the hospital and returned at 25 4/7 weeks' estimated gestational age with possible spontaneous rupture of membranes. An amniocentesis was performed and revealed a gram stain positive for many gram positive cocci as well as a glucose of < 2 mg%. The patient was started on intravenous ampicillin and gentamicin and induction of labor with oxytocin was begun. Approximately 1 day after the patient's delivery, the culture from the amniocentesis was noted to have grown methicillin resistant Staphylococcus aureus, and the patient's (as well as the neonate's) regimen was switched to vancomycin.

A Medline search revealed no cases of methicillin resistant Staphylococcus aureus causing chorioamnionitis. When chorioamnionitis or refractory endometritis is encountered in a patient who works in the health care industry, methicillin resistant staphylococcus aureus must be considered.