We have only had two or three cases of infections due to MRSA in the history
of my ward.  One of them was in the mother of a very premature baby.  The
focus of infection was her stitches, and she had a vaginal birth.  Baby was
in special care unit.  The MRSA was not diagnosed until nearly a week post
partum because her history with known risk factors for MRSA didn't ring the
proper bells and it was only discovered by a routine culture after she
developed symptoms of infection.  Not an incident our ward is proud of!  She
had been visiting her baby in the usual way, no restrictions, until the
culture came back, when full contact isolation precautions were instituted
for baby, mother was banned from the special care unit, all staff there and
on the maternity ward had to be tested and quarantined if they cultured
positive, and it was a royal pain even though none of us cultured positive,
not even those of us like me who had been helping her with milk expression
and with wound care for her infected stitches.

The baby was on a respirator because of prematurity.  He was being gavage
fed banked milk and whatever milk mother had been able to express.  Several
samples of her milk cultured positive for MRSA, and I reiterate, the
infection site was her perineum.  I am absolutely convinced that the culprit
was a lapse in simple hand hygiene by mother.  Swabs were taken from baby's
tracheal tube, and they cultured positive for MRSA as well.  However, and
this is clinically important, the baby never had a single sign or symptom of
illness from the infection.  He was colonized but did not become ill.  The
pediatricians decided just the same to keep him om donor milk without MRSA,
he was treated, as was his mother, and they were in isolation together on
the adult surgical ICU for some time.  I don't know how it all turned out
except that mother and baby recovered and did go home, together.  The
pediatricians here would be very hesitant to give such a vulnerable baby
anything but unpasteurized human milk, even though they felt uneasy about
the safety of his own mother's milk due to bacterial contamination.

Rachel Myr
Kristiansand, Norway

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