February 27, 2024

Methicillin-Resistant Staphylococcus aureus (MRSA) and Breastfeeding

Mothers with a MRSA infection can usually continue to breastfeed while receiving treatment that is compatible with breastfeeding. Special precautions are needed if the infant is in the neonatal intensive care unit.

About Staphylococcus aureus

Staphylococcus aureus (staph) is a type of bacteria found on people's skin. Staph bacteria can be carried by individuals and not cause any symptoms. But it can also cause serious infections that can lead to sepsis or death. Methicillin-resistant Staphylococcus aureus (MRSA) is a staph bacteria that resists several antibiotics.

These bacterial pathogens can be associated with mastitis (a breast infection) and breast abscesses in breastfeeding mothers. They require prompt medical attention. In most cases, mothers with a staph or MRSA infection can continue to breastfeed their infant in consultation with their health care provider.

Breastfeeding with MRSA

Mothers with an MRSA infection can usually continue to breastfeed or feed expressed breast milk. Continued breastfeeding is appropriate and recommended for most healthy infants. Breastfeeding promotes drainage and helps to resolve the infection if it involves the breast.

How bacteria spreads

Staph bacteria, including MRSA, are not transmitted in human milk. However, these bacteria can be transferred through direct contact with infected tissue. This contact could be through an open lesion on the breast or through expressed milk that has come in contact with infected tissue.

Breastfeeding precautions

Breastfeeding can continue on the affected breast as long as the infant's mouth does not come in contact with purulent drainage or open infected tissue. This applies even if a drain is present in the case of an abscess.

All open infectious tissue should be covered entirely with clean, dry bandages while breastfeeding or expressing milk. Continued breastfeeding is also recommended for most healthy infants when their mother is colonized or carrying MRSA. ("Colonized" means bacteria are present, alive, and growing, but the mother does not have a MRSA infection.)

When to avoid breastfeeding

A mother may not be able to avoid contact with infectious tissue while breastfeeding or expressing milk. In that case, the mother can express milk from the affected breast and discard it until she is no longer infectious on that side. This is usually after she has undergone 24 to 48 hours of antibiotic therapy.

Expressing milk is important for maintaining milk production while not directly breastfeeding from the affected breast. Expressed breast milk from the unaffected breast can be fed to an infant. Mothers should practice appropriate hand hygiene and clean breast pump parts thoroughly.

MRSA treatment while breastfeeding

Medications

Several medications used to treat MRSA are compatible with breastfeeding. See the Drugs and Lactation Database (LactMed®).

Drainage and breastfeeding

The mother may require abscess drainage. Outpatient treatment using a needle or catheter aspiration will allow the infant to remain with the mother and continue breastfeeding. Breastfeeding also promotes abscess drainage and helps resolve the infection.

In some cases, a drain may be left in the abscess to allow for healing. In these situations, the infant can continue to breastfeed or receive expressed milk from that breast as long as the infant's mouth or the pump's flange does not come in contact with the drain insertion site.

NICU precautions

Special precautions are needed if a breastfeeding mother is infected with MRSA and her infant is in the neonatal intensive care unit (NICU). Infants in the NICU, or who are premature or small-for-gestational-age, are more susceptible to illness and death due to MRSA.

Special precautions

For infants in the NICU, a facility might recommend special precautions. For example, they might recommend using gowns and gloves when caring for infants whose mothers are carrying or are infected with MRSA. The facility might also place the mother and infant in their own room.

If the MRSA infection is in the breast, such as with mastitis, it might be prudent to minimize the infant’s exposure to infected tissue or contaminated milk. This might include:

Culturing (testing) expressed breast milk to confirm the breast milk does not contain staph bacteria before feeding it to the infant.
Feeding the infant pasteurized, donor human milk until the mother's milk is culture-negative for MRSA or until the signs of active infection have resolved. The mother can express and discard her milk during this time.

The mother may need lactation support to continue to express her milk. This helps maintain her milk supply while she receives treatment.