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Athletes playing dirty: MRSA infections have invaded locker rooms.

No longer limited to health-care institutions, methicillin-resistant Staphylococcus aureus has invaded locker rooms.

A recent report from the Centers for Disease Control and Prevention reviewed several reported clusters of skin and soft tissue infections among competitive athletes linked to methicillin-resistant S. aureus (MRSA). Physicians should consider the potential for MRSA when treating such infections in their athletic patients, the CDC said (MMWR 52[33]:793-95, 2003).

A cluster of infections surfaced among members of a Colorado fencing club in February 2003, when club leaders reported five cases of possible MRSA infections to their local health department. Three of these were confirmed and two were probable. Four patients each reported one to six abscesses (on the legs or thighs in four, on the abdomen in three, the axilla in one, the buttocks in one, the hand in one, and behind the knee in one). The fifth patient was hospitalized for 11 days with paraspinal myositis with bacteremia. The mean age of those infected was 31 years (range 11-51 years). Two patients with confirmed cases had recurrent infections requiring antimicrobial therapy; they made multiple health care visits before their wounds were cultured. All patients recovered.

After 62 of 70 club members responded to a questionnaire, investigators learned that although those infected claimed not to have shared clothing, masks, or weapons, sharing is common among team members, and no showers were available at the practice facility.

Club members, as well as coaches and administrators, were educated in ways to stop the spread of MRSA, including improving hand hygiene, showering with soap and water after all practices, bandaging cuts and abrasions until healed, washing towels and supporters after each use, and establishing a cleaning schedule for the sensor wires that fencers attach to themselves during practice and competition.

Clusters of MRSA appeared among college football players in Pennsylvania in 2000 and in California in 2002. In the Pennsylvania cluster, 10 team members had skin and soft tissue infections that cultured positive for MRSA, and all the isolates had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. Seven players were hospitalized as a result of their infections. Possible risk factors included shaving, skin trauma from turf burns, and sharing unwashed bath towels with teammates.

In California, two college football players were hospitalized with MRSA skin infections, and one received both surgical debridement and skin grafts. Isolates from the two had indistinguishable PFGE patterns. Their teammates reported frequent skin trauma and inconsistent covering of wounds. College health staffers noted that shared balms and lubricants could potentially spread the infection.

In addition, the Indiana State Department of Health learned of two high school wrestlers diagnosed with MRSA skin infections, although neither one was hospitalized. Their isolates were not available for PFGE testing. The two athletes had never wrestled each other, suggesting that the infection may have been transmitted through shared items.

There have been reports of susceptible strains of S. aureus among athletic teams for years, but now the resistant strain is making an appearance, Jeff Hageman, an epidemiologist with the National Center for Infectious Diseases, said in an interview.

"The infections may be the same types that doctors have seen before, but the new twist is resistance," Mr. Hageman said. If an infection isn't responding, it may be a resistant strain, and physicians might want to consider taking a culture. If it's MRSA, this information will guide treatment.

Proper diagnosis is important. Physicians should encourage patients to seek medical treatment if they have an infection--most present as a boil or pimple--due to sports activity. Treatment may or may not include antibiotics. Sometimes an incision to drain the lesion is all that's needed, but the standard first line treatment is first generation cephalosporin, he added.

In addition, clinicians can play a role in infection prevention. (See box.)

Tips to Prevent MRSA Among Athletes

Physicians who see possible methicillin-resistant S. aureus infections in their athletic patients should observe these precautions:

* Cover all wounds and keep them covered. Suggest that players whose skin lesions can't be covered abstain from contact practices or games until the lesions heal or are coverable.

* Encourage good hygiene with one word: SOAP.

* Discourage athletes from sharing towels, clothes, or equipment with teammates.

* Recommend routine cleaning for shared equipment.

* Recommend first aid training for athletes and coaches, including how to recognize potentially infected wounds.

* Encourage athletes to report skin lesions to coaches, and encourage coaches to periodically assess athletes for skin lesions.

Source: MMWR 52[33]:795, 2003)


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Title Annotation:Infectious Diseases
Author:Splete, Heidi
Publication:Internal Medicine News
Date:Mar 1, 2004
Previous Article:Clinical capsules.
Next Article:Worldwide registry: fever, skin disorders top list of travel illnesses.

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