MRSA Outbreaks in Athletics
CA-MRSA, or community-associated Methicillin-resistant Staphylococcus aureus, is a pathogen that accounts for many of the infections that plague athletes in contact sports. S. aureus is a very common bacteria that lives on the skin and in the nose of a large percentage of the population, and MRSA is a species of S. aureus that has developed a resistance to methicillin, one of the primary antibiotics that was formerly used to treat it. Finally, the community-associated species of MRSA is the kind that infects people who have not recently been hospitalized and therefore are not at risk for HA-MRSA, or healthcare-associated MRSA. This page provides a background of CA-MRSA as well as risk factors and prevention methods for people involved in contact sports.
When penicillin was discovered in 1940 it was used to treat S. aureus infections. Within a few years, however, strains of S. aureus that were resistant to penicillin began to emerge and spread, creating a need for a new antibiotic that was effective against S. aureus . Methicillin was that new antibiotic, introduced in 1961. However, within a few years of that, MRSA strains started to appear in hospitals and clinics. This resistant bacteria is now known as HA-MRSA, and it wasn’t until the 1990s that the first case of CA-MRSA, or a MRSA infection in someone who hadn’t been infected in a hospital or healthcare-related place, was documented. Since that first case, CA-MRSA has been spreading rapidly, infecting many people, especially athletes who play contact sports.
Pathology and Resistance
S. aureus is gram positive, round and groups in clusters of many individual bacteria. They live on the skin and nose of many humans, and are able to withstand temperatures up to 50°C and conditions that are drier and saltier than those in which most bacteria thrive. They cause infection in two ways. The first is tissue invasion, in which a bacterium enters through any kind of wound or opening in the skin and starts a colony, around which the boil or abscess starts to form. The bacteria can spread from there and get into the joints, bloodstream and even to the heart and lungs, causing many difficulties, such as pneumonia, for the host. The second way is through toxins. CA-MRSA strands, such as USA300, tend to have Panton-Valentine leukocidin genes which make the organisms to produce cytotoxins which cause tissue necrosis and leukocyte (white blood cell) destruction. These are particularly dangerous, and can result in serious disease or death. CA-MRSA is resistant to beta lactam antibiotics (the ones that are similar to penicillin that work by inhibiting cell wall growth) because it has a gene that makes those antibiotics have trouble binding to the cell walls.
CA-MRSA infections start as small red boils, which resemble pimples or spider bites, which are painful and warm to the touch. Left untreated, they grow into large abscesses that need to be drained by a doctor. The bacteria can also get deep into the body and affect bones, joints, the heart valves and lungs, which can lead to nausea, chills, fever, lethargy and headaches.
S. aureus are found on the skin of up to a third of the population of healthy adults, and some of those bacteria are Methicillin resistant. Studies have shown that approximately 1% of the population has MRSA colonized on their skin or nose.
In order to understand how to prevent MRSA transmission, researchers collect information from athletes with known cases of MRSA about their behavior in the athletic facilities. Research by Begier et al. at the Clinic of Infectious Diseases investigated behavior tendencies of MRSA infected players on a college football team. This study, as well as others, have shown that there are certain athlete behaviors that are predictors for MRSA infections. The most prominent predictor is the development of skin trauma that is not properly cared for/covered during physical activity. Second, most athletes with reported cases of MRSA infection reported having frequent contact with other players because of their position. For instance, more reported cases came from linesmen rather than quarterbacks on the football teams. The third factor was athletes who reported having shared equipment without it being washed between uses. This factor explains MRSA outbreaks on teams where there is less person-to-person contact.
New research has shown that MRSA outbreaks are not limited to competitive sports participants, but also those who share their facilities. In the case of one MRSA outbreak on a high school football team in 2004, two dancers who changed their uniforms in the football locker rooms before games were also diagnosed with MRSA infections. Additionally, one custodian who tended to the locker room also reported a MRSA infection. Understanding which behaviors put athletes at risk for MRSA infections helped researchers recommend prevention methods for athletes, trainers, school administrators, and healthcare providers.
The most effective way to prevent MRSA transmission is to improve hygiene practices among players and to maintain clean equipment and athletic facilities. For Athletes, the most important hygiene practice is covering open wounds during physical activity. “Covering” means attaching a dressing or a bandage that will remain intact throughout physical activity. Showering immediately after physical activity, especially before using a whirlpool, will also reduce risk of infection. Personal items such as towels, spandex, and jerseys should be washed after every use. Additionally, players should refrain from sharing personal items with other teammates. Sports equipment should ideally be washed every other day, but should be cleaned at least once a week.
The CDC and the NCAA recommend that school administrators provide and maintain clean facilities and encourage proper hygiene practices in Athletic Training rooms. Facilities should be cleaned with commercial disinfectants or a 1:00 solution of diluted bleach. Athletes diagnosed with known cases of MRSA should not be allowed to partake in team activities unless the doctor agrees that the infection can be contained within a bandage or dressing.
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Edited by Jay Greene and Maura Allen, students of Rachel Larsen in Bio 083 at Bowdoin College