Champion's Edge Helpful Hint Zone:

The Newest Threat to Athletes: Methicillin-Resistant Staphylococcus Aureus (MRSA)

By: Bryan S. Bentz MS, ATC

Methicillin-resistant staphylococcus aureus (MRSA) is quickly developing into a widespread threat to athletes in all sports as well as the general population. MRSA is a very serious infection that was once confined mostly to hospitals. The infection has recently crossed over to the general population, and is now infecting athletes of all sports and levels.

Bacterial infections in athletes are very common and can greatly hamper their ability to compete and perform at their best, but these infections are usually easily treated with antibiotics such as penicillin, amoxicillin, methicillin, and oxacillin. MRSA is a staphylococcal bacterial infection (commonly known as a staph infection) that has become resistant to many of these antibiotics that doctors commonly prescribe to treat bacterial infections. This creates a very serious problem for both the athlete and the doctors that provide their medical care. There are a few high-powered new antibiotics that currently exist to treat this infection, but if the bacterial strain mutates further and builds up resistance to these drugs too, doctor's treatment options will be further limited.

The spread and occurrences of MRSA in athletics is increasing. Prior to 2002, resistant staph infections were virtually unheard of in such a healthy population. Many of the first athletic cases were reported in football. Now football players from the high school level to the pros have had outbreaks. Many collegiate teams, including national championship caliber programs, have also had major problems controlling the spread of this infection. MRSA is usually spread by direct person-to-person contact. MRSA is commonly found on the skin or in the nose of healthy people. Having the bacteria present in or on your body does not mean that you will develop infection, and many people live healthy lives without ever developing an infection. Sports such as football, wrestling, and soccer are among the highest risk to spread the infection due to the constant bumping, hitting, and contact with teammates and opponents. These sports generally also have exposed areas of skin and open wounds when practicing or competing that may come in close contact with other athletes. MRSA requires contact to be spread from person to person and is not spread through the air. However, it can be spread by direct contact with contaminated towels or equipment that athletes may share or use during workouts. Once an infection develops in an athlete it can quickly spread throughout a team and to opponents.

Many MRSA infections start as a small skin lesion or pimple, but the bacteria can also travel through the blood stream and settle into internal tissues, such as bone. Skin infections often occur in the area of a previous wound that allowed the bacteria to enter the body. Wounds such as turf burn abrasions, fingernail scratches, or even a small open blister or pimple could allow the infection to enter and manifest. When infected, the first symptoms may yield a small painful red swollen spider bite or boil looking skin lesion. If left untreated the infection will spread to surrounding tissues creating a pus filled abscess. Without treatment the infection then may advance and spread to the bloodstream making it harder to treat and control. Advanced infection symptoms may include shortness of breath, chills, and fever and ultimately could result in death if not properly treated.

Treatment for MRSA requires proper diagnosis. Any infection that does not heal in a timely matter, does not respond to antibiotic therapy, or that is draining pus or other fluid should have MRSA ruled out as a possibility. Diagnosis of MRSA requires a culture of the infected area. The culture is then sent to a lab that will determine if the infection is an antibiotic resistant strain such as MRSA. Many physicians also advocate a sterile incision into the wound to allow proper drainage of pus. The wound should then be covered and treated with special antibiotic ointments and observed during the healing process for worsening or spread to surrounding tissues. Wound dressings should be kept clean and dry and changed twice a day. Hospitalization may be required in some cases. Return to play should not be considered until the wound is healed of all infection and the athlete is no longer at risk of spreading the bacteria to teammates and opponents.

• Share shower towels
• Share razors and equipment
• Share deodorant
• Share balms or ointments among teammates or friends
• Share blankets or pillows at tournaments or on the bus
• Lay on the floor of the locker room
• Use community towels on the sidelines to be shared among athletes, including ice buckets and wet towels to cool athletes (use single use disposable towels instead or do not directly touch athletes)
• Use whirlpools and other common use medical equipment when infected
• Share beds with friends or teammates without changing the linens first

• Clean equipment, weights, mats, and work-out machines after each individual use, not each session
• Maintain a clean locker room, including showers, floors, and carpets
• Occasionally wipe down and disinfect meeting rooms, desks, and common areas
• Encourage showering and hair washing with hot water and antibacterial soaps and shampoos after every practice, competition, or workout
• Frequently wash uniforms, practice gear (including pads and sports braces), and towels in hot water. Add bleach if you can without ruining your clothes
• Avoid close direct contact with infected individuals
• Finish all antibiotics prescribed to you by your doctor, unless your doctor tells you otherwise
• Use gloves when handling, washing, or moving bloody or sweaty equipment, jerseys, or bandages. Throw away used bandages and bloody gauze in red biohazard bags
• Train athletes, coaches, and medical staff to recognize potentially infected wounds and administer basic first aid treatment for wounds
• Keep all wounds (even small abrasions, turf burns, or scratches) bandaged and covered with an antibiotic ointment when participating. If a wound can not be adequately covered consider excluding the athlete from participation
• Report any skin abnormalities, lesions, or wounds to your doctor or certified athletic trainer
• Place and use alcohol-based hand sanitizers in athletic facilities and in medical bags
• Have medical staff and coaches wash with soap and water, or use an alcohol-based hand sanitizer, after contact with each patient/ athlete that is bleeding or very sweaty

MRSA is a serious problem that has crossed over from the hospital setting to the general population and athletics. Though it is a threat to athletes and the people they come in contact with, it can often be prevented. By being aware of the signs and symptoms of MRSA, using good hygiene, and carefully following the prevention steps listed above many MRSA cases can be avoided, allowing athletes to continue their training routines and to perform at their top level.

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