Journal Review: Gridiron infections show MRSA exists in community

Gridiron infections show MRSA exists in community

CDC developing guidelines for athletics

Kazakova SV, Jeffrey C, Hageman JC, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005; 352:468-475

Infected football players are the latest evidence that methicillin-resistant Staphylococcus aureus (MRSA) is emerging in American communities. A community-acquired strain of the ubiquitous MRSA USA300 clone was responsible for a cluster of skin abscesses among professional football players in the United States, investigators reported.

The St. Louis Rams squad had recurrent problems during the 2003 season and may have transmitted MRSA to their opponents. "Abscesses also occurred in a competing team after a game with the Rams, suggesting that transmission of MRSA occurred during game play," the authors noted.

However, it remains possible all the MRSA cases were acquired in the community rather than during the game, they conceded. All MRSA skin abscesses developed at sites of turf burns on areas of skin not covered by a uniform (e.g., elbows and forearms). These abrasions were usually left uncovered, and when combined with frequent skin-to-skin contact throughout the football season, probably constituted both the source and the vehicle for transmission. Infection occurred only among linemen and linebackers and not among those in backfield positions, probably because of the frequent contact among linemen during practice and games. Investigators noted a lack of regular access to hand hygiene (i.e., soap and water or alcohol-based hand gels) for trainers who provided wound care; skipping of showers by players before the use of communal whirlpools; and sharing of towels — all factors that might facilitate the transmission of infection in this setting.

"Clinicians and other personnel involved in the care of sports participants should be aware of the emergence in the community of MRSA with distinct microbiologic and epidemiologic characteristics," the authors advised. "Infections with these organisms predominantly cause skin abscesses in otherwise healthy persons who often have no health care exposures."

Obtaining cultures in suspected cases of infection and performing antimicrobial-susceptibility testing will facilitate early identification of cases and initiation of targeted treatment. Clinicians should drain abscesses and ensure that wounds are covered and contained with clean, dry dressings. Infected persons should receive guidance regarding enhanced hand and personal hygiene to prevent transmission. Frequently touched surfaces should be cleaned in accordance with manufacturer-recommended guidelines. Chlorhexidine-containing soap and nasal decolonization with mupirocin have been recommended to control outbreaks; however, data demonstrating the independent benefit of these agents in controlling MRSA in community clusters are lacking.

The Centers for Disease Control and Prevention is collaborating with the National Collegiate Athletic Association in developing guidelines for the prevention and control of community-associated MRSA among college football players. The guidelines will include educational materials targeted to athletic trainers and will describe infection-control practices and measures for responding to cases or clusters of infections.