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From the National Federation of High School Associations

CA-MRSA and the Athlete

Over the past several years, skin infections in sports have come to the forefront. Whether it is in professional or high school sports, the risks and problems remain the same. In 2003, the St. Louis Rams professional football team suffered an outbreak of a severe bacterial infection, Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA). An infection that can be controlled when limited to one player, but when several team members are involved, it can spread quickly and become difficult to contain.

The presence of CA-MRSA in our communities has skyrocketed in the past several years. Believed to have developed from over-usage of antibiotics in our society, its presence is noted in the normal public and accounts for 59 percent of skin and soft tissue infections seen in the emergency room.

MRSA infections typically present as a small area of redness or cellulitis to the infected area of skin. The lesion initially may be mistaken as a "spider bite," which develops quickly into a boil that requires cutting open, or lancing, to drain. More serious consequences, although rare, may develop in the form of sepsis (spread of the infection throughout the body), which can lead to death. Factors promoting this occurrence are delayed treatment or use of the wrong antibiotics.

The uniqueness of these bacteria is twofold: resistance to normal antibiotics and its development into a boil. Even with this type of presentation, there is no way to determine if CA-MRSA is the cause without performing cultures or special tests on the draining material.

Staphylococcus aureus can be a normal bacterium that occasionally exists on the surface of our skin. Its presence is a dynamic process that changes relative to our exposure and hygiene. Close contact with a person or environment where it is prevalent will increase our risk of carrying it. This can happen through daily interaction with others. A simple handshake or even sharing contaminated towels in a bathroom can serve as the vector of transferring it. Changes in our level of exposure or more diligent hygienic practices can remove it, thus allowing it to be removed from the body and not be found.

One body part that gets a lot of attention where the bacterium may reside is the nose. Whereas 20 to 30 percent of humans may normally harbor methicillin-sensitive staph aureus in their nose, 0.8 percent may have CA-MRSA at any one time. Not all who carry this bacterium will get an infection, but they could serve as a source for others. Usually a break in the skin or an abrasion serves as the portal for the bacteria to invade and allow an infection to develop. Exposure to this bacterium can occur during athletic activities. Risks for infection increase when simple abrasions or cuts develop through the normal course of the sport.

Other risk factors for its development include:

  • contact sports
  • sharing hygiene products in the locker room (such as deodorant, razors, towels)
  • utilizing the whirlpool without showering before entering
  • abrasions that aren't properly cared for
  • sharing bars of soap in the shower, and
  • shaving in the genital regions.
When all these risks are taken into account, treatment is presumptive and requires close follow-up to ensure proper measures are taken. At this time, draining the boil is the most effective means of getting rid of the infection. Using antibiotics may be helpful, especially if the infection has spread beyond the local abscess.

Re-institute showering after sports

Prevention of this infection requires a refocus on basic hygienic principles. Twenty years ago, there was a change in the high school setting. Showering at school was not mandated after gym or athletic events. This needs to change. Showering immediately after gym class or practice/competition is the most important means to help prevent a skin infection.

Skin infections in sports can have serious consequences, but with proper treatment and following of hygienic principles, these conditions can be controlled.

Source: National Federation of High School Associations (NFHS) 

B.J. Anderson, M.D., who is a family practitioner at Boynton Health Service at the University of Minnesota in Minneapolis, Minnesota, serves on both the Minnesota State High School League Sports Medicine Advisory Committee and the NFHS Sports Medicine Advisory Committee. Anderson is team physician for the Augsburg (Minnesota) College wrestling team, and medical advisor for Minnesota/USA Wrestling. He may be contacted at amosnandie@msn.com.