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When most people think of a professional athlete, they picture someone in the peak of health, the picture of fitness. These days, sports team often hire nutritionists, and of course, utilize the services of physical therapists, podiatrists and trainers, in their efforts to develop the healthiest individuals possible. Yet, many in this industry are running scared, frightened by a possible attack of the next superbug infection.
A hot topic in medical journals and sports publications alike is that of MRSA infections. But what kind of infection is this, and why is it so dangerous? Another popular question is how do healthy athletes become afflicted with this condition?
It is difficult to not have some familiarity with this problem, having garnered so much press, so much attention, but if you are not a health professional, and have not read in detail, some answers to these questions, I will attempt to provide some
Perhaps the first topic to discuss is what exactly does MRSA stand for? It is the popularized name for a species of bacteria, which are part of a group termed staph (short for staphylococcus). What is special about this strain is the resistance to many antibiotics which this organism has developed. The first one discovered was a powerful drug called methicillin. Thus, because of the "bug's" ability to stand up to the drug, it has become universally referred to as methicillin-resistant staph aureus, aka MRSA.
MRSA is a contagious bacterium, resistant to many of our strongest antibiotics, which makes it challenging to treat. Often referred to as a superbug, MRSA infections may begin as a skin sore, pimple, or boil, before becoming serious, potentially harmful, and sometimes fatal.
Many bacterial infections are only dangerous to those with an impaired immune system, the debilitated or infirm. But even a healthy athlete, should they become inoculated with MRSA, can become severely ill, and yes, sometimes even die. And yet, Staph aureus bacteria commonly reside inside the nose and on the skin of people, and can be cultured from the nose of one out of every three people, but cause no sickness whatsoever.
The resistant variety can be found in 2 out of every 100 people, although actual contagion is typically contracted in a healthcare setting. But staph infections are commonplace, and are a particular concern to surgeons, since they are the cause of many wound and surgical infections.
MRSA infections are typically classified as healthcare-associated or community-associated, with approximately 86 percent of all invasive MRSA infections being healthcare-associated. Community-associated MRSA is contracted outside of a hospital setting, but is significantly less common.
Factors that cause an increased risk of developing community-associated MRSA include such disparate possibilities as living in an environment with a lot of people (eg military bases, jails, campus housing), cuts or scrapes to the skin, and the regular injection of drugs.
The media has carried many stories about virulent bacteria, with MRSA being one of the most prominent. Deaths have occurred, sometimes in healthy, young people, so this is not a condition to be trifled with. Early recognition is critical. Staph skin infections, including MRSA, early on appear as a bump on the skin that could be mistaken for an insect bite. The infected area will generally be reddened, inflamed, painful and hot to the touch. Another distinctive characteristic of these organisms is that they stimulate the production of purulence, which is pus. When the infection becomes blood-borne, a fever will develop, which will often be accompanied by chills, confusion, and fatigue.
MRSA frequently causes illness in people with a compromised immune system who interact with or reside in hospitals and healthcare facilities. But not everyone will contract a MRSA infection just because they come into contact with the bug. Some examples of those who are more likely include those who have been in a hospital for a long period of time, those on dialysis, people receiving cancer treatment, as well as certain medications that affect immune function.
Because many people visit hospitals, they are an excellent environment for bacteria to be spread. A break in the skin barrier – such as a surgical wound, burn, use of a catheter, or intravenous line - can allow the bacteria to enter the body. Age is also a factor since multiple, complex health issues will lower someone's ability to fend off contagion.
MRSA can spread from person-to-person (skin-to-skin contact) and from person-to-object-to-person when an individual has active MRSA or is colonized by the bacteria. Skin-to-skin contact with someone carrying MRSA is not necessary for infection to spread.
MRSA bacteria have the ability to survive for extensive periods on surfaces and objects in hospitals. This allows them to be transmitted to an individual with no contact at all from the person who was the source of the bacterium.
Surfaces such as door handles, floors, even cleaning equipment, have all been found to harbor MRSA. One study looked at staph survival on some common materials to determine the survival of resistant staph. These included cotton clothing, scrub suits, lab coats, even drapes made of 100% polyester. They found that S. aureus survived on these materials for an extensive length of time, 4 to 21 days on cotton, polyester 1 to 40 days, and polypropylene for more than 40 days. Clearly, these results demonstrate the need for meticulous disinfection procedures to limit spread of bacteria.
Many individuals participating in sports will experience regular skin-to-skin interaction. Contact or collision sports (ice hockey, soccer, football, basketball) all can lead to the transmission and development of a MRSA infection.
The average age of a person with community-associated MRSA is 23, so obviously these are not the infirm or debilitated. In fact, the numbers show us that these occur mostly in younger individuals who tend to be much more involved in sports. These infections obviously are an issue that concerns high level sports teams, so many of them are instituting better sanitary measures in an effort to reduce the incidence.
Around 94,360 invasive MRSA infections are diagnosed annually in the U.S., with 18,650 associated deaths. Recent data shows that these infections are developing less frequently. A CDC study noted that severe, healthcare associated infections declined by 54 percent between 2005 and 2011. This could be because of better awareness, and better hand-washing and sanitary practices, but this has not been confirmed.
Still, these infections are responsible for thousands of deaths in American hospitals every year, and they cost the economy billions of dollars. New antibiotics are being developed. Even the use of a special ultraviolet light, which may be usable in the surgical setting (where some of the most problematic and dangerous infections develop) is being investigated.
Bacterial resistance is a serious problem, but MRSA is not the only concern. Infectious disease experts everywhere are troubled, nervous even, about this trend to resistant bacteria. Learning about proper hand-washing practices and other appropriate methods of sanitary technique is essential. This is especially true if you are going into a healthcare setting.
Or into a crowded situation, especially with skin-to-skin contact. These methods of sanitary practice can greatly lower your risk if put into practice. As is so often the case, when it comes to staying healthy, education is key.
Editor's note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.