College athletes in contact sports more likely to carry MRSA, Study finds

In a press conference yesterday at IDWeek 2014, the annual meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association and the Pediatric Infectious Diseases Society at the Pennsylvania Convention Center, researchers unveiled their findings that college athletes in contact sports are more likely to carry the superbug methicillin-resistant Staphylocuccus aureus (MRSA) than those in non-contact sports as well as those in the general population.

This study is the first to observe college athletes outside of an actual outbreak of MRSA. What researchers found was that even if they don't show signs of infection, these athletes are more likely to carry MRSA (called colonization) usually in their noses and throats, which increases their chance for an infection later, as well as the likelihood that they will spread it to others.

During the two-year study, they found that in contact sports, colonization rates ranged from 8 to 31 percent, while in non-contact sports the range was 0 to 23 percent. In the general population only 5 to 10 percent is colonized with MRSA.

One of the important takeaways from the study was that even when athletes are healthy, they still might be carriers of MRSA. Because of this, more focus needs to be put on prevention, said Dr. David Calfee of Weill Cornell Medical College, New York-Presbyterian/Weill Cornell Medical Center, the moderator of the press conference panel.

Calfee also said, "Historically MRSA was associated with healthcare settings, but that is not so much the case anymore. Today it is more of a community-based infection. We see it more in prisons, the military and in sports which suggests that crowded conditions, skin to skin contact and skin injury are big factors."

The researchers also called for more work to be done studying the epidemiology of this infectious disease.

Dr. C. Buddy Creech, MPH, Vanderbilt University Medical Center, Nashville, Tenn. explained, "Our findings tell us that specific strains are needed to cause infection. We need to better understand the epidemiology of MRSA ."

This particular study followed 377 male and female Vanderbilt University varsity athletes playing 14 different sports, including 224 who played contact sports such as football, soccer, basketball and lacrosse and 152 who played non-contact sports, including baseball, cross country and golf. During two academic years (August 2008 to April 2010), these athletes came in monthly for nasal and throat swabs in order to track how long it took for them to be colonized with Staphylococcus aureus (staph), including the antibiotic-resistant MRSA as well as how long they carried it. A self-administered questionnaire was given at the beginning of the study to determine risk factors for colonization.

MRSA is a leading cause of skin and soft tissue infections, which often heal on their own or are easily treated. Highly antibiotic-resistant MRSA however can lead to pneumonia and infections of the blood, heart, bone, joints and central nervous system, and kills about 18,000 people every year.

Study findings indicated that athletes in contact sports are at a higher risk for getting colonized with or infected by MRSA because they have skin-to-skin contact and often have cuts and scrapes that allows the bug to enter the body. Football players seem to be the most susceptible group.

"Sports teams can decrease the spread of MRSA by encouraging good hygiene in their athletes, including frequent hand washing, showering after every practice and game, and avoiding sharing towels and personal items such as soap and razors," said Natalia Jimenez-Truque, PhD, MSCI, research instructor, Vanderbilt University Medical Center, Nashville, Tenn.

She emphasized that athletes with scratches and cuts should not practice or play in the game.

"If you can't refrain from play, then treat and cover up wounds appropriately," she added. "70% of athletes infected end up being hospitalized so prevention is very important."

Brandon Noble, former Washington Redskins defensive tackle and MRSA survivor shared his personal story at the press conference. He said that it all started in 2004 after he was recovering nicely from his second knee surgery. He found a hot spot on his knee that quickly spread, despite taking antibiotics. At his daughter's second birthday party, he found himself just lying on the couch feeling really sick. When his parents took him to the emergency room, the infectious disease doctor told them that if they waited another twenty-four hours he probably would have lost his leg.

He spent 7 days in the hospital having to undergo surgery again before being sent home with a picc line. He spent another 3 months healing. When he finally got back in the game after rehab, he ended up with a bone bruise on his left leg which became infected with MRSA as well. This time it was harder for him to bounce back. Noble suffered from pulmonary embolisms and needed to be on blood-thinners. When he was told that he couldn't practice or play while on them, he knew that he had no choice but to retire.

"It was a snowball effect of the first infection that ended my career," he said.

The threat of MRSA is always in the back of his mind and now that his one son is in middle school and playing football, he and his wife are extra vigilant.

Noble agreed with the researchers on the panel with the importance of prevention."As soon as you get turf burn, treat and cover it up."

Although little staph has been found in locker rooms and training centers, keeping equipment clean is also vital.

"Locker rooms are really gross places and athletes don't realize it," he added. "After practice, I would lie on the table in the training room and watch television and then go take a shower. Then another player would come right in and lay down in the exact same spot."

Jimenez-Truque said that more education is needed especially for parents of young athletes in middle school and high school. Something as easy as making sure everything in their child's gym bag gets thoroughly cleaned right after each practice or game could make a difference.

Creech emphasized that it was impossible to eradicate all staph from our skin. He said, "The idea that we can prevent it is pretty tough. People will carry staph as long as we have noses."

According to Medline Plus, many healthy people normally have staph on their skins and most of the time they never get infected from it. The concern comes more from newly acquired strains.

"Staphylococcus aureus is really good at inventing itself," said Creech.

Read more Sports Doc for Sports Medicine and Fitness.