Methicillin resistant staphylococcus aureus (MRSA) is a virulent strain of cocci-type bacteria that is highly resistant to multiple types of antibiotics. MRSA first emerged in hospitals, with the first reported case appearing in the medical literature in 1963. The infection remained confined to the hospital setting until community acquired cases were reported in the 1990s. The first community acquired cases occurred in a high school wrestling team in 1993, followed by a rugby club in 1998. Studies have shown that 25%-30% of individuals are colonized with MRSA on the skin or in the nose and throat. Current statistics show that 50% of skin infections are caused by MRSA. The ubiquity of the bacteria has led to increasing rates of infection in the community. Infections occur in the setting of poor hygiene, with bacteria entering the skin through an abrasion or cut.
Types of MRSA Infections
MRSA infections most often involve the skin, manifesting initially as folliculitis. Patients often describe the initial findings as an “infected pimple”. If not treated promptly, the infection may progress to more extensive soft tissue infection such as cellulitis, endocarditis (infection of the lining of the heart), sepsis (blood infection), and necrotizing fasciitis (the so-called “flesh-eating” disease).
Transmission of MRSA
The most common method of transmission of MRSA infection is through an open wound, such as a cut or abrasion of the skin. MRSA may colonize the skin in individuals with poor hygiene habits ( lack of hand washing or showering). MRSA colonization increases the risk for infection, both for the colonized individual, and those in close contact with the individual. Sharing of personal items (razors, towels), and lack of cleanliness of exercise equipment also increases the risk of infection.
Treatment of MRSA Infections
Initial diagnosis of MRSA infection should include culture of any drainage for the purpose of microbiologic diagnosis. Diagnostic cultures can guide appropriate antibiotic therapy by revealing antibiotic susceptibility of the bacteria. Initial treatment includes incision and drainage of the infection, if needed, followed by oral antibiotics. Patients may be given one of the following oral antibiotics:
- Trimethoprim-sulfamethoxazole (Bactrim DS)
- Doxycycline
- Clindamycine
- Tetracycline
- Minocycline
In more severe infections, I.V. antibiotics may be used.
Prevention of MRSA Infections
Since most infections are a result of a lack of cleanliness, care should be taken with personal hygiene. Additionally, athletes should refrain from sharing personal care items, and facilities should properly clean and disinfect training equipment periodically. Sports participants should cover all cuts and abrasions, to prevent infection. Players should be counseled to avoid sharing personal care items, and training staff should be instructed on proper disinfecting of equipment.
Return to Play for Athletes
Athletes should be held out of practice and competition when first diagnosed with an MRSA infection. In mild cases, the athlete may return to competition after receiving antibiotic therapy and cleared by a physician to participate. Athletic clearance is usually given after it is determined that the risk of communication of MRSA has been eliminated by treatment.
Reference: Emedicine from WebMD - MRSA in Athletes
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