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Written by Jason Browdy, M.D.
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Page 1 of 3  Methicillin-resistant Staphylococcus aureus (MRSA) infections have been a concern in hospital settings for several decades. But in recent years, there have been many reports of MRSA infections in the general community, and several MRSA outbreaks have been reported amongst athletes and sports teams.
What is MRSA?MRSA stands for "Methicillin-resistant Staphylococcus aureus." Prior to the development of antibiotics, infections with bacteria such as Staphylococcus aureus had a high morbidity and mortality rate. With the development of penicillin, survival from staphylococcus infections improved dramatically. However, like any other living organism, bacteria have the capacity to mutate, and eventually penicillin resistance evolved.
Semi-synthetic penicillins such as Methicillin were introduced in the 1960s to treat Staphylococcus that was resistant to penicillin. However, like a game of evolutionary chess, Methicillin resistance emerged, hence the term "MRSA."
Various Strains of MRSAWhile a variety of strains have been identified, MRSA has generally diverged into two types of strains: hospital-acquired MRSA and community-acquired MRSA. In general, hospital-acquired MRSA infects people exposed to at least one of many health care risk factors such as recent hospitalization or surgery. Hospital-acquired MRSA strains are usually resistant to multiple antibiotics. In contrast, community-acquired MRSA strains can infect healthy, young individuals with no particular risk factors. These individuals typically have no history of long-term antibiotic exposure, thus community-acquired MRSA is generally more sensitive to a broader array of antibiotics.
The Center for Disease Control (CDC) recently estimated that 94,000 invasive MRSA cases occurred in the United States in 2005, and an estimated 19,000 were fatal. While most of the invasive cases occurred in individuals with health care risk factors, the CDC estimated that 14% of invasive infections were community-acquired. Invasive infections can involve the blood stream or organs such as the lungs or kidneys. Most community acquired MRSA infections are noninvasive, involving primarily soft-tissues, but there are several reports of soft-tissue MRSA infections that have progressed into invasive infections.
MRSA In AthletesAthletes at all levels have been the subject of an increasing number of reports of MRSA soft-tissue infections. One of the first documented athletic outbreaks of MRSA occurred in 1993 when six wrestlers at a single Vermont high school developed skin infections.
The most high profile outbreak involved the Saint Louis Rams. During the 2003 football season, five of 58 team members had MRSA soft-tissue infections. A college football team in Connecticut also reported an outbreak in ten players in 2004. The Washington Redskins reported five cases before they took extra precautions to prevent the spread of MRSA. In September of this year, 11 Eureka High School students were infected with Staphylococcus, including seven football players. Two students were hospitalized.
Eddie Hedrick, the Emerging Infections Coordinator for the Missouri Department of Health, has noted an increase in the amount of drug-resistant Staphylococcus infections. Governor Matt Blunt has recently directed the Department of Health and Senior Services to increase efforts to educate more people about staph detection, treatment and prevention.
Why Does MRSA Occur in Athletes?Staphylococcus bacteria are commonly carried on the skin or in the nose. The bacteria can be spread by direct physical contact or by contact with objects contaminated with the bacteria, such as towels, sheets, dressings or sports equipment. In the case of the Rams breakout, MRSA was cultured from team whirlpools, taping gels, and from 42% of staff nasal swabs. In the Connecticut breakout, the state health officials found that players with turf burns were seven times more likely to get an MRSA infection. They also found that players that shaved part of their body were six times more likely to develop MRSA infections.
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