Page 127 - Athletic Health Handbook
P. 127
where patients often have an immuno- surfaces or objects, lack of generalized failure by medical personnel to culture
logic compromising systemic disease cleanliness, crowding, compromised the wounds and prescribe appropriate
for which they are administered multi- skin integrity, and increased antimi- antibiotics. Frequently, broad-spec-
ple antibiotics. It is commonly believed crobial usage. trum antibiotics are often initiated
that antibiotic overuse contributes to that are ineffective against MRSA
the development of MRSA. Patients Several risk factors for infection infection. Fortunately, systemic
with skin infections caused by MRSA have been better identified as the illness is uncommon, though hospital
are much more likely to have been number of infections increases. First, admission is occasionally required for
treated with antibiotics in the months competitive sports participants often administration of intravenous antibi-
prior to the infection than those develop abrasions and skin trauma otics and surgical wound debridement.
infected with methicillin-sensitive S. that may facilitate entry of bacteria.
aureus (MSSA). S. aureus resistance Even in sports where there is limited Treatment of Established
to commonly used antibiotics in contact, protective clothing can cause MRSA Infections
superficial skin and soft-tissue wounds skin chafing, resulting in abrasions.
caused by S. aureus has greatly Second, most documented outbreaks Treatment of MRSA infections
increased in recent years. Specifically, involve frequent physical contact involves a three-pronged attack: (1)
the Staphylococcal cassette chromo- among players (e.g., football and administration of appropriate antibi-
some mec, found in MRSA, does not wrestling). Upper body infections otics, (2) debridement of all necrotic
develop in methicillin-susceptible appear to be the most common in tissue, and (3) prevention of spread
S. aureus exposed to antimicrobials. this setting where frequent contact to either another part of the body or
Instead, patients usually acquire occurs to areas of skin left uncovered. to another person. Clindamycin and
MRSA through direct spread or trans- For example, we have noted that an trimethoprim-sulfamethoxazole can
mission. Prior antibiotic therapy outbreak among professional football be effective against less virulent strains
is believed to provide a selective players primarily involved linemen of CA-MRSA. Vancomycin has been
advantage for such transmission. where there was recurring contact of the standard antibiotic for more
exposed arms between competitors. aggressive MRSA infections, however,
Outbreaks of community-associ- Third, some sports, such as fencing, it requires intravenous administration.
ated MRSA (CA-MRSA) have been have limited skin-to-skin contact but Linezolid can be administered either
recently noted in previously asymp- involve the use of multiple pieces of orally or intravenously. It has shown
tomatic, healthy individuals with no shared equipment and clothing which to decrease the length of hospital stay
obvious risk factors, including children may act as vehicles for S. aureus for the treatment of complicated
attending daycare, prison inmates, and transmission. This mechanism of MRSA skin infections and is effective
homosexual couples. The common bacterial transfer is also seen at the in achieving a clinical cure rate of
denominator among these groups high school level where budget limi- 92.3 percent in skin infections caused
appears to be close physical contact tations necessitate sharing of such by MRSA in children. Linezolid and
and sharing of clothing or personal items as towels and water bottles that vancomycin have been demonstrated
items. It is recognized that CA-MRSA are infrequently laundered or cleaned. to be equally effective in the treatment
can be spread through competitive of MRSA infections in hospitalized
sports. Transmission of S. aureus (both Clinically, these lesions typically adults. Athletes may be allowed to
susceptible and resistant strains) in present as quarter or half-dollar sized compete while being treated for
this population usually occurs through (2–3 cm) erythematous wounds infection as long as the skin lesion
close physical contact with a person surrounding a purulent center. is thoroughly covered and the player
who has either a draining lesion or is Depending upon the duration and does not exhibit systemic signs of
an asymptomatic carrier of S. aureus. severity of the infection, cellulitis infection (i.e. fever, malaise).
Previous rates of asymptomatic MSSA may also be present. Rarely does
carriage among the general population the infection penetrate through the Screening for colonization with
have been estimated at 20 percent underlying fascia. These lesions are MRSA is a key aspect of infection
to 30 percent; whereas, MRSA frequently at or adjacent to the site control to limit the spread of this
nasal colonization rates are typically of a prior scratch, abrasion, or lacera- organism. Colonization of the nares
less than 5 percent. Risk factors for tion, and are typically located on with MRSA in asymptomatic patients
nasal carriage include: close physical the extremities. Players may describe increases the risk of subsequent MRSA
contact, exposure to contaminated multiple such infections over the infection. Nasal mupirocin ointment
course of an athletic season due to has been the standard treatment to

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