Feb. 2, 2005 -- Staph infections may pose a bigger risk to some professional football players than a tackle or quarterback sack, and the best defense may be better hygiene on the field and in the locker room.
New research shows a fall 2003 outbreak of methicillin-resistant Staphylococcus aureus (MRSA) skin infections among the St. Louis Rams were likely spread among players on as well as off the field through rough play and shared towels, whirlpools, and weights.
Researchers blame "turf burns" or areas of skin rendered raw by a run-in with artificial turf as both the source and means of spreading the fast-spreading bacteria that invade the body via cuts in the skin.
"These abrasions were usually left uncovered, and when combined with frequent skin-to-skin contact throughout the football season, probably constituted both the source and the vehicle for transmission," write researcher Sophia V. Kazakova, MD, MPH, PhD, of the CDC, and colleagues in the Feb. 3 issue of the New England Journal of Medicine.
The study also showed that linemen were 10 times more likely to develop the infection than a heavily guarded quarterback or other backfielder; the heavier the linebacker, the greater the risk.
Antibiotic-Resistant Infections On the Rise
The Rams asked the CDC for some defensive assistance and to investigate the outbreak in November 2003. By that time, a number of players had developed large skin abscesses caused by MRSA and additional infections were found in members of an opposing team, which suggested that the bacteria might be spread during play.
Methicillin is an antibiotic commonly used to treat staph infections. But the emergence of a growing number of staph strains that are resistant to treatment with this antibiotic is a major problem, as doctors have to consistently turn to more powerful antibiotics to treat them.
These types of antibiotic-resistant infections are commonly seen in health care settings, but the CDC says an increasing number of MRSA infections are being reported in people without links to hospitals, including football players.
In this case, researchers found that eight MRSA infections occurred during the 2003 football season among five of the 58 Rams players (9%). All of the infections occurred at the site of a turf burn and rapidly progressed to large abscesses 5 to 7 centimeters in diameter that required surgery to drain.
Most of the infections resolved within 10 days after the start of treatment, but three of the Rams players developed recurrent infections. Although none of the players required hospitalization, the affected players missed a total of 17 days due to their staph infection.
Mounting a Defense Against Staph Infection
After observing the team in action, researchers pointed out gaping holes in the team's defensive lines against infectious diseases that left them vulnerable to penetration by bacteria like staph.
- Turf burns were reported frequently among players during games and practices (about two to three turf burns per week).
- Trainers who provided wound care did not have regular access to hand-washing facilities or alcohol-based hand sanitizers.
- Towels were frequently shared on the field during practice and games with as many as three players per towel.
- Rams players often did not shower before using communal whirlpools.
- Weights and other training equipment were not routinely cleaned at the training facility.
In addition, researchers found the football players received an average of 2.6 antibiotic prescriptions per year. That rate is 10 times higher than among people of the same age and sex in the general population and may contribute to antibiotic resistance among the players.
Researchers beefed up the Rams' defense by installing wall-mounted soap dispensers at their training facility and instructing them in infection-control measures, such as appropriate wound care and monitoring of skin infections.
Based on these findings, the CDC has also initiated a joint effort with the National Collegiate Athletic Association (NCAA) to develop guidelines for the prevention and control of community-associated MRSA among college football players.