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‘Staph’ skin infections in Sport

CA-MRSA stands for community acquired methicillin resistant staphylococcus aures, an
increasingly more common infection found among athletes. Staphylococcus aureus (staph) are
bacteria commonly living on the skin or in the nares (nose) of healthy people. About 30% of the
population are carriers (colonized without infection).  Most infections caused by staph are skin
infections and are not serious.  MRSA is a type of staph that is resistant to antibiotics called beta-
lactams which include methicillin, oxacillin, penicillin and amoxicillin. Approximately 1% of the
population is colonized with MRSA.  Making headlines recently, have been outbreaks among
professional and high school sports teams with some serious infections resulting in death.

Staph skin infections present as a pimple or boil.  They may be associated with warmth, redness,
and pus drainage.  When a pimple or boil rapidly worsens, suspect MRSA.  They are often
mistaken for spider bites and treated with incorrect antibiotics in many cases.

The CDC reports the following factors to be associated with the spread of MRSA skin infections:
close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and
surfaces, crowded living conditions, and poor hygiene.
 All factors common in sports participation.

Staph skin infections are transmitted most commonly by skin to skin contact.  

The bottom line: Practice good hygiene:

1.        Do not pick your skin or your nose or pick your nose and then your skin.
2.        Keep your hands clean by washing thoroughly with soap and water,scrub your hands for
more than 15 seconds.
3.        Keep all superficial wounds clean and covered with a bandage until healed.
4.        Avoid contact with other people’s wounds.
5.        Avoid sharing personal items such as towels, razors, and sports equipment.
6.        In the gym wipe off equipment before and after use and have clothing or a towel between
you and the equipment.

If you do contract a staph skin infection or have pimples or boils that pop up and worsen quickly:
seek medical attention, notify your coach, team, and/or trainer, cover your lesions, keep your
hands clean, wash all bedding and personal items in hot water, and avoid sharing towels, clothing
or equipment, and avoid picking at your skin.

Treatment:

If an abscess or boil (collection of pus in walled off space) is present, incision, drainage, and
culture should be performed.  Prior to antibiotic sensitivity testing, antibiotics may be prescribed by
your health care provider.  If surrounding skin is not angry red warm infectious appearing
(cellulitis), then they may wait and monitor you without antibiotics.  Over prescribing antibiotics
for non bacterial infections (such as viral colds) has lead to bacterial resistance and should be
avoided.  After incision and drainage, even if culture comes back positive for MRSA, some
infection disease specialists have recommended in the absence of cellulitis, monitoring without
antibiotics to prevent further resistance.

Current antibiotics that may be prescribed for MRSA are Bactroban (topical cream); oral agents
such as: Trimethoprim-Sulfamethoxazole (TMP-SMX or Bactrim DS) with or without Rifampin,
Doxycycline/Minocycline for sulfa allergic patients, or Clindamycin (if erythromycin resistant only
after a lab test called the D-Test is performed to evaluate for clindamycin resistance); and  IV
antibiotic such as Vancomycin, Daptomycin, or Linezolid for disseminated systemic infections.

For recurrent infections, your doctor may culture your nose and treat with nasal mupirocin
(bactroban ointment) to your nares 2x/day for 5 days to try to
eradicate colonization, plus Hibiclens body washes.

Return to play:

No player involved in contact sports may return to play with any new, healing, moist, or active
draining lesions.  Some recommend 48 hours of oral antibiotics as well prior to return.  No
consensus guidelines exist to date (10/17/07).

For Health Care Professionals:
Link to Johns Hopkins Point of Care Information Technology
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