During the fall of 2002, many athletic teams in Texas suffered an outbreak of boils. The problem was large enough that the Texas Department of Health (TDH) issued a letter to all Texas Athletic Trainers outlining appropriate treatment.

The boils seemed to be caused by Methicillin Resistant Staphylococcus (Staph) aureus (MRSA). This is a strain of bacteria that has evolved to be resistant to Methicillin antibiotics. Methicillins are derivatives of the older antibiotic penicillin. There are other multidrug-resistant organisms seen in the medical community however, MRSA is the most commonly seen. These outbreaks have normally been confined to the nursing home or hospital setting.

Many of the bacterial agents that are resistant to “standard” antibiotics can normally be found living on or in the human body. This is referred to as COLONIZATION. These colonies of bacteria are not present in sufficient numbers to cause any illness or infection. It is estimated that 25% - 30% of the population is colonized in the nose with Saph bacteria at a given time.

The term INFECTION refers to a state where the organism is present in a quantity large enough to cause an illness.

Staph bacteria are one of the most common causes of skin infections in the United States and are common causes of pneumonia and bloodstream infections. Since a large segment of the population actively harbors the bacteria, precise numbers about Staph infections are not known.

Staph is spread among people having close contact with infected people. MRSA is almost always spread by direct physical contact, and NOT through the air. Spread may also occur through indirect contact by touching objects (i.e., towels, sheets, wound dressings, clothes, workout areas, sports equipment) contaminated by the infected skin of a person with MRSA or Staph bacteria.

If you think that an infection is caused by MRSA, see a physician immediately. This wound will look like the classic “boil.” A large area of red skin with a head or pocket of exudate (pus) in the center.

The wound should be cultured to determine if it contains any antibiotic resistant bacteria. This culture will allow the physician to treat the specific bacteria causing the infection. Prescribing the incorrect antibiotic agent can make resistant bacterial infections worse.

There are forms of Staph aureus that are NOT multidrug-resistant. These types of infections will respond to “normal antibiotics.” Examples of antimicrobial agents that are effective against MRSA are: Rifampin, Clindamycin or Vancomycin.

WHAT INCREASES THE RISK FACTORS

There are several risk factors for both colonization and infection:

Severity of Illness,

Previous exposure to antimicrobial drugs,

Underlying disease or illness, such as;

    Chronic Kidney Disease,

    Insulin-Dependent Diabetes,

    Peripheral Vascular Disease, and

    Dermatitis or Skin Lesions.

Invasive procedures, such as;

    Dialysis,

    Presence of Invasive Devices (plates, etc), and

    Urinary Catheterization.

Repeated Colonization by Multidrug-Resistant Organisms,

Previous Colonization by Multidrug-Resistant Organisms, and

Advanced Age.

Many of these issues do not apply to the high school athlete. Several, however, can be of direct concern.

Previous exposure to anitmicrobial drugs is of larger concern in the medical community today than ever before. When we are sick, we expect the treating physician to prescribe medication to make us better. Many times in the past years, physicians have prescribed antimicrobial or antibiotic medications when they were not needed. This has resulted in bacteria mutating into forms that are resistant to “standard antibiotics.” These mutated strains are often responsible for the types of infections that cause MRSA infections.

PREVENTION

There is no 100% prevention for a microbial infection. Several easy steps can be taken to lower the risk of a “minor infection” or “minor cut” from becoming a “major infection.”

These include:

Wash hands and wounds with soap and water after treating a “minor wound.” Proper washing technique is to scrub aggressively for 30 seconds or more. Anti-bacterial soaps offer no more cleaning power than other soaps. The time spent washing is more important.

Wash hands after treating another person’s wound.

Towels used for drying hands after contact with your own wound or another's should be used only once and laundered.

Disposable gloves should be worn when treating another individual to prevent a colonization spread from the caregiver to the patient and vice versa.

Bed linens and clothing should be changed and washed if wounds are oozing through protective bandages.

Treatment areas, such as sinks and counter tops should be cleaned immediately after use.

The patient’s environment should be cleaned routinely and when soiled with body fluids.

Notify physicians and other healthcare personnel who may care for the affected individual that they may be infected with a antimicrobial resistant bacteria.

Keep cuts and abrasions clean and covered with proper dressings until healed. During athletic contests, the wound should be properly cleaned and covered. Placing a hydrogen peroxide soaked guaze pad over the wound will help to prevent colonization of the wound by MRSA. This pad can be held in place easily with Coban® or an equivalent product.

Avoid contact with another person’s wounds or any material that may have been contaminated from the wound.

Shower regularly after athletic practices and games.

Please visit The Centers For Disease Control or The Texas Department of Health for more information.