More than half of athletic trainers report treating MRSA

May 2007

More than half of athletic trainers have treated athletes for skin infections caused by an antibiotic-resistant superbug, according to study results presented at the 17th Annual Scientific Sessions of the Society for Healthcare Epidemiology of America, held recently in Baltimore.

Methicillin-resistant Staphylococcus aureus was once a concern only among hospitalized patients and immunocompromised patients. During the past 10 years, however, incidences of MRSA have increased among otherwise healthy people.

“All health care providers who treat athletes should be concerned about MRSA,” Kristin Brinsley-Rainisch, MPH, a health scientist at the CDC, told Infectious Disease News. Brinsley-Rainisch presented results from the study conducted by CDC researchers.

“If an athlete presents with a purulent skin infection, health care providers should consider MRSA as the cause. It’s also important to provide athletes with information on appropriate wound care to prevent transmission,” Brinsley-Rainisch said.

Increased risk

Athletes are at an increased risk because the bacteria can be spread through skin-to-skin contact in sports and from shared clothing, sports gear or other items such as towels. Increased likeliness of athletes to have open sores from sports injuries also multiplies their susceptibility to MRSA.

MRSA in otherwise healthy people was first widely recognized as a problem in the late 1990s. Although the infections are not considered life-threatening, MRSA skin abscesses may require surgical draining. Another concern is the bacteria’s resistance to first-line antibiotics.

In rare cases, MRSA can cause potentially fatal conditions, including pneumonia, blood stream infections and necrotizing fasciitis, also known as a ‘flesh-eating’ disease. There are reported deaths of athletes associated with MRSA infection.

Trainers questioned

Through a web-based survey, researchers questioned certified athletic trainers (n=364) regarding experience with skin infections. Respondents had a median of nine years experience. More than half of trainers surveyed (56%), worked with high school athletes, whereas 35% worked with college athletes. The remainder worked with professional teams or in clinical settings.

Fifty-three percent of respondents reported treating MRSA. Of those who reported treating MRSA, 86% said they had treated MRSA in male athletes, and 35% reported treating MRSA in female athletes.

Ninety-two percent of the trainers surveyed reported treating an athlete for skin infections caused by any organism. The average number of infection treatments in the past year was 7.5 per trainer. Infections typically occurred on the lower leg (38%), forearm (31%) or knee (29%).

In infections suspected to be caused by MRSA, trainers reported applying a bandage (97%) or a warm compress (84%) and cleaning the infection site (83%). Respondents reported referring athletes to another health care provider for systemic (98%) or topical (76%) antibiotics, for nasal (97%) or wound (96%) cultures or to perform incisions and drainage (92%). Trainers reported they were more likely to wash their hands with soap and water or use a hand sanitizer after treating the athlete than before (P<.01 for both). During athletic events, trainers were more likely to use alcohol-based hand sanitizers between athletes than to wash their hands with soap and water (P=.002).

The survey was administered by the National Athletic Trainers Association through its website to certified athletic trainers for three weeks in fall 2006. Only one response per facility was allowed.

MRSA prevention

Athletes and trainers should adhere to infection control practices, including washing hands with soap or an alcohol-based hand sanitizer, before and after treating infections.

Infections should be cleaned and covered before the athlete returns to the sport. If infections do not clear up or worsen with standard care, the athlete should be assessed for MRSA.

Athletes should report all infections and should avoid sharing towels, razors and athletic gear. Whirlpools should be avoided unless they are cleaned properly.

For more information:

• Brinsley-Rainisch KJ, Goding AM, Sinkowitz-Cochran RL, et al. MRSA infections in athletics: Perceptions and practices of certified athletic trainers; Abstract #70; Presented at: The 17th Annual Scientific Sessions of the Society for Healthcare Epidemiology of America. April 14-17, 2007; Baltimore.