MRSA: Implications in Sports Medicine

Transcription

1 MRSA: Implications in Sports Medicine Staphylococcus aureus, often referred to as staph, are bacteria commonly carried on the skin or in the nose of healthy people

2 Staphylococcus Aureus Occasionally, staph can cause an infection Staph bacteria are one of the most common causes of skin infections in the US Most of these infections are minor pimples, boils Most can be treated without antibiotics However, staph infections can cause serious infections surgical wound infections, pneumonia

3 MRSA: Methicillin-Resistant Staphylococcus Aureus In past, most serious staph bacterial infections were treated with a certain type of antibiotic related to penicillin In recent years, treatment of these infections more difficult because staph bacteria have become resistant to various antibiotics, including the commonly used penicillin related antibiotics These resistant bacteria are called methicillin-resistant staphylococcus aureus, or MRSA

4 Where are staph and MRSA found? Staph bacteria and MRSA can be found on the skin and in the nose of some people without causing illness.

5 What is the difference between colonization and infection? Colonization occurs when the staph bacteria are present on or in the body without causing illnesss ~25-30% of the population is colonized in the nose with staph bacteria at a given time

6 What is the difference between colonization and infection? Infection occurs when the staph bacteria cause disease in the person People also may be colonized or infected with MRSA, the staph bacteria that are resistant to many antibiotics

7 Who gets MRSA? Staph bacteria can cause different types of illness skin infections, bone infections, pneumonia, severe life-threatening bloodstream infections, and other illnesses Since MRSA is a staph bacterium, it can cause the same types of infections as staph in general; however, MRSA occurs more commonly among persons in hospitals and healthcare facilities

8 Who gets MRSA? MRSA infection usually develops in hospitalized patients: elderly very sick open wound tube going into body IV or catheter MRSA infections acquired in hospitals and healthcare settings can be severe

9 Who gets MRSA? Certain factors can put some patients at higher risk for MRSA: prolonged hospital stay receiving broad-spectrum antibiotics being hospitalized in an intensive care or burn unit spending time close to other patients with MRSA recent surgery carrying MRSA in nose without developing illness

10 Who gets MRSA? MRSA causes illnesses in persons outside of hospitals and healthcare facilities as well Cases of MRSA diseases in the community have been associated with: Injecting drug users Aboriginals in Canada, New Zealand or Australia Native Americans in US Incarcerated persons Players of close contact sports

11 Community-Associated MRSA Community-associated MRSA infections are typically skin lesions, but can also cause severe illness Most of transmissions appear to be from people with active MRSA skin infections

12 % MRSA of All Wound Cultures at UHC (17/ % MRSA (6/ 6 (9/ 63 ) % MRSA Year

13 How common is staph and MRSA? Staph bacteria are one of the most common causes of skin infection in the US and are a common cause of pneumonia and bloodstream infections Staph and MRSA infections are not routinely reported to public health authorities, so a precise number is not known Estimated as many as 100,000 persons are hospitalized each year with MRSA infections only small proportion of these have disease onset occuring in the community

14 How common is staph and MRSA? ~ 25-30% of the population is colonized in the nose with staph bacteria at a given time Numbers who are colonized with MRSA at any one time is not known CDC is currently collaborating with state and local health departments to improve surveillance for MRSA

15 Are staph and MRSA infections treatable? Yes. Most staph bacteria and MRSA are susceptible to several antibiotics Furthermore, most staph skin infections can be treated without antibiotics by draining the sore However, if antibiotics are prescribed, patients should complete the full course and consult their physicians if the infection does not get better

16 How are staph and MRSA spread? Staph bacteria and MRSA can 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 contaminated by the infected skin of a person with MRSA or staph bacteria towels, sheets, wound dressings, clothes, workout areas, sports equipment

17 How can I prevent staph or MRSA infections? Practice Good Hygiene!!! Keep your hands clean by washing thoroughly with soap and water Keep cuts and abrasions clean and covered with a proper dressing until healed Avoid contact with other people s wounds or material contaminated from wounds

18 Management of Staph or MRSA Infections in Athletic Setting Cover all wounds if wound cannot be covered adequately, consider excluding players with potentially infectious skin lesions from practice and/or competition until lesions are healed or can be covered adequately Encourage good hygiene, including showering and washing with soap after all practices and competitions Ensure availability of adequate soap and hot water pump soap dispensers with antibacterial soap; no bar soap

19 Management of Staph or MRSA Infections in Athletic Setting Discourage sharing of towels and personal items clothing or equipment Establish routine cleaning schedules for shared equipment Train athletes and coaches in first aid for wounds and recognition of wounds that are potentially infected Encourage athletes to report skin lesions to sports medicine staff Encourage coaches and sports medicine staff to assess regularly for skin lesions

20 What should I do if I think one of my studentathletes has a staph or MRSA infection? Consult your team physician!!!

21 Treatment of MRSA Infection Incision and drainage Culture wound Pharmacologic/supportive treatment Minocycline 100 mg po bid x 14 days (Septra DS as alternative) Rifampin 600 mg po qday x 14 days Bactroban: apply to nares bid x 14 days Hibiclens: head to toe bath Wash all bedding/clothes in dilute bleach solution Unresponsive patients Vancomycin IV; Zyvox (linezolid), Cubicin (Daptomycin) IV

22 MRSA Antibiotic Susceptibility Profile UHC Wound Cultures 2002-(ytd) 120 % Susceptible Ampic illi Augm ent Ceph alot Erythr om Genta my Oxacil lin Vanco m Quino lon Trm/S mx Tetrac ycl Clind am (ytd) Antibiotics

23 References 1. CDC. Methicillin-Resistant Staphylococcus aureus infections among competitive sports participants --- Colorado, Indiana, Pennsylvania, and Los Angeles County, MMWR 2003; 52(33);