Prevalence of Community-Associated Methicillin-Resistant Staphylococcus Aureus in High School Wrestling Environments

By Stanforth, Bethany; Krause, Andrew et al. | Journal of Environmental Health, January-February 2010 | Go to article overview

Prevalence of Community-Associated Methicillin-Resistant Staphylococcus Aureus in High School Wrestling Environments


Stanforth, Bethany, Krause, Andrew, Starkey, Chad, Ryan, Timothy J., Journal of Environmental Health


Introduction

Each year, approximately 12 million Americans visit a physician to be examined for Staphylococcus aureus or methicillin-resistant Staphylococcus Aureus (MRSA) infections (Centers for Disease Control and Prevention [CDC], 2008). MRSA infections total approximately two million annually, resulting in approximately 90,000 deaths and $4.5 billion in health care costs annually. In 2003 MRSA infections were the fifth-leading cause of death in acute care hospitals (Becton, Dickinson & Co., 2008).

MRSA is an evolving pathogen that has morphed into several potentially infectious strains (Shukla, 2006). The Centers for Disease Control and Prevention (CDC) define community-associated MRSA (CA-MRSA) as a strain of MRSA acquired by those who have not been hospitalized or undergone a medical procedure within the past year. CA-MRSA has unique microbiologic and genetic properties relative to health care-acquired MRSA (HA-MRSA), which allow the bacteria to spread more easily therefore causing more skin infections (CDC, 2005). Seventy percent of all MRSA infections are caused by five major strains of MRSA. The most predominant strain in the U.S. is USA 300 (Sampathkumar, 2007). Ninety-seven percent of infections reported from 11 different hospitals were of the USA 300 clone (Herman, Kee, Moores, & Ross, 2008). MRSA is able to survive on a range of surfaces for extended periods of time and can infect hosts even with limited exposure (Salgado, Farr, & Calfee, 2003; Shukla, 2006).

MRSA has recently been found to be capable of penetrating intact skin, allowing the bacteria to infect deeper layers of tissue (Shukla, 2006). MRSA colonization can persist for months and sometimes years, with a half-life of 40 months (Salgado et al., 2003). Previous studies have indicated that MRSA is commonly transferred through skin-to-skin contact with an infected person, but little is known about a person's likelihood of becoming infected through contact with MRSA-contaminated surfaces (Cohen, 2005). Many risk factors for developing MRSA exist within athletics, including the sharing of clothing, sports equipment, towels, balms, lubricants, razors, and soaps; improper care of skin lesions; and direct skin-to-skin contact with MRSA lesions (Beam & Buckley, 2006). The Indiana Department of Health reported that two wrestling teammates who had never wrestled against one another developed MRSA infections, thus implicating shared items as the source of transmission (CDC, 2003). Of the total cases of S. aureus diagnosed annually, the proportion of those infected with MRSA rose from 29% in 2001-2002 to 64% in 2003-2004 (McKenna, 2008). A CDC analysis found that 8% to 20% of all MRSA infections reported in hospitals were of the community strain (McKenna, 2008). Thus CA-MRSA is not only of interest to health department sanitarians but to hospital infection control personnel as well.

Athletic-related MRSA cases among athletes are most common in sports involving high levels of physical contact, such as wrestling, football, and rugby (Kirkland & Adams, 2008). Cases have also been reported, however, among athletes participating in soccer, basketball, field hockey, volleyball, rowing, martial arts, fencing, and baseball (CDC, 2005). Few studies have focused on the presence of MRSA in wrestling environments, where the athletes are potentially at the greatest risk. The first case of MRSA among a wrestling team was reported in 1993 as a forearm abscess (Lindenmayer, Schoenfeld, O'Grady, & Carney, 1998). Lindenmayer and coauthors conducted a study from January 1993 through February 1994, tracking the number of MRSA cases reported at a local hospital. During that year, seven of 32 (22%) wrestlers acquired MRSA (Lindenmayer et al., 1998). A recent MRSA prevalence study observed 90% of facilities had two or more positive MRSA surfaces. Nearly half of the 90 surfaces tested (46.7%) produced positive results for MRSA (Montgomery, Ryan, Krause, & Starkey, 2010). …

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