Fistic Medicine: Staph Infection

By Matt Pitt Jul 11, 2010
The 911 call went out as a possible knee injury. When paramedics arrived the boy’s heart had stopped beating. It happened that fast. Hours of work in the ER didn’t revive him. It was like a bomb going off: sudden, violent and, worst of all, inexplicable. Two days later the LA County Coroner had the answer: staph infection.

Staphylococcus aureus (S. aureus) is a bacteria with a beautiful name -- literally “golden.” Studies show that 80 percent of Americans are colonized with S. aureus: The bacteria lives harmlessly on the skin or within the nares or rectum. If the bacteria breaches the body's defense, infection occurs: Fighters face the risk of simple boils, muscle infections, joint destruction. Fortunately, in the age of antibiotics, treating a healthy person with a simple S. aureus infection is relatively trivial. A fighter who hides a simple Staph infection -- even a large, suppurative one -- is exposing his opponent to a very small danger.

Unfortunately, the antibiotics that have worked so well for so long against S. aureus infection have lost their efficacy. The “golden” bacteria is turning ugly. At first Methicillin Resistant Staph Aureus (MRSA) evolved, and more recently the very concerning multi-drug resistant Vancomycin Resistant Staph Aureus (VRSA). What killed the young man in my ER, and what will kill more than 20,000 Americans this year -- almost double AIDS -- was MRSA. The people at highest risk for acquiring MRSA are the chronically ill, prisoners, IV drug users and … athletes.

Especially grapplers.

S. aureus is communicated from one host to another through close contact: The prolonged skin-on-skin contact and skin tearing, shearing forces of contact sports make them high risk. A recent Nebraska study showed that in 2006, five per 10,000 football players, and 19.6 per 10,000 wrestlers, were colonized with MRSA. A year later the numbers had jumped to 25 per 10,000 and 60.1 per 10,000 respectively!

The absolute number is notable, but the jump in just one year is particularly disturbing. Extrapolating the Nebraska numbers to the present day arrives at estimates that 4-5 percent of high school wrestlers in America bear on their body bacteria that may maim or kill them. Or -- it has to be acknowledged -- an opponent.

If MRSA is potentially quite dangerous, and simple S. aureus easily managed, how does one tell them apart? The answer is, for an athlete it is impossible. Wound cultures or nasal swabs have to be taken and grown on antibiotic impregnated culture mediums -- a slow, expensive process. This puts an entire generation of grapplers at risk; they have developed understandably casual attitudes towards S. aureus but are now facing a growing epidemic of much more dangerous MRSA.

The potential for real danger to athletes has not gone unnoticed. Recent guidelines from National Athletic Trainers' Association outlines mechanisms to stop the transmission on S. aureus. Personal equipment -- razors, headgear, towels -- should not be shared. Training equipment should be disinfected regularly: A good gym should smell of bleach. Showering before training decreases total bacterial burden. Avoiding shaving immediately before competition prevents microscopic abrasions that open the skin to bacterial invasion. Athletes should check themselves and each other for suspicious skin lesions: pimples, sores, boils, red patches of skin.

This last precaution is the most vital and almost certainly the most difficult to promote. Competitive athletes are loath to voluntarily pull themselves from competition. Withdrawing from training is anathema to the ethos most sports teams promote. The issue is compounded by the very high recovery ratio: the proportion of athletes who contract a non-specific Staph infection and heal easily versus the relatively few who are badly harmed. These sorts of diseases are the most difficult for public health efforts to contain.

An effective system for professional fighting can be designed. State athletic commissions could require fighters to be tested for MRSA colonization each year, doctors would find and culture skin sores three days before competition to differentiate MRSA from simple S. aureus and ringside physicians would inspect each fighter the day of the fight and be empowered to exclude them from competition. Such a system would be expensive and run the perhaps intolerable risk of last-minute fight cancellations; it has not been adopted. There is no sign it will be.

There is hope. In time MRSA, and eventually the very difficult to treat VRSA, will become as ubiquitous as simple S. aureus -- 30 percent of the U.S. population will be colonized. Virtually every grappler will have it. Many of the people grapplers are in close contact with -- their children and love ones -- will suffer S. aureus-related diseases. When that time comes, the number of infections will be much higher and the recovery ratio will be much lower. At that point athletes, trainers, promoters and doctors will take the disease -- and it’s prevention -- quite quite seriously.

Whenever that time comes, some will hail it as a bold step advancing fighter safety. And some who have survived severe Staph infections -- and the survivors of those did not -- will mourn that it came too late.

Matt Pitt is a physician with degrees in biophysics and medicine. He is board-certified in emergency medicine and has post-graduate training in head injuries and multi-system trauma. To ask a question that could be answered in a future article, e-mail him at [email protected]

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