Drug-Resistant Staph Infection Spreads to Gyms, Day Care

By Stefan Lovgren
for National Geographic News
April 25, 2006
A potentially lethal strain of staph infection was once a worry mainly in hospitals. But MRSA (methicillin-resistant Staphylococcus aureus) is becoming increasingly common in gyms, day care centers, prisons, and other venues where people are in close contact and hygiene is often lacking.

MRSA is a type of Staphylococcus bacterium that is resistant to penicillin and some other antibiotics. The bacteria invade the body via cuts in the skin, causing infection that can be debilitating if not treated early and with the appropriate antibiotics. In rare instances MRSA can be lethal.

Athletes, including gymgoers, may be at risk. In 2003 five members of the St. Louis Rams football team were infected with MRSA. The infections of the players were associated with "turf burns." The bacteria were likely spread among players through shared towels, whirlpool baths, and weightlifting equipment.

MRSA is not, however, a disease that affects just athletes.

"This disease is spread by close skin-to-skin contact, crowding, sharing contaminated items," Nicole Coffin, a spokesperson at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, said. "Cleanliness is a big issue.

"At this point, everybody in the community can be at risk for MRSA," she said.

Changing Epidemiology

Staph bacteria are commonly carried by people on the skin or in their noses. Staph is the most common cause of skin and soft-tissue infection.

Some staph strains are resistant to conventional antibiotics, such as methicillin (a synthetic form of penicillin), and are known as MRSA.

"We think about one percent of the U.S. population, or about two million people, carry this drug-resistant form of staph," Coffin said.

MRSA has been seen in hospitals for about 30 years. There, it usually occurs among people with weakened immune systems, such as elderly patients with underlying illnesses, and patients who have had surgery.

The hospital-based infection may start out as redness around an intravenous line entry or a surgical wound, but it can spread to the lungs, causing pneumonia, or to the blood, causing breathing difficulties, fever, and malaise, possibly resulting in a life-threatening disease.

In 1998 health officials began seeing a new MRSA strain in people with no ties to health care settings. One major outbreak occurred in a prison.

Unlike the hospital-based MRSA, the community-based strain has been affecting healthy people.

"The fact that we're now seeing more infections among people without risk factors who are healthy represents a significant change in the epidemiology of this type of infection," Sara Zimmerman, an epidemiology specialist at the Mecklenburg County Health Department in Charlotte, North Carolina, said.

The community-based infections are usually more superficial and easier to treat than those in hospitals, and often resemble a pimple or a spider bite that can be red, swollen, and filled with pus.

If not treated appropriately, the infections can lead to serious infections of the blood or bone.

Health officials don't know how many people fall sick with the community-based MRSA. But the CDC's Coffin says about 25 percent of cases may result in hospitalization.

Gyms, Prisons, and Day Care Centers

Experts say the emergence of new MRSA strains shows the problem associated with antibiotics use.

"Due to the heavy use of antibiotics in Western medicine, these [staph] organisms have had the opportunity to develop mechanisms for resistance," Zimmerman said. "Unfortunately these organisms continue to exhaust our resources for combating these types of infections, making treatment options for clinicians very limited.

"Because this infection is so common, the focus has shifted to prevention and control versus eradication," she added.

MRSA is spread in two ways: by physical contact with an infected person or by touching inanimate objects like towels, linens, razors, or weightlifting equipment contaminated with bacteria.

It's not a disease that primarily affects athletes. But sports involving close contact, such as American football or wrestling, put athletes at higher risk for this infection.

Settings with close contact and lack of proper hygiene behaviors are particularly at risk, and prisons and day care centers may be highly vulnerable.

"Humans are reservoirs for staph," the CDC's Coffin said. "The most important thing for people to do is to keep an eye out for skin infections. Cover all wounds. If you have a skin infection, you should go to a doctor and have it looked at.

"Make sure your hands are clean, and don't share any personal items like towels and razors," she added.

After the outbreak among the St. Louis Rams players, officials there beefed up their defense against the disease by installing wall-mounted soap dispensers at the team's training facility and instructing players on how to care for wounds and how to monitor skin infections.

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