There's the Rub: Football abrasions can lead to nasty infections

Nathan Seppa

The scrapes and cuts endured by football players on U.S. professional teams can develop into drug-resistant bacterial infections that may spread to teammates in the locker room or to opponents on the field, a new study shows. Athletes who play most of their games on artificial turf might be more prone to infection than those who play mainly on grass fields because they experience more skin abrasions similar to rug burns. Researchers now report that serious infections may arise from such abrasions.

Scientists from the Centers for Disease Control and Prevention (CDC) in Atlanta investigated skin infections among St. Louis Rams players, who host games on artificial turf. Between August and November of 2003, Rams players averaged 2 to 3 so-called turf burns each week.

Three-fifths of the Rams players reported getting a prescription antibiotic during the 2003 season. On average, each player received 2.6 such prescriptions that year, roughly 10 times the average for men their age in the general population, the researchers report in the Feb. 3 New England Journal of Medicine.

In response to abrasions, 5 of the 58 players on the team developed abscessed Staphylococcus aureus infections that were resistant to drugs in the penicillin family and to antibiotics called macrolides.

The abscesses cleared up after treatment with other antibiotics, such as vancomycin and tetracycline, says Sophia V. Kazakova, a CDC physician. Two of the five players received intravenous antibiotics.

The infections in these five players arose from a recently identified strain of S. aureus that carries unusual genes. These cause the antibiotic resistance and enable the microbe to make Panton-Valentine leukocidin, a toxin associated with severe abscesses.

During the 2003 season, some opposing players developed abscessed staph infections containing these same genetic characteristics after playing the Rams on the artificial turf in St. Louis, the researchers report.

But Elliot J. Pellman, a physician and medical liaison for the National Football League (NFL), says that to assume the microbe was spread during the game "is speculative." Football players can also come into contact with bacteria during practices, in the locker rooms, and in the community at large, he says.

Pellman also said he could not judge whether artificial turf causes more abrasions than do grass fields, which sometimes freeze solid in December and January.

But physician John M. Dorman of Stanford University School of Medicine applauds the new study. "It's another argument for not using [artificial] turf," he says. Staphylococcus infections "are communicable by contact. On turf, players on both sides are getting abrasions," he says.

While added body protection might limit abrasions, Pellman cautions that covering players from head to toe during hot months would increase the risk of heat exhaustion.

CDC is collaborating with the NFL and the National Collegiate Athletic Association on guidelines for preventing the spread of staph infections among football players. These include installing dispensers containing antibacterial soap in locker rooms and instructing athletes to wash hands frequently, shower before using communal whirlpool baths, and avoid sharing towels, Kazakova says.

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References:

Kazakova, S.V., et al. 2005. A clone of methicillin-resistant Staphylococcus aureus among professional football players. New England Journal of Medicine 352(Feb. 3):468–475. Abstract available at http://content.nejm.org/cgi/content/abstract/352/5/468.

Further Readings:

Archer, G.L. 1998. Staphylococcus aureus: A well-armed pathogen. Clinical Infectious Diseases 26(May):1179–1181. Available at http://www.journals.uchicago.edu/CID/journal/issues/v26n5/my24_1179/my24_1179.web.pdf.

Becker, K., et al. 2003. Prevalence of genes encoding pyrogenic toxin superantigens and exfoliative toxins among strains of Staphylococcus aureus isolated from blood and nasal specimens. Journal of Clinical Microbiology 41(April):1434–1439. Available at http://dx.doi.org/10.1128/JCM.41.4.1434-1439.2003.

Dinges, M.M., P.M. Orwin, and P.M. Schlievert. 2000. Exotoxins of Staphylococcus aureus. Clinical Microbiology Reviews 13(January):16–34. Available at http://cmr.asm.org/cgi/content/full/13/1/16.

Gillet, Y., et al. 2002. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 359(March 2):753–759. Abstract available at http://dx.doi.org/10.1016/S0140-6736(02)07877-7.

Naimi, T.S., et al. 2003. Comparison of community- and healthcare-associated methicillin-resistant Staphylococcus aureus infection. Journal of the American Medical Association 290(Dec. 10):2976–2984. Available at http://dx.doi.org/10.1001/jama.290.22.2976.

Sources:

John M. Dorman
Stanford University
Vaden Health Center
866 Campus Drive
Stanford, CA 94305

Sophia V. Kazakova
Division of Healthcare Quality Promotion
National Center for Infectious Diseases
Center for Disease Control
1600 Clifton Road
Mailstop A35
Atlanta, GA 30333

Elliot J. Pellman
National Football League
Medical Department, New York Jets
ProHEALTH Care Associates
2800 Marcus Avenue
Lake Success, NY 11042

From Science News, Volume 167, No. 6, February 5, 2005, p. 85.