A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns
A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns
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DOI：
10.1086/425313
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发表时间：
2004-11-15
影响因子：
11.8
通讯作者：
Hadler, JL
中科院分区：
文献类型：
--
作者：
Begier, EM;Frenette, K;Hadler, JL
背景运动相关的耐甲氧西林金黄色葡萄球菌（MRSA）感染已成为一个备受瞩目的全国性问题，发病率很高。为了调查涉及大学足球队的MRSA爆发，我们对所有100名球员进行了回顾性队列研究。一个病例被定义为MRSA蜂窝织炎或皮肤脓肿诊断期间8月6日（足球营开始）至2003年10月1日。我们确定了10例患者（其中2例住院）。6个可用的伤口分离株具有不可区分的脉冲场凝胶电泳模式（MRSA菌株USA300），并携带Panton-Valentine杀白细胞素毒素基因，通过聚合酶链反应测定。在单变量分析中，感染与球员位置（相对风险[RR]，角卫和外接手分别为17.5和11.7）、人造草坪擦伤（即，"草坪烧伤"; RR，7.2），和身体剃毛（RR，6.1）。后卫和边路接球手是一个在争球和训练中经常直接接触的人群。4名有覆盖部位（臀部或大腿）感染的运动员中有3名剃了受影响区域的毛，这些感染也与每周共用漩涡浴缸≥ 2次有关（RR，12.2; 95%置信区间，1.4 - 109.2）。漩涡池水仅用稀释的聚维酮碘消毒，并且在使用之间保持不变。MRSA可能主要在练习比赛中传播，皮肤破裂促进感染。应考虑采取措施尽量减少运动员的皮肤破损，包括防止草坪烧伤和关于美容性身体剃毛风险的教育。MRSA污染的池水可能导致了覆盖场所的感染，但数量很少限制了这一结论的力度。然而，适当的漩涡消毒方法应在运动员中推广。
Background. Athletics-associated methicillin-resistant Staphylococcus aureus (MRSA) infections have become a high-profile national problem with substantial morbidity.Methods. To investigate an MRSA outbreak involving a college football team, we conducted a retrospective cohort study of all 100 players. A case was defined as MRSA cellulitis or skin abscess diagnosed during the period of 6 August (the start of football camp) through 1 October 2003.Results. We identified 10 case patients (2 of whom were hospitalized). The 6 available wound isolates had indistinguishable pulsed-field gel electrophoresis patterns (MRSA strain USA300) and carried the Panton-Valentine leukocidin toxin gene, as determined by polymerase chain reaction. On univariate analysis, infection was associated (P < .05) with player position (relative risk [RR], 17.5 and 11.7 for cornerbacks and wide receivers, respectively), abrasions from artificial grass (i.e., "turf burns"; RR, 7.2), and body shaving (RR, 6.1). Cornerbacks and wide receivers were a subpopulation with frequent direct person-to-person contact with each other during scrimmage play and drills. Three of 4 players with infection at a covered site (hip or thigh) had shaved the affected area, and these infections were also associated with sharing the whirlpool greater than or equal to 2 times per week (RR, 12.2; 95% confidence interval, 1.4-109.2). Whirlpool water was disinfected with dilute povidone-iodine only and remained unchanged between uses.Conclusions. MRSA was likely spread predominantly during practice play, with skin breaks facilitating infection. Measures to minimize skin breaks among athletes should be considered, including prevention of turf burns and education regarding the risks of cosmetic body shaving. MRSA-contaminated pool water may have contributed to infections at covered sites, but small numbers limit the strength of this conclusion. Nevertheless, appropriate whirlpool disinfection methods should be promoted among athletic trainers.