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Med Sci Sports Exerc 2018 09;50(9):1802-1809

Misericordia University, Dallas, PA.

Purpose: Although community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have reduced among inpatient populations, the incidence in athletics continues to range greatly dependent on the sport. Over the 2015 to 2016 and 2016 to 2017 school years, we assessed the annual CA-MRSA incidence, sport risk, referral practices, and management protocols or interventions among high school and intercollegiate athletics.

Methods: This study targeted high school and intercollegiate athletic programs across the United States. Read More

Med Sci Sports Exerc 2018 Apr 21. Epub 2018 Apr 21.

Misericordia University, Dallas, PA.

Purpose: Although community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have reduced among inpatient populations, the incidence in athletics continues to range greatly dependent on the sport. Over the 2015-2016 and 2016-2017 school years, we assessed the annual CA-MRSA incidence, sport risk, referral practices, and management protocols or interventions among high school and intercollegiate athletics.

Methods: This study targeted high school and intercollegiate athletic programs across the United States. Read More

JAMA 2016 Jul;316(3):325-37

Harvard Medical School, Massachusetts General Hospital, Boston.

Importance: Cellulitis is an infection of the deep dermis and subcutaneous tissue, presenting with expanding erythema, warmth, tenderness, and swelling. Cellulitis is a common global health burden, with more than 650,000 admissions per year in the United States alone.

Observations: In the United States, an estimated 14. Read More

J Pediatric Infect Dis Soc 2016 Jun 5;5(2):105-13. Epub 2014 Nov 5.

Division of Pediatric Infectious Diseases.

Background: Staphylococcus aureus is the leading cause of skin and soft tissue infections in the United States, and S. aureus colonization increases the risk of infection. Although athletes have a higher risk of infection with S. Read More

Clin Infect Dis 2016 07 18;63(2):195-204. Epub 2016 Apr 18.

Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence.

Background: Athletes are a vulnerable population for methicillin-resistant Staphylococcus aureus (MRSA) infection. Our aim was to determine MRSA colonization in asymptomatic athletes and estimate the risk for subsequent MRSA infection.

Methods: We searched the PubMed and EMBASE (through 29 October 2015) for studies on MRSA colonization among asymptomatic athletes. Read More

Med Sci Sports Exerc 2016 08;48(8):1530-8

1Rocky Mountain University of Health Professions, Provo, UT; 2Idaho State University, Pocatello, ID; 3Misericordia University, Dallas, PA; 4Indiana State University, Terre Haute, IN; 5University of Indianapolis, Indianapolis, IN.

Purpose: Position papers offer solutions to manage community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), yet few studies establish the infection rate, management protocols, and referral practices among student-athletes. Over the 2012-2013 and 2013-2014 school years, we assessed the annual CA-MRSA infection incidence, sport risk, referral practices, and management steps among high school and intercollegiate athletics.

Methods: This study targeted high school and intercollegiate athletic programs in the Northeastern United States. Read More

MMWR Morb Mortal Wkly Rep 2015 May;64(20):559-60

Skin infections are a common problem among athletes at all levels of competition; among wrestlers, 8.5% of all adverse events are caused by skin infections. Wrestlers are at risk because of the constant skin-to-skin contact required during practice and competition. Read More

J Athl Train 2015 Apr 24;50(4):432-7. Epub 2015 Feb 24.

Indiana State University, Terre Haute. Dr Kahanov is now at College of Health Sciences, Misericordia University, Dallas, PA. Young Kyun Kim, MA, is now at Moungji University, Yong-in, South Korea.

Context: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become a leading cause of skin and soft tissue infection in the nonhospitalized community. Care of the athletes in athletic training rooms is specifically designed with equipment tailored to the health care needs of the athletes, yet recent studies indicate that CA-MRSA is still prevalent in athletic facilities and that cleaning methods may not be optimal.

Objective: To investigate the prevalence of Staphylococcus aureus and CA-MRSA in and around whirlpools in the athletic training room. Read More

Actas Dermosifiliogr 2014 Mar 29;105(2):150-8. Epub 2013 Oct 29.

Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España.

Introduction: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that causes skin and soft-tissue infections.

Objective: To describe the clinical characteristics of skin infections caused by CA-MRSA and correlations with the available demographic and microbiological data.

Material And Methods: This was a descriptive study of patients with a microbiologically confirmed diagnosis of CA-MRSA infection treated in a dermatology department between June 2009 and December 2011. Read More

Iowa Orthop J 2013 ;33:107-13

Department of Epidemiology and University of Iowa College of Public Health , Iowa City , IA 52242 ; University of Iowa Carver College of Medicine , Iowa City , IA 52242.

Objective: To assess high school athletic programs' infection prevention policies and procedures and to estimate the frequency of skin and soft tissue infections (SSTIs) among Iowa's high school athletes.

Methods: An on-line survey of high school athletic programs.

Results: Nearly 60% of programs responded. Read More

J Sch Nurs 2014 Feb 31;30(1):42-8. Epub 2013 May 31.

1Office of Epidemiology, Nebraska Department of Health and Human Services, Lincoln, NE, USA.

Though historically confined to hospital settings, methicillin-resistant Staphylococcus aureus (MRSA) has received increasing attention in the wider community, particularly among athletes. A 2007-2008 investigation in Nebraska concluded that MRSA skin infections were an emerging problem among the state's student athletes. Statewide surveillance was subsequently conducted during 4 school years (2008-2012) to estimate incidence of skin and soft tissue infections (SSTI) consistent with MRSA among student athletes. Read More

Clin J Sport Med 2013 Sep;23(5):397-9

Department of Orthopedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida 33612, USA.

Numerous factors place athletes at increased risk for cutaneous infections, and as such, they are a common complaint in athletic training rooms. Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common etiology, and given its severe sequelae, a high index of suspicion in this population is justified. We present 2 cases of college athletes who presented to the athletic training room with findings suspicious for MRSA infection. Read More

Med Mal Infect 2012 Nov 29;42(11):533-44. Epub 2012 Oct 29.

Service de Médecine Interne, Hôpital d'Instruction des Armées Clermont-Tonnerre, rue Colonel-Fonferrier, BP 41, 29240 Brest Armées, France.

The development of sports activities promoted as a health factor should not hide the increased risk for diseases, more particularly infections. A review of articles made over the last 20 years was made with a descriptive epidemiological purpose. The most marked risk is skin infection with methicillin-resistant community acquired Staphylococcus aureus (27. Read More

J Athl Train 2012 Sep-Oct;47(5):516-8

Central Pathology Laboratory, Trinity College Dublin, St. James's Dublin, 8, Ireland.

Context: Old, evolving, and new infectious agents continually threaten the participation of competitors in sports.

Objective: To provide an update of the medical literature on infectious disease outbreaks in sport for the last 5 years (May 2005-November 2010).

Main Outcome Measure(s): A total of 21 outbreaks or clusters were identified. Read More

J Sch Nurs 2012 Oct 3;28(5):389-96. Epub 2012 Apr 3.

Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.

Skin and soft tissue infections (SSTIs) are frequent in student athletes and are often caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). We evaluated the awareness of CA-MRSA among high school coaches and athletic directors in Missouri (n = 4,408) and evaluated hygiene practices affecting SSTI transmission. Of 1,642 (37%) respondents, 61% received MRSA educational information during the past year and 32% indicated their school had written guidelines for managing SSTIs in athletes. Read More

J Am Board Fam Med 2011 Jul-Aug;24(4):429-35

Department of Family Medicine, Akron General Medical Center, Center for Family Medicine, 400 Wabash Avenue, Akron, OH 44307, USA.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections have been documented with increasing frequency in both team and individual sports in recent years. It also seems that the level of MRSA skin and soft tissue infections in the general population has increased.

Methods: One hundred ninety athletes from 6 local high school football teams were recruited for this prospective observational study to document nasal colonization and the potential role this plays in skin and soft tissue infections in football players and, in particular, MRSA infections. Read More

Clin Sports Med 2011 Jul;30(3):575-90

Intercollegiate Sports Medicine, Northwestern University, Evanston, IL 60208, USA.

Athletes are susceptible to the same infections as the general population. However, special considerations often need to be taken into account when dealing with an athlete who has contracted an infectious disease. Health care providers need to consider how even common illnesses can affect an athlete's performance, the communicability of the illness to team members, and precautions/contraindications related to athletic participation. Read More

Arch Pediatr Adolesc Med 2010 Jul;164(7):615-20

Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Children's Hospital at Vanderbilt, Nashville, TN 37232-2573, USA.

Objective: To determine the frequency and clinical importance of methicillin-resistant Staphylococcus aureus (MRSA) colonization in student athletes.

Design: Prospective observational cohort study.

Setting: A major university in the southeastern United States. Read More

J Environ Health 2010 Jan-Feb;72(6):8-11; quiz 66

E344 Grover Center, Ohio University, Athens 45701, USA.

Methicillin-resistant Staphylococcus aureus (MRSA) was once largely a hospital-acquired infection, but increasingly, community-associated MRSA (CA-MRSA) is causing outbreaks among otherwise healthy people in athletic settings. Secondary school athletic trainers, student athletes, and the general student population may be at elevated risk of MRSA infection. To identify the prevalence of MRSA on surfaces in high school athletic training settings, 10 rural high school athletic training facilities and locker rooms were sampled for MRSA. Read More

J Clin Microbiol 2010 Feb 9;48(2):609-11. Epub 2009 Dec 9.

Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

We report a skin and soft-tissue infection outbreak among football team members due to a USA300 methicillin-susceptible Staphylococcus aureus (MRSA) strain with genes coding for Panton-Valentine leukocidin and the arginine catabolic mobile element. We postulate that the strain is a community-associated USA300 MRSA strain that lost methicillin resistance but retained important virulence factors. Read More

J Community Health Nurs 2009 Oct;26(4):161-72

University of Kentucky, Lexington, Kentucky, USA.

An interventional prevention program, Training CAMP Program, was implemented with college football players (n = 98) in a Midwestern NCAA Division II college during the 2008 college football season. The program goal was a 50% reduction in community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) cases, as compared to the previous 3 seasons' average number of cases (12.6). Read More

J Sch Nurs 2009 Aug 7;25(4):282-91. Epub 2009 Apr 7.

Centers for Disease Control and Prevention Epidemic Intelligence Service Officer assigned to the Nebraska Department of Health and Human Services, Lincoln, Nebraska, USA.

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of skin and soft-tissue infections among athletes. To determine statewide incidence among high school athletes, we surveyed all 312 Nebraska high schools regarding sport programs offered, program-specific participation numbers, number of athletes with physician-diagnosed MRSA infections, and athlete's sport at infection onset. Among 271 (86. Read More

Am J Sports Med 2009 Feb 6;37(2):406-18. Epub 2008 Nov 6.

Boston Medical Center, Boston University, 1 Boston Medical Center Place, Family Medicine, Dowling 5, Boston, MA 02118, USA.

Dermatologic conditions are a common presenting complaint in the athletic training room. There are many different causes for rashes, and treatment options vary depending on the condition and the severity. Bacterial infections of the skin have a variety of different appearances and can spread rapidly among individuals. Read More

Cutis 2008 Aug;82(2 Suppl 2):13-7

Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA.

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) strains continue to emerge as important causes of sepsis, folliculitis, skin abscesses, necrotizing pneumonitis, empyema, and bone and joint infections. Community-acquired methicillin-resistant S aureus often affects young, previously healthy individuals, including athletes and children in day care. Drainage remains the most important intervention for an abscess. Read More

J Am Acad Dermatol 2008 Sep 11;59(3):494-502. Epub 2008 Jun 11.

Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Methicillin-resistant Staphylococcus aureus infections have become an increasingly common condition among athletes. Physical contact, shared facilities and equipment, and hygienic practices of athletes all contribute to methicillin-resistant S. aureus transmission among sports participants. Read More

Clin Dermatol 2008 Jan-Feb;26(1):16-26

University of Houston Health Center, University of Houston, Houston, TX 77204, USA.

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is currently a problem of epidemic proportion. Athletes represent a specific group of individuals who are at increased risk to develop CAMRSA skin infections. In this article, the previously published reports of cutaneous CAMRSA infections in athletes are categorized by sport and summarized. Read More

J Am Acad Orthop Surg 2008 Feb;16(2):98-106

Department of Orthopedic Surgery, Grandview Hospital and Medical Center, Dayton, OH, USA.

Staphylococcus aureus (S aureus) remains one of the most common pathogens for skin and soft-tissue infections encountered by the orthopaedic surgeon. Community-acquired methicillin-resistant S aureus (CA-MRSA) has become increasingly prevalent, particularly among athletes, children in day care, homeless persons, intravenous drug users, men who have sex with men, military recruits, certain minorities (ie, Alaskan Natives, Native Americans, Pacific Islanders), and prison inmates. Risk factors include antibiotic use within the preceding year, crowded living conditions, compromised skin integrity, contaminated surfaces, frequent skin-to-skin contact, shared items, and suboptimal cleanliness. Read More

Am J Clin Dermatol 2007 ;8(5):259-70

University of Houston Health Center, University of Houston, Houston, Texas, USA.

Dermatologists and other healthcare providers need to be aware of the epidemiology, clinical features, management, and prevention of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection. Currently, infection caused by CAMRSA is considered to represent a worldwide epidemic and infectious skin lesions are a frequent occurrence. Athletes, certain ethnic populations, children, homeless persons, homosexual men, household members of infected people, HIV-infected patients, intravenous drug abusers, military personnel, newborns, pregnant and postpartum women, tattoo recipients, and urban dwellers of lower socioeconomic status in crowded living conditions are individuals at increased risk of developing CAMRSA infection. Read More

Clin J Sport Med 2007 Sep;17(5):393-7

Departments of Pediatrics and Surgery, Sections of Pediatric Emergency Medicine and Orthopedic Surgery and Rehabilitation Medicine, Thee University of Chicago, Chicago, Illinois, USA.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has gained international recognition as a superbug that causes serious infectious outbreaks in high-risk populations such as athletes. Clusters of cases in various athletic teams, particularly contact sports, have been reported since 1993 in the United States and more recently in Canada. CA-MRSA infections are not limited to North America, and all athletes are considered high risk. Read More

Clin Sports Med 2007 Jul;26(3):383-96

Sports Medicine Program, Maine Medical Center, Portland, ME 04101, USA.

Bacterial skin dermatoses are common in athletes, and it is the role of team physicians to be able to recognize and treat such problems. Despite the skin's role as an efficient barrier, a moist environment coupled with frequent skin trauma and contact by athletes with equipment and other players predispose to acquiring infections. In the past 10 years, there has been a dramatic rise in methicillin-resistant Staphylococcus aureus (MRSA) infections. Read More

J Am Acad Dermatol 2007 Jan;56(1):1-16; quiz 17-20

Department of Dermatology, Geisinger Medical Center, Danville, PA 17821, USA.

Unlabelled: Published data confirm that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing in incidence in both urban and rural settings. The statistical risk is higher for athletes, military personnel, prison inmates, intravenous drug abusers, the homeless, children in daycare, and certain Native American groups, but the infections are by no means restricted to these populations. Roughly 85% of the infections involve the skin and subcutaneous tissue, with the most common presentations being an abscess or folliculitis. Read More

Tex Med 2006 Apr;102(4):56-61

Texas Department of State Health Services, 1100 W 49th, Austin, TX 78756, USA.

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging infection in athletes. Our study assessed MRSA burden in Texas 4A and 5A high school athletic departments by contacting 447 licensed athletic trainers (LATs) regarding skin infections in athletes; 186 (41.6%) responded. Read More

J Athl Train 2006 Apr-Jun;41(2):141-5

Department of Athletic Medicine, University of Southern California, Los Angeles, CA 90089-0602, USA.

Context: Methicillin-resistant Staphylococcus aureus (MRSA) was once primarily a hospital-acquired organism, but now community-acquired MRSA (CA-MRSA) is causing outbreaks among otherwise healthy sport participants.

Objective: To investigate MRSA skin and soft tissue outbreaks within a collegiate football team and the effect of infection control measures over 3 years.

Design: Retrospective analysis. Read More

MMWR Morb Mortal Wkly Rep 2006 Jun;55(24):677-9

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have emerged as a major cause of skin disease in the United States. Outbreaks of CA-MRSA have occurred among athletes, inmates at correctional facilities, and military recruits. This report summarizes investigations of six unlinked clusters of skin and soft tissue infections caused by CA-MRSA among 44 recipients of tattoos from 13 unlicensed tattooists in three states (Ohio, Kentucky, and Vermont); use of nonsterile equipment and suboptimal infection-control practices were identified as potential causes of the infections. Read More

Am J Sports Med 2006 Nov 27;34(11):1860-5. Epub 2006 Mar 27.

Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, USA.

Recent outbreaks of infectious diseases in athletes in competitive sports have stimulated considerable interest. The environments in which these athletes compete, practice, receive therapy for injuries, and travel, both domestically and internationally, provide varied opportunities for the transmission of infectious organisms. The purpose of this medical literature review is to identify the agents most commonly reported in the medical literature as responsible for infectious disease outbreaks in specific sports and their modes of transmission and to guide targeted prevention efforts. Read More

Curr Sports Med Rep 2005 Oct;4(5):265-70

Department of Infectious Diseases, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA 90033, USA.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a major pathogen, with distinct clinical characteristics and target populations. It has a striking ability to infect the young and the healthy. Persons in crowded conditions are at risk, including athletes, military personnel, jail inmates, and children in daycare. Read More

South Med J 2005 Jun;98(6):596-602

Dermatologic Surgery Center of Houston, The Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USA.

Objectives: Cutaneous community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) has been identified in otherwise healthy individuals either with or without methicillin-resistant S. aureus (MRSA)-associated risk factors who participate in athletic activities. The purpose of this study was to describe the clinical features of CAMRSA skin infection that occurred in university student athletes, evaluate the potential mechanisms for the transmission of MRSA infection of the skin in participants of athletic activities, and review the measures for preventing the spread of cutaneous CAMRSA infection in athletes. Read More

Clin Infect Dis 2004 Nov 26;39(10):1446-53. Epub 2004 Oct 26.

Infectious Diseases Division, Connecticut Department of Public Health, Hartford, CT 06134, USA.

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. Read More