CDC Warns Of MRSA In Athletes

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By Brian McCurdy, Associate Editor

Methicillin-resistant Staph aureus (MRSA) infections have become increasingly prevalent in recent years in various populations. Over the past year and a half, there have been outbreaks of MRSA on athletic teams, prompting a recent report by the Centers For Disease Control and Prevention (CDC) that warned competitive athletes of the potential for infection. In an August edition of the Mortality and Morbidity Weekly Report (MMWR), the CDC noted an MRSA outbreak on a Colorado fencing team that occurred in February. One month before that, two Indiana high school wrestlers suffered the infection. The MMWR report added that two college football players in Los Angeles were hospitalized with MRSA infections in September 2002. More recently, USA Today reported that eight members of a Wisconsin high school football team recently became infected with MRSA, one of whom was hospitalized for 16 days. The CDC points to several potential reasons for the transmission of S. aureus in the athletes. It notes the abrasions that competitive athletes develop may be a point of entry for pathogens and adds that protective clothing may be abrasive in certain sports. Staph aureus can also be transmitted directly between athletes and the CDC notes athletes like the fencers may share protective clothing and equipment, which could cause the spread of infection. Although David G. Armstrong, DPM, has not seen many MRSA infections in athletes, he recalls one case of a high school athlete, an NCAA Division 1 1,500 meter track prospect. The runner presented with an ingrown toenail and concomitant streaking up his leg. After doing a partial nail avulsion, Dr. Armstrong took a culture from the resulting pus, which grew out as MRSA. Dr. Armstrong first started the athlete on an oral first-generation cephalosporin. However, he says it didn’t have coverage against that strain, ultimately delaying coverage by a few days. Adding an IV line and three days of vancomycin at home resolved the boy’s infection, notes Dr. Armstrong, the Director of Research and Education in the Department of Surgery, Podiatry Section of the Southern Arizona Veterans Affairs Medical Center in Tuscon, Ariz. “What he had going for him was his good health and young age,” says Dr. Armstrong, a member of the Board of Directors of the American Diabetes Association. “While I don’t know if he ultimately got his scholarship, I do know that it could have seriously been threatened if this hadn’t been jumped on aggressively.” How Can Athletes Prevent MRSA Infections? The CDC advised athletes and coaches in prevention measures. Among these were good hand hygiene and showering after athletic events; using bandages for cuts and abrasions; washing towels, clothing and athletic equipment; and consulting a healthcare provider if wounds seem infected or do not heal. “I don't know that you can protect against it,” says Patrick DeHeer, DPM. “If a break in the skin barrier occurs, proper cleansing of the wound and professional examination would be the most important aspects.” Dr. DeHeer, a team podiatrist for the Indiana Pacers and the Indiana Fever, says one doesn’t see that many infections in athletes, especially when it comes MRSA. However, he points out that nearly 50 percent of all Staph infections are MRSA and that Zyvox (Pfizer) is an alternative to IV vancomycin that “would be very helpful in this group of potential patients.” FDA Approves New Lipopeptide For Skin Infections By Brian McCurdy, Associate Editor The Food and Drug Administration (FDA) has approved an injectable cyclic lipopeptide to treat complicated skin infections. Daptomycin for injection (Cubicin, Cubist Pharmaceutical, Inc.) is indicated for such skin infections as well as major abscesses, infected ulcers and post-surgical wound infections. Cubist says its once-a-day antibiotic has been effective against Staph aureus which has shown resistance to other antibiotics. “There has been a frightening increase in (complicated skin) infections over the past decade and the tools currently available to combat this problem have become less effective,” says Dr. Robert Weinstein, Cubist’s scientific advisor. “The approval of Cubicin gives physicians a new weapon against (these types of) infections.” Clinical studies of Cubicin involved more than 1,400 patients and determined the drug is equivalent to standard antibiotics for complicated skin infections, according to the FDA. A Reuters article on the FDA approval of Cubicin noted that the drug’s reported side effects were “mild to moderate in intensity, and included constipation, nausea, fever and headache.” Texas Amendment Secures Malpractice Cap By Brian McCurdy, Associate Editor Heading off any potential legal challenge to tort reform, Texas recently passed an amendment to the state constitution (Proposition 12) to permit the legislature to determine caps on noneconomic damages. The amendment, which was backed by the American Medical Association (AMA), passed by 51 percent. Texans voted last summer to cap noneconomic damages against a single practitioner or a single healthcare institution and capped noneconomic damages against more than one institution at $500,000. The state had passed a similar cap on damages in 1977 but the Texas Supreme Court struck it down as unconstitutional. Janice Roven, JD, says she is surprised that type of amendment was able to pass. Roven says the perception is that caps should reduce insurance premiums but that decision is ultimately up to the insurance company. “It is also perceived that if you cap noneconomic losses, attorneys may lose interest in pursuing malpractice claims since their fees will be reduced,” notes Roven, an attorney who has represented podiatrists. The AMA notes that two companies have announced rate reductions. Texas Medical Liability Trust will cut its rates by 12 percent starting in January and The Doctor’s Company also plans a similar reduction. For more info on malpractice insurance, see “What You Can Do About Malpractice Insurance” on page 20.

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