Wednesday, September 11, 2013

Don't worry....its just a little infection

As if the actual game of football itself wasn’t dangerous enough, two Tampa Bay Buccaneers’ players (Carl Nicks and Lawrence Tynes) were recently sidelined due to MRSA infections (Methicillin-resistant Staphylococcus Aureus) they believe they contracted at one of the organization’s facilities.  According to the CDC, approximately one out of every 20 hospitalized patients will contract a hospital acquired infection (HAI) such as MRSA.  In both settings, these infections often occur because of a failure to comply with common prevention measures and the end result can be devastating, costly, and sometimes even deadly.

MRSA is the term used to describe strains of bacteria that can live on the skin or in the nose without causing symptoms but can be life-threatening when it reaches the bloodstream or vital organs.  What makes MRSA different from other staph bacteria is that it has built up a resistance to the antibiotics doctors typically use to treat staph infections.   It spreads easily in crowded areas or areas where skin-to-skin contact happens regularly such as a locker room, weight room or training room and has been a serious problem to the NFL in the past.
An NFL physicians’ survey determined that from 2006 to 2008, four of the 32 teams including St. Louis Rams, Cleveland Browns, Washington Redskins and San Francisco 49ers had documented cases of MRSA.  A New England Journal of Medicine (NEJM) study followed the St. Louis Rams through one season and found that five of the 58 Rams players (9 %) developed MRSA infections.  In all cases, the infections developed at turf-abrasion sites and were significantly associated with the lineman or linebacker position.  During the time of the survey, no less than six Cleveland Browns players had documented cases of MRSA and three of them owe the end of their careers to the infection they contracted while with the team. 

The lasting effects of MRSA are not limited to football as high-profile names in every sport have been put on the shelf for extended periods including former MLB slugger Sammy Sosa, White Sox outfielder Álex Riós, Grizzlies forward Rudy Gay, Rockets forward Shane Battier, Nuggets forward Kenyon Martin. Ex-middleweight champ Kelly Pavlik nearly died from an infected cut on a knuckle.
Consider the impact MRSA can have on someone that does not have the resources or knowledge to deal with the infection when it strikes.  DaVonte King was 13 when he came home from football practice in Green Bay, WI complaining about his head and ankle. He had no visible cuts or bruises and the diagnosis was a sprain so he was sent home and cleared to go to school the next day.  Three days later he was rushed to the hospital after he started to spit up blood where it was discovered that he had a septic blood clot. He was airlifted to a Milwaukee children's hospital, where he spent the next 50 days, a month of that on life support. His left leg was amputated just below the knee.

About a decade ago, hospital-related MRSA infections sickened more than 90,000 people nationwide each year, leading to roughly 20,000 deaths.  As hospitals improved prevention measures, those numbers dropped by about a third, with fewer than 10,000 deaths in 2011, according to the CDC.  However, as in-hospital infections are on the decline, more people are checking into hospitals with MRSA than those with either HIV or influenza, combined.

Most of these patients are likely picking up the bacteria even before they reach the hospital grounds so it’s probably safe to conclude that the increases being seen can be blamed on community-associated MRSA, a different strain of the germ.  At least some of the increase reported may simply be due to the fact that hospitals are more alert with better screening but nonetheless, that doesn't change the fact that more people in general are becoming carriers for MRSA.  
In addition to the impact on patient outcomes, there are also significant cost implications associated with these infections.  According to research published last week in JAMA Internal Medicine, HAIs account for a large proportion of the harms caused by health care and are associated with nearly $9.8 billion per year in added costs.  Specific to MRSA, a Duke University Medical Center study found that patients with surgical site infections due to MRSA were 35 times more likely to be readmitted and seven times more likely to die within 90 days compared to uninfected surgical patients.  Furthermore, these patients also required more than three weeks of additional hospitalization and accrued more than $60,000 in additional charges.

These stunning stories and staggering statistics drive home the importance of why prevention of MRSA is so crucial.  Simple steps like washing hands and equipment regularly, the use antiseptic bandages to cover wounds and adherence common prevention measures can have a significant impact.  The NFL is a physical sport and the related injuries generally consist of strains, tears, abrasions, breaks and bruises but not infections.  The long-term effect MRSA will have on the careers of the Tampa Bay players impacted is yet to be seen but what is clear is that they sought treatment and ended up with something much worse.  Likewise in healthcare, where patients who don't come into the hospital with MRSA.....should never leave with it.

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