Skin Infection Rates Research Articles

Клиника, диагностика и терапия герпетического кератитана современном этапе: три грани одной проблемы

This article presents modern aspects of clinical manifestations, laboratory diagnostics and treatment of herpetic keratitis (HK). A total of 68 patients participated in the study. In 75 percent of patients high relapse rates of Herpes Simplex skin infection were revealed in the period before HK onset (one-six times per year). Trigger factors for keratitis were thoroughly analyzed. Among them we discovered a number of new ones: the instillation of prostaglandin analogues, paranasal sinus surgery, septoplasty and blepharoplasty. 51 out of 68 patients had active herpetic keratitis, whereas 17 people were in the remission phase. Polymerase chain reaction (PCR) test results for the herpes viruses (HSV, VZV, CMV, EBV, HHV-6) in various body fluids (tears, saliva, blood and urine) from patients with HK are discussed. Herpesvirus DNA was determined in 96 percent of cases (49 out of 51 patients with active HK). Among these 49 patients a monoinfection was detected in 47 percent of cases and mixed infection - in 53 percent. According to the obtained results, we proposed some optimized treatment solutions // Russian Ophthalmological Journal, 2017; 1: 90-7. doi: 10.21516/2072-0076-2017-10-1-90-97.

Nationwide increase in hospitalizations for heroin-related soft tissue infections: Associations with structural market conditions

IntroductionLittle is known about trends in national rates of injection-related skin and soft tissue infections (SSTI) and their relationship to the structural risk environment for heroin users. Use of Mexican-sourced “Black Tar” heroin, predominant in western US states, may have greater risk for SSTI compared with eastern US powder heroin (Colombian-sourced) due to its association with non-intravenous injection or from possible contamination. MethodsUsing nationally representative hospital admissions data from the Nationwide Inpatient Sample and heroin price and purity data from the Drug Enforcement Administration, we looked at rates of hospital admissions for opiate-related SSTI (O-SSTI) between 1993 and 2010. Regression analyses examined associations between O-SSTI and heroin source, form and price. ResultsHospitalization rates of O-SSTI doubled from 4 to 9 per 100,000 nationally between 1993 and 2010; the increase concentrated among individuals aged 20–40. Heroin market features were strongly associated with changes in the rate of SSTI. Each $100 increase in yearly heroin price-per–gram-pure was associated with a 3% decrease in the rate of heroin-related SSTI admissions. Mexican-sourced-heroin-dominant cities had twice the rate of O-SSTI compared to Colombian-sourced-heroin-dominant cities. DiscussionHeroin-related SSTI are increasing and structural factors, including heroin price and source-form, are associated with higher rates of SSTI hospital admissions. Clinical and harm reduction efforts should educate heroin users on local risk factors, e.g., heroin type, promote vein health strategies and provide culturally sensitive treatment services for persons suffering with SSTI.

A Cluster Randomized Controlled Evaluation of the Health Impact of a Novel Antimicrobial Hand Towel on the Health of Children Under 2 Years Old in Rural Communities in Nyanza Province, Kenya.

To assess the health impact of reusable, antimicrobial hand towels, we conducted a cluster randomized, yearlong field trial. At baseline, we surveyed mothers, and gave four towels plus hygiene education to intervention households and education alone to controls. At biweekly home visits, we asked about infections in children < 2 years old and tested post-handwashing hand rinse samples of 20% of mothers for Escherichia coli. At study's conclusion, we tested 50% of towels for E. coli. Baseline characteristics between 188 intervention and 181 control households were similar. Intervention and control children had similar rates of diarrhea (1.47 versus 1.48, P = 0.99), respiratory infections (1.38 versus 1.48, P = 0.92), skin infections (1.76 versus 1.79, P = 0.81), and subjective fever (2.62 versus 3.40, P = 0.04) per 100 person-visits. Post-handwashing hand contamination was similar; 67% of towels exhibited E. coli contamination. Antimicrobial hand towels became contaminated over time, did not improve hand hygiene, or prevent diarrhea, respiratory infections, or skin infections.

Trimethoprim-Sulfamethoxazole Therapy Reduces Failure and Recurrence in Methicillin-Resistant Staphylococcus aureus Skin Abscesses after Surgical Drainage

To determine whether a 3-day vs 10-day course of antibiotics after surgical drainage of skin abscesses is associated with different failure and recurrence rates. Patients age 3 months to 17 years seeking care at a pediatric emergency department with an uncomplicated skin abscess that required surgical drainage were randomized to receive 3 or 10 days of oral trimethoprim-sulfamethoxazole therapy. Patients were evaluated 10-14 days later to assess clinical outcome. Patients were followed for 6 months to determine the cumulative rate of recurrent skin infections. Among the 249 patients who were enrolled, 87% of wound cultures grew Staphylococcus aureus (S aureus) (55% methicillin-resistant S aureus [MRSA], 32% methicillin-sensitive S aureus), 11% other organisms, and 2% no growth. Thirteen patients experienced treatment failure. Among all patients, no significant difference in failure rates between the 3- and 10-day treatment groups was found. After we stratified patients by the infecting organism, only patients with MRSA infection were more likely to experience treatment failure in the 3-day group than the 10-day group (P = .03, rate difference 10.1%, 95% CI 2.1%-18.2%) Recurrent infection within 1 month of surgical drainage was more likely in patients infected with MRSA who received 3 days of antibiotics. (P = .046, rate difference 10.3%, 95% CI 0.8%-19.9%). Patients with MRSA skin abscesses are more likely to experience treatment failure and recurrent skin infection if given 3 rather than 10 days of trimethoprim-sulfamethoxazole after surgical drainage. ClinicalTrials.gov: NCT02024867.

Effect of the comprehensive nursing intervention on clinical efficacy of lymphedema after breast cancer surgery

Objective To investigate effect of the comprehensive nursing intervention on clinical efficacy of lymphedema after breast cancer surgery.Methods In our hospital, 157 cases with breast cancer lymphedema appeared were randomly divided into control group （78 cases） and observation group （79 cases）, control group was given routine nursing intervention, observation group was given comprehensive nursing intervention.The upper limb perimeter, the limb function rehabilitation, infection between two groups patients before and after nursing intervention were compared.Results After nursing intervention, double upper limbs perimeter of the patients in observation group was significantly lower than that in the control group （ P〈0.05 ） .hand function recovery proficiency, excellent （ 82.3%, 100%） were significantly higher than those in the control group, infection rate （1.27%） were significantly lower than that in the control group （ P〈0.05, 0.01） .Conclusions Comprehensive nursing intervention can effectively alleviate after radical mastectomy lymphedema symptoms, lower limb skin infection rate, promote the recovery of upper limb function. Key words: Comprehensive nursing intervention; Upper limb function; Lymphedema; Breast cancer

Evidence-based protocol for prophylactic antibiotics in open fractures: improved antibiotic stewardship with no increase in infection rates.

Evidence-based guidelines for prophylactic antibiotic use in open fractures recommend short-course, narrow-spectrum antibiotics for Gustilo Grade I or II open fractures and broader gram-negative coverage for Grade III open fractures. No studies to date have assessed the impact of these guidelines on infection rates in open fractures. Infection rates before and after the new protocol implementation were examined. A new protocol was implemented including antibiotic prophylaxis based on grade of open fracture: Grade I/II fractures, cefazolin (clindamycin if allergy); Grade III fractures, ceftriaxone (clindamycin and aztreonam if allergy) for 48 hours. Aminoglycosides, vancomycin, and penicillin were removed from the protocol. Data for 174 femur and tibia/fibula open fractures (101 preprotocol and 73 postprotocol) were analyzed. Patients who were moribund or managed at another institution for greater than 24 hours were excluded. The National Healthcare Safety Network risk index was used to provide risk adjustment. No significant differences in the study cohorts (preprotocol and postprotocol) were identified for demographics (age, 37.2 [14.8] years vs. 40.0 [17.9] years; male, 71.3% vs. 79.5%) or mechanism of injury (motor vehicle crash, 67.3% vs. 64.4%; other blunt, 28.7% vs. 32.9%; penetrating, 4.0% vs. 2.8%). After protocol implementation, the use of aminoglycoside and glycopeptide antibiotics was significantly reduced (53.5% vs. 16.4%, p = 0.0001). The skin and soft tissue infection rate per fracture event was 20.8% before and 24.7% after protocol implementation (p = 0.58). There was no statistically significant change after stratification for fracture grade, National Healthcare Safety Network risk index, or fracture site. The rate per fracture event of resistant gram-positive and gram-negative organisms (15.8% vs. 17.8%, p = 0.84) and methicillin-resistant Staphylococcus aureus (2.0% vs. 4.1%, p = 0.65) was not different. Implementation of an evidence-based protocol for open fracture antibiotic prophylaxis resulted in significantly decreased use of aminoglycoside and glycopeptide antibiotics with no increase in skin and soft tissue infection rates. Therapeutic study, level IV.

Urinary Tract Infections, Familial Occurrence and Association with other Infections

Background: Despite the frequency, expense, and morbidity of urinary tract infections (UTIs) in the pediatric population, the familial occurrence of UTIs has not been well studied. Methods: Standardized medical and family histories were collected in 75 cases of UTI in female children along with 300 race and ethnicity matched controls. UTI was defined by urinalysis and culture. Results: In the cases of UTI, grandmothers and brothers of the cases had significantly more UTIs. Rates of skin infections, otitis media and pneumonia were not significantly different between cases and controls. A constipation history was significantly associated with UTIs. Conclusions: UTIs have a familial expression pattern; additionally, they are associated with constipation and may be associated with otitis media.

Skin Infections in Young People (Aged 14–18 Years)

Skin infections are a major cause of preventable hospitalization, with young people being particularly susceptible. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection typically presents as skin infection. CA-MRSA infection rates have increased rapidly in the past decade. Exploration of literature specific to young people aged 14-18 years is therefore timely. Integrative review using the methods described by Whittemore and Knafl was undertaken. Electronic databases of Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews, and Google databases were searched for English-language articles published after 1990. Twenty primary studies were included and the findings are reported here. Data analysis revealed factors influencing skin infections in young people may be host-, transmission-, or pathogen-specific. Strategies to address host and transmission factors may be effective in controlling skin infection rates in young people.

Acute toxicity and risk of infection during total skin electron beam therapy for mycosis fungoides

Detailed rates of acute toxicity and skin infection during total skin electron beam therapy (TSEBT) for mycosis fungoides have not been reported in a large, modern series. We sought to demonstrate the rates of acute toxicity and skin infection during TSEBT. We retrospectively reviewed 89 consecutive courses of TSEBT. In all, 82 courses were prescribed a dose of 30 to 36 Gy and were included in the toxicity analysis. We recorded the types and grades of acute treatment toxicities and the incidence of infection during TSEBT for comparison with the previously documented baseline incidence of infection in mycosis fungoides. The most common toxicities included erythema/desquamation (76%), blisters (52%), hyperpigmentation (50%), and skin pain (48%). The worst reported toxicity grade per patient was grade 1 in 21%, grade 2 in 67%, and grade 3 in 10%, with no grade 4 or 5 toxicities. According to the previously reported rate, a total of 2.4 infections were expected for our cohort at baseline. The number with skin infection was 26 (32%) (relative risk 10.8, P < .01), and of these, 12 (15%) were culture confirmed (relative risk 5.0, P < .01). This was a retrospective study design. The risk of cutaneous infection is significant during TSEBT.

Washeteria closures, infectious disease and community health in rural Alaska: a review of clinical data in Kivalina, Alaska

BackgroundKivalina is a northwest Alaska barrier island village of 400 people vulnerable to storm surges exacerbated recently by delayed winter sea and shore ice formation. The village has no in-home piped water or sewage; the “washeteria” is the only structure providing public showers, laundry facilities and flush toilets. In October 2004, a storm damaged the washeteria septic system resulting in prolonged facility closures. We assessed rates of gastrointestinal, respiratory and skin infections potentially impacted by prolonged washeteria closures.MethodsWe obtained washeteria closure dates from 2003 to July 2009 and defined >7 day closure as prolonged. We received de-identified data on all Kivalina clinic visits from 2003 to 2009 and selected visits with ICD-9 diagnosis codes for respiratory, skin, or gastrointestinal infection; subsequent same patient/same illness-category visits within 14 days were excluded. We compared annual visit rates, for all ages combined, before (2003–2004) and after (2005–2009) the “2004” storm.ResultsThe washeteria had prolonged closures for 34 days (4.7%) in the 2 years 2003–2004 and 864 days (51.7%) between January 2005 and July 2009. Closures ranged from 8 to 248 days. Respiratory infection rates declined significantly from 1.32 visits/person/year in the 2003–2004 period to 0.99 visits/person/year in the 2005–2009 period. There was a significant increase in skin infection rates after 2004, peaking at 0.28 visits/person/year in 2007 and then declining significantly to 0.15 visits/person/year in 2009. Gastrointestinal infection rates remained stable and low throughout (average: 0.05 visits/person/year). No temporal association was observed between respiratory, gastrointestinal or skin infection rates and prolonged washeteria closures.ConclusionThe Kivalina washeteria was closed frequently and for extended periods between 2005 and 2009. Initial closures possibly resulted in increased skin infection rates. No increase in respiratory or gastrointestinal infections was noted. Evaluation of community adaptations to closures and other factors (e.g. childhood pneumococcal vaccination) would expand understanding of these findings.

Three-Year Evaluation of Nosocomial Infection Rates of the ICU

Background and objectives: Evaluating the incidence of nosocomial and invasive device-related infections enables the comparison of the health care associated infection (HAI) between the intensive care units of different hospitals and different units in the same hospital. Material and methods: A retrospective surveillance study was performed to identify nosocomial infections, device-related infections rates, and causal agents from January 2007 through December 2010 in the Anesthesiology Intensive care unit (ICU). HAI were defined according to the CDC (Centers for Disease Control and Prevention) criteria, and invasive device-related infections were defined according to National Nosocomial Infection Surveillance System (NNIS) criteria. Results: During a two-year period, 939 patients were analyzed throughout a total of 7,892 patient- days. The rates of HAI were 53% in 2007, 29.15% in 2008, 28.85% in 2009 while 16.62% in 2010. Most common HAI was blood stream infection. The rate of soft tissue and skin infection was the second most common. Overall, the most common agents were Gram(-) 56.68%, Gram(+) 31.02% and Candida spp 12.3% among patients with nosocomial infections. Conclusions: The incidence of HAI in the ICU of our hospital was high, compared to the Turkish overall rates obtained at the Refik Saydam Center in 2007. When the rates of device-related infections between 2007 and 2008 were compared, they were higher in 2007. The rates of device- related infections were diminished in 2008 to below-national mean rates by infection control measures. Since the rate of urinary catheter-related infections are still high, we should exert continuous efforts for infection control.

Three-Year Evaluation of Nosocomial Infection Rates of the ICU

Background and objectivesEvaluating the incidence of nosocomial and invasive device-related infections enables the comparison of the health care associated infection (HAI) between the intensive care units of different hospitals and different units in the same hospital. Material and methodsA retrospective surveillance study was performed to identify nosocomial infections, device-related infections rates, and causal agents from January 2007 through December 2010 in the Anesthesiology Intensive care unit (ICU). HAI were defined according to the CDC (Centers for Disease Control and Prevention) criteria, and invasive device-related infections were defined according to National Nosocomial Infection Surveillance System (NNIS) criteria. ResultsDuring a two-year period, 939 patients were analyzed throughout a total of 7,892 patientdays. The rates of HAI were 53% in 2007, 29.15% in 2008, 28.85% in 2009 while 16.62% in 2010. Most common HAI was blood stream infection. The rate of soft tissue and skin infection was the second most common. Overall, the most common agents were Gram(−) 56.68%, Gram(+) 31.02% and Candida spp 12.3% among patients with nosocomial infections. ConclusionsThe incidence of HAI in the ICU of our hospital was high, compared to the Turkish overall rates obtained at the Refik Saydam Center in 2007. When the rates of device-related infections between 2007 and 2008 were compared, they were higher in 2007. The rates of devicerelated infections were diminished in 2008 to below-national mean rates by infection control measures. Since the rate of urinary catheter-related infections are still high, we should exert continuous efforts for infection control.

External Fixation with Supercutaneous Calcaneal Locking Plate for Displaced Intra-Articular Calcaneal Fractures

The purpose of this study was to retrospectively evaluate patients who had open reduction and external fixation of displaced intra-articular calcaneal fractures with supercutaneous calcaneal locking plates used as external fixators. Between October 2007 and June 2009, 25 cases were performed. According to the Sanders classification system, 17 cases were type IIA and there were two cases each of type IIB, type IIC, type IIIAC, and type IV. Three months after surgery, when imaging studies confirmed bone union, the plates and screws were removed in the outpatient clinic. The average time of follow-up was 36 (range, 33 to 48) months. Two cases (8%) had superficial wound necrosis and no pin tract infections were noted. The reduction of the articular surface and bone union were good. Two cases of type IIA developed lateral wall exostosis, which resulted in peroneal tendinitis. The preoperative x-rays of the 25 patients had an average Böhler's angle of 12° ± 9° and Gissane's angle of 87° ± 8°. Their postoperative x-ray films demonstrated that the Böhler angle improved to 30° ± 7° and the Gissane angle to 116° ± 7° (p < .01). According to the Ankle-Hindfoot Clinical Rating System of the American Orthopaedic Foot and Ankle Society (AOFAS), their average score was 91 (range, 68 to 100) points. Using a supercutaneous calcaneal locking plate to treat calcaneal fractures caused limited tissue irritation, a low rate of local skin infection, satisfactory reduction of the articular surface, stable fixation, and an overall reduced cost.

Nosocomial Infections in Leukemic and Solid-Tumor Cancer Patients: Distribution, Outcome and Microbial Spectrum of Anaerobes

Nosocomial infections cause significant morbidity and mortality in cancer patients. As a result of their debilitated immune system, cancer patients are likely candidates for colonization with anaerobes. We sought to compare the distribution of nosocomial infections in neutropenic and non-neutropenic cancer patients and to calculate the associated mortality rates. This is the first study to demonstrate a complete microbial spectrum of anaerobes in various infection sites in hospitalized cancer patients. Frequencies of bloodstream infections (BSI), respiratory tract infections (RTI), and GI tract infections (GITI) were significantly higher in neutropenic cancer patients (p < 0.01). Conversely, urinary tract infection (UTI) and skin infection (SI) rates were significantly higher in non-neutropenic cancer patients (p < 0.01). Mortalities attributed to BSI, UTI, RTI, SI, and GITI occured at the respective percentage frequencies of 12.5%, 11.5%, 10.4%, 7.7% and 4.9%. Anaerobes constituted 4.7% of total isolates, and were recovered from SI (66.3%) and GITI (33.6%), but not respiratory tract, urine, or blood. Most anaerobes (79.2%) were isolated from solid-tumor patients. The most common infection in cancer patients was RTI (55.8%), mainly in leukemic patients, followed by SI (18%), only in solid-tumor patients, GITI (9.7%), BSI (9.4%), and UTI (7.1%). The most frequent isolates of Fusobacterium necrophorum (32.7%) and Eubacterium lentum (23.8%) were mostly recovered from solid-tumor patients. These were followed by Clostridium perfringens (11.9%), Clostridium difficile (10.9%), Eubacterium limosum (5.9%), and Veillonella parvula (5%). Control measures are needed to minimize risks of nosocomial infection outbreaks by anaerobes. Continuous monitoring of the presence of anaerobes in various infection sites in hospitalized cancer patients is needed in order to be able to provide the best supportive care for cancer patients.

Disseminated cryptococcus presenting as cellulitis in a liver transplant recipient

CASE REPORT A 57­year­old African–American male presented to our hospital with a one week history of progressive right lower extremity pain and swelling, associated with fevers, chills and night sweats. Review of systems revealed a one week history of dry cough and right­sided pleuritic chest pain. He received an orthotopic liver transplant four months earlier at our institution for end stage liver disease and cirrhosis secondary to Hepatitis C. After transplantation, his maintenance immunosuppressive regimen included tacrolimus (2 mg every morning, 1 mg every evening), and mycophenolate mofetil (1000 mg twice daily). On admission, he was afebrile. His right lower extremity was exquisitely tender to palpation; erythema, warmth and 2+ pitting edema were also noted (Figure 1). No nodules, ulcers, pustules or papules were noted on the lower extremities. His white­blood­cell count was 9900 cells per uL, with 85% neutrophils and 2% bands. Radiography of the right lower extremity did not reveal a fracture and an ultrasound did not demonstrate a deep vein thrombosis. Chest X­ray revealed a new nodular density in the right mid­lung. Computed tomography (CT) scan of the chest was obtained and revealed multifocal pneumonia (Figure 2). Vancomycin and cefepime were initiated empirically for suspected bacterial cellulitis and pneumonia. Despite 48 hours of antibiotic therapy, the patient’s symptoms failed to improve. Serum cryptococcal antigen was obtained and the titer was positive at 1:10. A skin biopsy was performed and revealed necrotizing granulomas, with the GMS stain revealing yeasts. Bronchoscopy and transbronchial biopsy also showed yeasts (Figure 3). C. neoformans was subsequently isolated from his bronchoalveolar lavage. Lumbar puncture was performed and the CSF was unremarkable. The patient received liposomal amphotericin B at 3 mg/kg per day for two weeks, during which time tacrolimus dosing was decreased by 50% and mycophenolate mofetil was discontinued. Improvement in cellulitis and pulmonary infiltrates was noted and he transitioned to oral fluconazole. His tacrolimus dosing remained reduced for the first three months of therapy as an outpatient. The patient completed a 12­month course of fluconazole and has not demonstrated relapse to date. DISCUSSION In 2010, the Transplant­Associated Infection Surveillance Network identified Cryptococcus as the 3rd leading cause of invasive fungal infections in solid organ transplant recipients, with an incidence of 8% and a one­year mortality rate of 27% [1]. Although cryptococcal disease has a median onset of greater than one year post­transplantation, this varies with the type of organ transplanted; in the case of liver transplant recipients it is 8.8 months [1, 2]. While the majority of cryptococcal disease among solid organ transplant recipients is disseminated or involves the central nervous system, it may also present with skin, soft tissue or osteoarticular infection [3]. Rates of skin and soft tissue infection have been reported in the range of 13–18% [2, 4]. A variety of manifestations have been reported: nodules, maculopapular lesions, ulcers, pustules, abscesses and cellulitis, with the most common site being the lower CLINICAL IMAGES OPEN ACCESS

Survey of skin disorders in newborns: clinical observation in an Egyptian medical centre nursery

The frequency of neonatal skin disorders has not been well studied in Egypt. Our aim was to address patterns of dermatological changes in a sample of Egyptian newborns. In a descriptive prospective cohort study 600 newborns in Sohag University hospital nursery were dermatologically examined within the first 5 days of birth. Skin disorders were detected in 240 neonates (40.0%). Birthmarks were found in 100 neonates (16.7%), mainly melanocytic type (mongolian spots in 11.7% and congenital melanocytic naevi in 2.7%). Fungal skin infections, including oral moniliasis, fungal infection in the napkin area or candidal intertrigo, were detected in 13.3% and bacterial infections in 1.3% of neonates. Comparisons with other studies worldwide indicated a higher rate of fungal infections and lower rate of birthmarks in our study. Routine neonatal dermatological evaluation is recommended, especially in view of the high rate of fungal skin infections.

Sun and the immune system

There is increasing epidemiological and laboratory evidence demonstrating the local and systemic immuno-modulatory (primarily suppressive) effects of solar ultraviolet radiation (UVR) exposure in humans. Solar UVR exposure, at levels consistent with day-to-day activities, can influence immune function directly via chromophores present in the skin or indirectly, via its central role in the synthesis of vitamin D pre-cursors. Using latitude gradient as a surrogate epidemiological exposure marker, high UVR exposure has been associated with lower rates ofautoimmune illnesses (e.g., multiple sclerosis), allergy states (e.g., asthma) and ANCA-associated vasculitis. Conversely, high UVR exposure has been associated with higher rates of skin cancer and infection (e.g., herpes virus, intracellular pathogens). Recent work has also focussed on the role of UVR exposure on vaccination response. Quantifying the relative contributions of direct or indirect (vitamin D) mechanisms towards UVR associated immune modulation has been challenging, as both involve activation of a similar milieu of local and systemic cytokines and influence the number, migration and function of antigen presenting cells and regulatory immune cells. Better understanding in this area will assist in fine-tuning the ‘sun smart' public health message and potentially better target populations who would benefit from vitamin D supplementation.

U.S. Skin and Soft Tissue Infection Rates, Costs Rise

U.S. Skin and Soft Tissue Infection Rates, Costs Rise

Skin and Soft Tissue Infection Rates, Costs Rise

Skin and Soft Tissue Infection Rates, Costs Rise

Incidence of Staphylococcus aureus Nasal Colonization and Soft Tissue Infection Among High School Football Players

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. 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. Athletes had nasal swabs done before their season started, and they filled out questionnaires regarding potential risk factors for skin and soft tissue infections. Those enrolled in the study were then observed over the course of the season for skin and soft tissue infections. Those infected had data about their infections collected. One hundred ninety of 386 available student athletes enrolled in the study. Forty-four of the subjects had nasal colonization with methicillin-susceptible S. aureus, and none were colonized with MRSA. There were 10 skin and soft tissue infections (8 bacterial and 2 fungal) documented over the course of the season. All were treated as outpatients with oral or topical antibiotics, and none were considered serious. Survey data from the preseason questionnaire showed 21% with skin infection, 11% with methicillin-susceptible S. aureus, and none with MRSA infection during the past year. Three reported a remote history of MRSA infection. We documented an overall skin infection rate of 5.3% among high school football players over a single season. Our results suggest that skin and soft tissue infection may not be widespread among high school athletes in northeast Ohio.