Military recruits at training facilities are at risk for community-associated (CA) MRSA. Between October 2000 and June 2002, a large U. S. military facility recorded 235 cases of CA-MRSA. In November 2002, military authorities implemented a variety of hygienic measures including an emphasis on hand washing and showering. In addition, sharing personal items was prohibited, and antibiotic therapy was instituted to eliminate nasal colonization. The outbreak ended in December 2002. In many of these cases, infections were on arms and legs where skin abrasions were expected from training exercises.168
Another example surfaced in September 2005 when five members of the St. Louis Rams professional football team reported MRSA infections at turf-abrasion sites. The abscesses were large (more than 2 inches [5 cm] in diameter) and required surgical incision and drainage. Molecular analysis of the infecting bacteria showed that all cases were due to USA300, which was common in the community. A variety of infection control procedures were instituted. For example, hand washing was encouraged using bactericidal agents, as was showering before whirlpool treatments. The common practice of towel sharing was stopped, and weight-training equipment was regularly sanitized. In addition, antibiotic treatment was used on infected players. Although MRSA appeared to spread to opposing teams during games, analysis could not distinguish between the infecting strains and strains present elsewhere in the community.169
A third example was observed with a Dutch soccer team. In June 2005, several players noticed soft-tissue infections, and in October, one member of the team was hospitalized for an MRSA infection. Screening of team members and their close associates (56 persons) revealed MRSA in nine players and two roommates. DNA fingerprinting of the MRSA isolates showed that they were identical, consistent with person-to-person transmission. Members of the team were advised to share no personal item, to use disposable towels after showering, and to place a disposable towel on locker room benches before sitting. Ventilation was improved in the team locker room, which was also cleaned more frequently. These strategies, plus antibiotic treatment, stopped the outbreak.170
Because nasal surveillance appears to be effective with hospital-associated S. aureus, a similar strategy was examined with a professional football team.171 In this example, none of the players exhibited nasal colonization at the beginning of the season. Nevertheless, five cases of infection occurred during the season, and at the time of infection none of the five exhibited nasal colonization. Thus, screening for nasal colonization may not be an effective strategy for predicting disease.