MRSA Report

MRSA is in the news. What is it? MRSA is a type of infectious skin disease spreading into BJJ, Judo, MMA and grappling schools as well as infiltrating it's way into wrestling programs and other contact sports programs. It is contagious, it is ferocious, and yes, it can kill you if left untreated.

MRSA is an acronym for Methicillin-resistant Staphylococcus aureus. MRSA is also known as oxacillin-resistant Staphylococcus aureus (ORSA) and multiple-resistant Staphylococcus aureus. Staphylococcus aureus (S. aureus) (shown above) is a bacterium that is the leading cause of staph infections. The types of infections this bacterium can cause range from pimples, boils and abscesses to more serious and life threatening infections such as pneumonia, meningitis, endocarditis, toxic shock syndrome and septicemia. The S. aureus bacteria can live harmlessly on the human body on the scalp, groin and armpits, and can also colonize in the nostrils, throat, urinary tract and open wounds. Penicillin was originally used to treat S. aureus infections, however, today, approximately 80% of all S. aureus bacterium are penicillin resistant. In 1959, Methicillin was employed as an antibiotic to treat infections caused by penicillin resistant S. aureus. However, in 1961 the first case of Methicillin-resistant S. aureus was reported in a hospital in England. Yet, MRSA was a relatively uncommon finding in hospitals until the 1990's when it exploded in prevalence and is now considered endemic (endemic: meaning that in order for the infection to sustain itself, one infected person must pass the infection on to one other person). MRSA infections were typically confined to hospital settings (HA-MRSA, hospital associated-MRSA), however it has since broken free from the post-surgical wards and become prevalent in the community (CA-MRSA, community associated-MRSA). S. aureus strains that can still be treated with methicillin have since been termed as Methicillin Sensitive Staphylococcus aureus, or MSSA. It is evident, that the over use of antibiotics for less than severe infections has lead to the evolution of resistant strains of bacterium such as MRSA. MRSA (shown in photo below) can cause skin infections as mild as skin boils to as severe as necrotizing faciitis (flesh eating disease). If left untreated, the infections can lead to septicemia, pneumonia, meningitis, endocarditis, and toxic shock syndrome - all of which can be lethal to humans.

Aside from the wrestling and grappling mats, MRSA transmission has been reported to occur in the palors of UNLICENSED tattoo artists (no cases have been reported from reputable parlors and artists) (reference: Centers for Disease Control, MMWR 55: pg. 677-679, June 22, 2006.), as well as through HETEROSEXUAL sexual intercourse (Cook H et al., 2007. Clin Infect Dis 44: pg 410-413.)

Typically, vancomycin and teicoplanin have been the most commonly employed antibiotics used to combat MRSA infections, and are often administered intravenously. However, the S. aureus bacterium are a rapidly evolving microorganism and in 1996 in Japan it was found that some strains of MRSA have developed resistance to these countermeasures as well. These new MRSA strains were called Vancomycin Intermediate-resistant Staphylococcus aureus (VISA). By 2002, the strains with with intermediate resistance to vancomycin became more robust and developed into bonafide VRSA strains (Vancomycin Resistant Staphylococcus aureus). As of 2005, 3 cases of VRSA have been reported in the United States.















Preventative Measures: anti-Microbial Agents

The use of anti-microbial agents can be employed as a preventative measure to stave off infection from bacteria and fungi. Their use is wide spread in a variety of household products such as dish soaps, toothpastes, mouthwashes, disinfectant wipes, skin care products, children's toys, clothes and textiles and plasticware. One of the most common anti-microbial agents (also called biocides) in use is Triclosan (also known as Irgasan).

Why Triclosan? In 1995 there was a MRSA endemic in a neo-natal intensive care unit and the staff at the hospital began washing their hands with soap containing Triclosan. This preventative measure as well as treating the infected infants with anitbiotics stemmed the spread of the infection. Since then Triclosan has been considered the #1 antimicrobial agent to prevent the infection of MRSA. Adult patients with dermal MRSA infections are often given baths containing 2% Triclosan to help kill the bacteria. The Triclosan molecules bind to and inhibit proteins that are critical for fatty acid synthesis within the bacteria cell, and hence are important for not only cellular metabolism, but also the construction and maintenance of the cellular membrane.

Triclosan (5-chloro-2-(2,4-dichlorophenoxy)-phenol) is a powerful chemical antibaterial and antifungal agent. Triclosan has been used more frequently in recent years for the anti-microbial treatment of fabrics (both natural and synthetic) that make up both everyday clothes as well as sport specific and activity wear. The Ciba Specialty Chemical Corporation sells it's Ciba Tinosan AM 100 (TM), which contains Triclosan, to textile companies for impregnation into fabrics.

Grappling specific products have been made that contain Ciba Tinosan (TM). There are rash guards, grappling shorts and skin care products that are sold by OTM.com, and Kennedy Industries is a leader in skin and mat care/cleansing regarding antimicrobial agents (primarily "KenShield (TM) Skin Creme"). While these are great preventative measures against acquiring MRSA bacterium and becoming infected, proper personal hygiene following training sessions is always a must. Using an antibacterial soap that contains Triclosan (if a product contains Triclosan it must state so on the label as mandated by the FDA and EPA) is a measure that one can employ. However, in those individuals with healthy immune systems, regular soap or shower gel should suffice. Unfortunately, a popular soap/shower gel touted amongst the wrestling and grappling communities, Defense Soap (TM) has yet to show effectiveness against S. aureus (MSSA) or the more dangerous MRSA upon review of their clinical report.

The Downside to Triclosan?

It is hypothesized, and even highly likely, that both MRSA, MSSA could develop resistance to Triclosan. Reports have shown that strains of E. coli and Salmonella enterica have possibly developed Triclosan resistance, and some other bacterium have a natural resistance to the biocide. Resistance to Triclosan has been developed in the laboratory when MRSA bacterium have been subjected to less than lethal doses of the agent. When used at "full dose", Triclosan (and it's treated products) is lethal to many microorganisms (MRSA, MSSA, certain fungi, etc.). However, at lesser doses it has been shown that MRSA strains can acquire resistance in a laboratory setting. It is therefore possible that Triclosan treated products could lose adequate concentrations of the biocide (from wearing and washing) over time, and contain less than adequate doses of the Triclosan protectant, thereby allowing for an environment where these microorganisms can develop resistance. However, several major scientific studies have shown that MRSA strains in the wild (outside the lab) can not, or have not (yet), developed resistance to Triclosan.

Tree Huggers Don't Like Triclosan

In one scientific report it was suggested that Triclosan can bind to chlorine compounds in tap water to form chloroform, which is classified as a possible carcinogen by the EPA. Upon interaction with chlorine and other compounds in water, Triclosan can produce intermediate compounds that, when exposed to ultra violet radiation (sun light), convert to dioxins that can contaminate the water and soil. It is uncertain at this time how readily Triclosan converts to dioxins in the wild or how dangerous the dioxins might be, but studies are still on-going in this area.

To Wear, or not to Wear?

In my opinion, I would only wear Triclosan (Ciba Tinosan (TM)) clothing and use Triclosan skin products if I were a person with a compromised immune system, in a gym with a high class attendance, in a gym with previous outbreaks of Staph infection, or I regularly attended large scale tournaments. But this is only my personal opinion. I would, regardless of healthiness, take care of every cut, scrape or laceration with antibacterial agents (Neosporin, etc.) and always take my full course of perscribed antibiotics when fighting a serious bacterial infection. All too often we hear or read of otherwise healthy individuals contracting a MRSA infection and winding up in the hospital. It could happen to you. Proper personal hygiene such as showering within an hour of training sessions, using adequately hot water, lathering up and allowing the soap to sit on the skin for 30 seconds or more before rinsing, washing gis and other training apparel after every use (not every other use or longer!) and regularly washing bedding and clothes is critical to preventing infection from MRSA and other microorganisms including ringworm. Also, pay attention to your body and monitor odd looking red spots, pimple like bumps and bumps that look like spider bites on your skin. If the "pimple" begins to develop red streaks or rings emanating from it, you might have a staph infection - go see a doctor.