Oh, MRSA, MRSA, Me

Ah, spring. The time of year when everyone turns their attention to that favorite pastime: March Madness. Yes, that great college basketball tournament brings us lots of incredible sights -- close wins, disputed fouls and the spread of resistant germs.

Players sit on the bench with towels around their necks. The buzzer sounds, they wipe their face and neck, and run onto the floor, passing their towel to the guy they are subbing for in play. He wipes his head and neck with the same towel and the circle of spread is complete.

One of the most common resistant germs we encounter today is methicillin-resistant Staphylococcus aureus, fondly known as MRSA. Once only encountered in hospitals, MRSA has been spreading outside hospital walls, resulting in more and more folks in the general community becoming infected in the last decade. And athletes should know, as they have been at the center of this epidemic more than once.

In 2003, the St. Louis Rams reported an outbreak of MRSA skin infections. These were found in linemen and linebackers. The higher the body mass index, the higher the risk. Whirlpools, along with taping gel and other locker room items were found to be colonized with MRSA. Screening of other teams showed wide colonization throughout the NFL, suggesting transmission between players during games, since the type or clones of MRSA were exactly the same. Common risks factors appeared to be: leaving abrasions uncovered during play; failing to have appropriate hand-hygiene items; getting into whirlpool tubs before showering, sharing bars of soap; and, yes, sharing towels.

Further outbreaks have been seen nationwide in wrestlers. Obviously, close skin-to-skin contact with abrasions is high risk. But beyond hand-to-hand combat, other vectors exist for spread. Again, open wounds, poor hygiene, contaminated mats and weight equipment have all been studied and found to be potent partners in the epidemic.

Multiple medical studies have reproduced the same results. The Centers for Disease Control and Prevention has also released these prevention guidelines for athletes:

-- Perform frequent and appropriate hand hygiene

-- Shower after exercise and before getting in any pool

-- Do not share soap or towels

-- Protect skin with proper equipment and cover all wounds

-- Do not share razors or ointments

-- Clean gym equipment after personal use

-- Wash and dry uniforms after every use

Team doctors and trainers are encouraged to oversee and support appropriate prevention strategies such as these. Clearly, they haven't been watching the game film.

So why even be concerned about these issues? Well, unfortunately MRSA can be a very serious infection. What might begin as a seemingly small pimple can become a skin abscess that requires surgical drainage and hospitalization. These abscesses can recur for years, resulting in continued spread throughout every community, increasing the burden of disease across the entire population, including the vulnerable, such as the very young, extremely old and immunocompromised, who can't fight off even the slightest infection.

Beyond skin infections, MRSA can cause severe, even life-threatening infections in the bloodstream, lungs and bones, just to name a few. As many as 28 percent of patients have died from pneumonia related to this germ. As for bloodstream infections, as many as one-third of patients have succumbed to them.

MRSA infections create very difficult treatment scenarios for providers. While there are still drugs available to treat these infections, they are not first-line therapies, meaning the tried-and-true drugs with which we have the most experience are no longer available.

Delays in knowing the resistance pattern of the germ can also put us behind the eight ball, increasing at the very least the duration of hospitalization and treatment, and, at the very most, the risk of death. In MRSA-related bone infections, multiple debridements, or surgeries to try and clean out the infection, are often required followed by weeks of IV therapy. And even if only the skin is involved, recurrences are common, requiring attempts to decolonize patients with medication up the nose as well as weekly bleach baths, strategies that are often met with limited and transient success.

The major lesson to be learned from MRSA's unnerving evolution over the past decade is one that is as scary as it is necessary. More germs will become resistant to our best treatments, causing more harm and even death in their wake. Antibiotics will only last so long -- the more we use them, the less effective they will become. No antibiotic is perfect; all antibiotics will lose their effectiveness at some point. If the antibiotic pipeline dries up, more suffering will occur, reminiscent of the pre-penicillin era.

The key is to decrease the burden of these germs in society; to minimize our exposure to these bacteria. We can start with our athletes, where we have identified risk and come up with simple strategies to prevent the spread of deadly infections. We just need to pay attention and make these activities a priority.

So yes, it's spring. Time for NCAA March Madness. Let's go dancing. Just BYOT -- bring your own towel.

Dr. Elaine Cox is the medical director of infection prevention at Riley Hospital for Children at Indiana University Health in Indianapolis. She is also the Riley clinical safety officer. Dr. Cox practices as a pediatric infectious disease specialist and also instructs students as a professor of clinical pediatrics at the Indiana University School of Medicine. The former director of the pediatric HIV and AIDS program, Ryan White Center for Pediatric Infectious Diseases at Riley, Dr. Cox helped lead the effort to change Indiana law to provide universal HIV testing for expectant mothers.