Editor’s Note: This article is a reprint. It was originally published October 25, 2017.
Penicillin was the first antibiotic, discovered in 1929, but it wasn’t until the early 1940s that large-scale fermentation processes were developed for mass production.1 Prior to this, many people died from what today is cured with a round of antibiotics. You may be so used to the idea that infections can be cured it is almost incomprehensible antibiotics may lose a significant amount of usefulness by 2050 in the fight against bacteria.2
Scientists estimate nearly 300 million people will lose their life to antibiotic-resistant infections by 2050 as bacteria continue to develop defenses against antibiotics. The global cost of treatment for these infections is estimated to reach $100 trillion by 2050.3 Data from the U.S. Centers for Disease Control and Prevention (CDC) indicate that 48.6% of Americans have taken a prescription drug in the past 30 days and 24% have taken three or more.4
As disturbing as those numbers may be, nearly 80% of antibiotics sold in America are used in livestock farming. Low doses are routinely fed to factory farmed livestock to prevent disease associated with poor hygiene and close quarters, and to make the animals to grow bigger faster.5 Long-term use of low dose antibiotics contributes greatly to the growing resistance of bacteria to the drugs prescribed.
Although the U.S. Food and Drug Administration (FDA) has known since 19776 that the use of antibiotics in animal feed to promote growth would likely lead to the development of antibiotic-resistant bacteria, they have also quietly approved the use of 30 potentially dangerous antibiotics, 18 of which they rated “high risk,” for use in livestock feed.7
Today, the real dangers from antibiotic-resistant infections have triggered the development of protocols to protect athletes — from grade school through the pros.
Hidden Dangers in the Locker Room
According to some experts, athletes may be at greater risk of acquiring methicillin-resistant Staphylococcus aureus (MRSA) than others due to their close skin-to-skin contact and increased likelihood for breaks in their skin from cuts and scrapes.8 Roughly 120,000 Americans are infected with MRSA each year and 20,000 die.9 What began as a significant problem in hospitals has migrated into general public areas and populated training rooms, weight rooms and locker rooms.
Like others, some athletes are infected during, or immediately after, a surgical procedure. While athletes at all levels and sports may acquire the infection, it appears to be more common in wrestlers and football players as there is more skin-to-skin contact and skin breaks in these sports. Several prominent NBA and NFL players have suffered from MRSA, resulting in a loss of their career or their life.
In the early 2000s, there were six players from the Cleveland Browns who suffered MRSA infections over a five-year period.10 One player suffered an infection twice in those five years. MRSA infections have affected Peyton Manning of the Indianapolis Colts and Kenny George from the University of North Carolina, who lost part of his foot to the infection.11
A study of the St. Louis Rams found that during the 2003 season, there were eight MRSA infections in five of the 58 players on the team. That same year the infection claimed the life of Ricky Lannetti, a football player from Lycoming College Pennsylvania.12
After a hockey player at Colgate University developed a MRSA infection, Steve Chouinard, director of sports medicine and athletic director, began an aggressive approach to protect his players.13 His first step was to use ozone gas to disinfect the players’ gear.
Any shared products were thrown out, such as bar soap, in favor of one-off use products, and water bottles were sterilized each night. Although these measures were started more than a decade ago, the school continues to make changes and institute new measures.
Unfortunately, sweaty gym locker rooms are a perfect place for bacteria to flourish unless the schools and players address the problem aggressively. Although the CDC reports a decline in community-acquired MRSA,14 the sports world has not had a similar study and therefore is unsure if the measures taken are making a significant impact on the health of their players. At the same time, social behaviors of teens are changing, increasing their risk of infection.
Some teens are unwilling to take a communal shower in the locker room after practice, leaving the gym in sweat-stained clothing, and taking home bacteria acquired from other players and the gym facilities. Body shaving is another common practice that may cause small cuts where MRSA can multiply and enter the body. According to the National Athletics Trainers’ Association, these small cuts may increase the risk of acquiring MRSA sixfold, compared to not shaving.
MRSA Threatens Life and Limb
According to the CDC,15 MRSA is responsible for severe health problems, including sepsis (bloodstream infections), pneumonia and infections at breaks in the skin, such as surgical incisions or cuts. When a MRSA infection is not treated quickly, the infection can lead to loss of a limb or death. A number of studies have demonstrated that infections with MRSA are preventable in community and health care settings.
In the beginning, this strain of Staphylococcus was resistant to all beta-lactam antibiotics, of which methicillin is one.16 However, over time some bacteria have developed multiresistance against several classes of antibiotics, increasing the danger of the infection and likelihood it may lead to permanent damage. The resistance to antibiotics has not changed the properties of the staphylococcus bacteria that trigger disease and infection, only the sensitivity to antibiotics.
Staphylococcus aureus is a bacterium normally found in the nose and on the skin. In fact, 1 in 3 people carry the bacteria in their nose without evidence of disease and 2 in every 100 people carry MRSA.17 When infected, staph can infect bone, causing osteomyelitis (bone infection), endocarditis (infection of a heart valve), urinary tract infections and infections of the bursa sac protecting a joint.
Since MRSA is often resistant to multiple categories of antibiotics, it makes treatment extremely difficult, oftentimes requiring the use of stronger antibiotics that have a high rate of side effects and are often very expensive.18 Symptoms of an infection will depend on the area of the body affected. On the skin, the infection may first be mistaken for an insect bite, as they are raised, red, itchy, painful and often full of pus.19
If the infection affects a bone, or is in the bloodstream, you may experience a high fever, confusion, chest pain, pain in the area infected (joint) and rash. MRSA is highly contagious and passes easily from person to person with skin contact, which is why it is so easily passed between athletes in a locker room who share gym equipment, athletic equipment or towels.
In one study, researchers found staph was able to survive up to 140 days on polyester and up to three days on polyester blends.20
Community-acquired MRSA is more likely to show up in a younger population, while hospital-acquired MRSA is more often in those over 68.21 Your risk of acquiring an infection rises with your age, a break in your skin or living or working in close quarters.
Hygiene Practices May Reduce the Spread of MRSA
The best intentions of school administrators and athletic trainers can easily be undone by poor hygienic practices. If players refuse to shower after practice, or wear dirty uniforms or use the same towel for more than one practice, they can easily spread an infection to areas of their body or a teammate’s body with an open cut or abrasion. Recommendations from the CDC to athletes, parents, administrators and trainers to reduce the spread of the infection include:22
Wash hands often and clean your body regularly, especially after any exercise or after sweating
Cover any area where the skin has been broken until it has healed
Avoid sharing any personal items, such as bar soap, towels, razors or body sponges
Ensure any equipment used has been cleaned and sanitized between players
If you believe you may be infected, get care immediately
Towels May Spread More Than MRSA
Towels are unique breeding grounds for infection as they trap moisture, dirt, skin cells and bacteria. MRSA is not the only infection that can be spread by wet, dirty, overused towels. You may also contract:23
Acne
Tinea cruris (jock itch) and tinea pedis (athlete’s foot)
Impetigo
Scabies
Meningitis
Yeast infections
Warts
Lice
Hepatitis
Crabs (lice)
Trichomoniasis24
Caring for your towel at home or the gym is an important way of reducing the spread of infections and disease.
Carolyn Forte,25 executive director of the Cleaning Lab at the Good Housekeeping Institute, recommends you wash your bath towels at home after two or three uses, as long as the towel has dried thoroughly between uses and you don’t share your bath towel with others in your family. Dry your towels outside when possible so the UV rays from the sun can kill bacteria on the towels.
Hand towels are different as they are often used by multiple people in the family and usually get much dirtier, faster. Hand towels should be washed every two days, and possibly every day if you have a large family.
Wash your towels in the hottest water safe for the fabric with a cup of white vinegar before washing a second time with detergent to help ensure your towels are as clean as possible. Avoid using dryer sheets and fabric softener on your towels and underwear as these products inhibit the fabric’s ability to absorb sweat and liquid.26
Shed a Light on It
Efforts to reduce the number of infections and treat current infections have had limited success as the bacteria continue to evolve and adapt to their environment, growing resistant to different categories of antibiotics. However, research at Columbia University Medical Center27 has turned attention to the use of far-ultraviolet (UV) light to fight superbugs.
Since most UV light increases your risk of skin cancer and cataracts, the scientists choose to test UV light in the 200 nanometers (nm) range, which is safe for human skin and eyes. In this UV wavelength, the light cannot penetrate the dead layer of skin cells on the top of your skin or outer protection over your eyes, but bacteria remain susceptible.
In animal tests using mice, the findings demonstrated no skin or eye damage, but the light was effective as a conventional germicidal to kill MRSA.28 Scientists are now moving forward in their evaluation of whether the same reduction in MRSA colonies will be evident on larger animals and in humans.
While you likely do not have a far-UV light available at home, you do have one of the best methods of killing bacteria and fungus under the sun. In other words, you have the sun.
Sun exposure has a long history in the treatment of health conditions, including depression,29 suppressing symptoms of multiple sclerosis (MS),30 regulating melatonin production31 and relieving symptoms of fibromyalgia.32 It also was the standard treatment for tuberculosis before the advent of antibiotics.33
Preventing the Spread of MRSA
This short video was developed by the Indianapolis Colts for their athletes and organization to help prevent MRSA infections and to help prevent the spread of an established infection. As just mentioned, you may reduce your risk of harboring and spreading MRSA by optimizing your vitamin D level. Also, remember to regularly wash your towels and to only use fresh, clean towels at the gym or locker room. Here are further strategies you may use to prevent infections:34,35
Thoroughly wash hands throughout the day, and use a clean, dry towel afterward
Shower with soap and water immediately after exercising or after direct contact sports, and dry with a clean, dry towel
Avoid contact with other people’s bandages or open cuts
Do not share towels in the locker room or on the sidelines at a sporting event
Avoid using hot tubs or whirlpools, especially if you have an open cut or scrape on your skin
Avoid going barefoot; wear flip-flops in the shower or the locker room and clean them after each use
All athletic areas and sports equipment should be thoroughly cleaned and sanitized after each use, including any mascot uniforms, player uniforms, towels, examination tables, showers or equipment used by athletic trainers or sports medicine physicians
