KAPALUA, HAWAII — Bars of soap and the sharing of personal items such as razors and towels have been banned from the New York Yankees clubhouse as a prophylaxis against the spread of methicillin-resistant Staphylococcus aureus infections.
“Baseball got put on notice in 2005 when two of its biggest stars got community-acquired staph infections,” said Steve Donohue, the team's assistant trainer, as he described these and other defensive measures to physicians at the Winter Clinical Dermatology Conference, Hawaii.
Reporting growing concern about the risks faced by professional athletes, he cited the illnesses of major league players Barry Bonds and Sammy Sosa, both of whom were waylaid last year, and the death of St. Louis Rams football announcer Jack Snow in January.
An abscess and staph infection on the bottom of Mr. Sosa's left foot put him on the Baltimore Orioles' disabled list twice during the 2005 season. Mr. Bonds played only 14 games for the San Francisco Giants, while he battled a bacterial infection after knee surgery.
Mr. Donohue said the Orioles management had infectious disease experts screen the Orioles clubhouse. He reported they found methicillin-resistant Staphylococcus aureus (MRSA) in two places: a carpet in front of Mr. Sosa's locker and ripped mats in the weight room.
Mr. Snow, 62, a former star player for the Rams, died after being hospitalized for several months with a staphylococcus infection. Describing the death as tragic, Mr. Donohue said he did not know whether it was caused by MRSA.
He noted, however, that a study reported 5 of 58 Rams players (9%) had MRSA infections during the 2003 season (N. Engl. J. Med. 2005;352:468–75). Three infections were recurrent, bringing the team's total number of MRSA infections to eight.
While the authors of the Rams study did not find MRSA in nasal or environmental samples, they did find methicillin-susceptible S. aureus bacteria in whirlpools and taping gel and in 35 of 84 nasal swabs (42%) taken from players and staff members.
“This study is particularly scary,” Mr. Donohue said at the meeting, which was sponsored by the Center for Bio-Medical Communication Inc.
Professional athletes in team sports have many risk factors for MRSA infections, according to Mr. Donohue. He listed turf burns and abrasions, shared equipment, body shaving (which he said has “increased sharply with the body-building and weight-lifting culture that has taken over baseball a little bit”), and frequent antibiotic use.
“In sports, players tend to be treated more aggressively, because they can't miss any time,” Mr. Donohue said.
In the football study, the investigators calculated that the Rams players received an average of 2.6 antimicrobial drug prescriptions per year, according to entries in a team pharmacy log during 2002. This was described as more than 10 times the rate for men of the same age in the general population, which receives 0.5 prescriptions per year. During the 2003 season, about 60% of Rams players surveyed reported they had taken or received antimicrobial drugs.
Mr. Donohue said the Yankee trainers have taken aggressive countermeasures to control and prevent MRSA infection from spreading in locker rooms at home or on the road. These include limiting the activity of anyone with an infection, providing alcohol-based hand rubs and antimicrobial soaps, banning the sharing of personal items such as towels and razors (which must be disposable), and being vigilant about surface and spa infection.
Players are educated about proper hand washing, he said, and trainers are alert to the risk from skin infections. Especially worrisome are situations when “a player complains of bug bites without seeing any bugs.”
The team may need to do more, Mr. Donohue speculated, as he threw out two questions for his physician audience to ponder: “One, should nasal swab surveys be part of our spring training routine physical? Two, if we have a player who is infected with MRSA, would you prophylactically use [mupirocin] Bactroban nasally on the rest of the team to try and prevent colonization?”
Yankee manager Joe Torre added in an interview at the meeting, “With all the players so close to each other physically, you are always concerned about something. Our ball club—it's only because of Steve and Gene [head athletic trainer Eugene Monaghan]—if there is ever a danger whether it be a rash or conjunctivitis, they make sure they separate that player from the rest of the team, because they understand how dangerous [the threat of infection] could be.”
Dr. Darrell S. Rigel, clinical professor at New York University, New York, also observed that MRSA is becoming a serious concern for the Yankee team, to which he is a dermatologic consultant. “At any level of sports you have to think about it,” said Dr. Rigel, a program director of the conference.