There’s the Rub: Football abrasions can lead to nasty infections

The scrapes and cuts endured by football players on U.S. professional teams can develop into drug-resistant bacterial infections that may spread to teammates in the locker room or to opponents on the field, a new study shows. Athletes who play most of their games on artificial turf might be more prone to infection than those who play mainly on grass fields because they experience more skin abrasions similar to rug burns. Researchers now report that serious infections may arise from such abrasions.

Scientists from the Centers for Disease Control and Prevention (CDC) in Atlanta investigated skin infections among St. Louis Rams players, who host games on artificial turf. Between August and November of 2003, Rams players averaged 2 to 3 so-called turf burns each week.

Three-fifths of the Rams players reported getting a prescription antibiotic during the 2003 season. On average, each player received 2.6 such prescriptions that year, roughly 10 times the average for men their age in the general population, the researchers report in the Feb. 3 New England Journal of Medicine.

In response to abrasions, 5 of the 58 players on the team developed abscessed Staphylococcus aureus infections that were resistant to drugs in the penicillin family and to antibiotics called macrolides.

The abscesses cleared up after treatment with other antibiotics, such as vancomycin and tetracycline, says Sophia V. Kazakova, a CDC physician. Two of the five players received intravenous antibiotics.

The infections in these five players arose from a recently identified strain of S. aureus that carries unusual genes. These cause the antibiotic resistance and enable the microbe to make Panton-Valentine leukocidin, a toxin associated with severe abscesses.

During the 2003 season, some opposing players developed abscessed staph infections containing these same genetic characteristics after playing the Rams on the artificial turf in St. Louis, the researchers report.

But Elliot J. Pellman, a physician and medical liaison for the National Football League (NFL), says that to assume the microbe was spread during the game “is speculative.” Football players can also come into contact with bacteria during practices, in the locker rooms, and in the community at large, he says.

Pellman also said he could not judge whether artificial turf causes more abrasions than do grass fields, which sometimes freeze solid in December and January.

But physician John M. Dorman of Stanford University School of Medicine applauds the new study. “It’s another argument for not using [artificial] turf,” he says. Staphylococcus infections “are communicable by contact. On turf, players on both sides are getting abrasions,” he says.

While added body protection might limit abrasions, Pellman cautions that covering players from head to toe during hot months would increase the risk of heat exhaustion.

CDC is collaborating with the NFL and the National Collegiate Athletic Association on guidelines for preventing the spread of staph infections among football players. These include installing dispensers containing antibacterial soap in locker rooms and instructing athletes to wash hands frequently, shower before using communal whirlpool baths, and avoid sharing towels, Kazakova says.