Men's Journal

Over the past decade, a lethal bacteria called MRSA has leaped from hospitals to farms to the playing fields. Now it may be a bigger concern than a blown-out knee.

by Gary Taubes

The closest that NBA superstar Grant Hill ever got to dying was in March 2003. Hill, then with the Orlando Magic, had just undergone his fourth ankle surgery in four years. His recovery proceeded normally for the first four or five days, then his body temperature spiked to a fever of 104. “I was shaking, and I couldn’t control it,” Hill says. “My wife rushed me to the hospital. I remember them wheeling me down a corridor, telling me to stay alert. They had to hold my arms down so they could put in an IV. When they took the splint off my leg — I was still recovering from surgery — the whole leg was red and black.”

The diagnosis was an infection caused by a bacteria known as methicillin-resistant staph aureus, or MRSA (pronounced MER-sa), a particularly nasty bug that’s responsible for the deaths of almost 20,000 Americans a year — a number greater than the 18,000 attributed to HIV/AIDS. After six months with an IV dripping antibiotics into his arm, Hill finally recovered, only missing one season on the court.

In the past decade MRSA has gone from being the type of bug that was acquired only in hospitals to what the experts call a “community-acquired infection” that you can get whenever you have an open wound — most notably, during contact sports. One community particularly affected was the National Football League. After New England Patriots quarterback Tom Brady blew out his ACL and then required several procedures to clean out a postsurgical infection, rumors spread that the infection was MRSA, that his rehab was far behind schedule, and even that his career was hanging in the balance. The Cleveland Browns were hit the hardest: LeCharles Bentley, the team’s center, developed a MRSA infection after knee surgery and needed three additional operations to eradicate it. Wide receiver Joe Jurevicius had arthroscopic surgery on his knee in January 2008, developed a staph infection two weeks later, and has since required five more procedures to clean it out. And tight end Kellen Winslow made the news with his disclosure that an “unidentified illness” that had put him in the hospital for a few days was indeed a MRSA infection. But it’s not just pro athletes being stricken by the bacteria.

In 2005, according to the Centers for Disease Control, almost 280,000 Americans were hospitalized for MRSA infections, most of which were acquired without victims knowing how they got it. The fact is that one in every three Americans now has staph aureus living harmlessly, at least for the moment, in his skin or in nasal passages, and more than 2 million are colonized with MRSA. If we get a scrape or a cut even when we’re just sitting at our desks, and the bug finds a way into our bloodstream, virtually any organ or tissue can come under attack, and the result can be a deadly bone or joint infection — even if the bacteria involved happen to be susceptible to antibiotics.

“Staph aureus is a sneaky bug that likes to hide, and it’s hard to kill,” says Vance Fowler, an infectious disease specialist at Duke University. “Whenever you have staph aureus in your bloodstream, the question is not just how to kill it, but where else did it go? What other tissue did it seed? This is why in some of the really desperate situations, we’re talking about lifelong suppression by antibiotics. The patient has to be on antibiotics forever, just to keep the bacteria from recurring.”

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The Three Stages of Infection

Lives on your skin
MRSA is present on the skin and in the nostrils of more than 2 million people in the United States. But unless you receive some sort of abrasion to your skin, the bacteria is totally harmless.

Enters your body
When MRSA enters your body through broken skin, the bacteria thrives and creates a raised, pimple-like red boil that is sore to the touch.

Attacks your organs
The infection can move through your body within just a few days and cause serious damage including septic shock, heart and kidney failure, bone infection, and, eventually, death. 

That the world is now awash in antibiotic-resistant bacteria — “superbugs,” as the media likes to call them — comes as no surprise to infectious disease specialists. “Resistance happens,” is how Karen Bush, an anti-infectives researcher at Johnson & Johnson, describes it. In other words, while many Americans find it hard to believe in evolution, bacteria have little trouble. The more an antibiotic is used against bacteria, the more bacteria evolve to resist it. Even before penicillin was first used in 1943 to successfully treat staph infections, a naturally occurring enzyme in bacteria had been identified that could render penicillin ineffective. Within two years, one in five staph aureus infections had that particular enzyme and were resistant to penicillin.

By 1961 the first methicillin-resistant staph aureus had been detected. MRSA itself was little more than a nuisance bug in hospitals through the 1980s (only about 1 percent of hospital staph infections were methicillin-resistant). But for reasons nobody quite understands, MRSA exploded through hospitals in the 1990s, and now probably 70 percent of all hospital staph strains are MRSA.

The turning point came when MRSA began to appear in individuals who hadn’t been near a healthcare facility. Fred Tenover, an antibiotic-resistance expert at the Centers for Disease Control, calls this a “real biological success story.” The first reports were in the late 1990s, from day-care centers and a high school wrestling team. MRSA was also being found in army recruits, in prisoners, in homosexual men, crystal-meth users, and both pigs and pig farmers.

In 2003, when CDC researchers studied one outbreak among the St. Louis Rams football team — five players had MRSA infections during the course of the season, all at “turf-abrasion” sites — more than 40 percent of the Rams personnel, including staff members, were colonized by MRSA. The bug is that easy to pass along. Rub your nose or shake hands with a friend, and you’ve done it.

Charles (last name withheld), a middle-aged writer who lives in bucolic Massachusetts, acquired his MRSA infection apparently while swimming in a local pond with his children. He says he noticed a tiny red spot on his calf (“the only thing I can remember,” he says, “and it seems so ridiculous, I hesitate to mention it, is that one of the little fish took a teeny nibble out of my leg there”) and within a few days his leg swelled and the red spot “started to look real angry and started seeping a little bit.” A physician immediately referred him to the emergency room, and the next thing Charles knew he was on IV antibiotics, and an infectious disease specialist wielding what’s technically known as a debriding instrument was scraping pus from a golf ball–size abscess in his leg. “Even with this,” he says, “it took another 10 days to two weeks with powerful antibiotics before they announced it was really gone.”

The catch, unfortunately, is that it wasn’t really gone — or, if it was ,he then developed a vulnerability toward subsequent MRSA infections. In the three years since the original, Charles has had one more MRSA infection, and each of his two children have had them. His daughter’s second was in her hip joint after taking what her father calls a “few whacks” on her side during a gymnastics class; she needed intravenous antibiotics for four weeks. Then his son had a skin infection, and his daughter got another infection in the same place.

That’s five severe staph infections in one family since 2005 — a phenomenon known as “interfamilial transmission.” This is a “fairly new thing in the world of staph infections,” says Fowler. “It’s been seen before in things like strep throat, but now we’re seeing it for MRSA, too.” The bug is “pretty contagious,” he says, “and the bacteria itself can survive on countertops, kitchen sinks, faucets — you name it, it’s likely to be there.”

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How to avoid MRSA infections

■ Keep a close watch out for any open wounds or angry pimples. Even something as simple as an ingrown hair can become infected with MRSA.
■ Avoid contact with others with an open wound. If somebody playing has one, make sure they cover it up.
■ Don’t share equipment without first wiping it down with an alcohol-based cloth. Most gyms have these on hand.
■ There is no immediate cure for a MRSA infection, but using Bacitracin on a boil may help
slow infection until the area can be lanced.

Since the more antibiotics we prescribe the more resistant bacteria we get, the obvious strategy to minimize the spread of superbugs is to rein in the indiscriminate use of antibiotics. This is partly what Lou Rice, an infectious disease specialist at the Louis Stokes Cleveland VA Medical Center, describes as the “get a little sniffle, get a little Levaquin” problem. If a head cold lasts longer than a week, we’re off to the doctor for antibiotics, and our doctors prescribe them, even when they know that the problem is a virus — not a bacteria — which means antibiotics are not the cure.

One of the great misconceptions about staph infections, Rice says, is the belief that antibiotics actually kill off the infecting bacteria. The fact is that antibiotics merely shock the bacteria into submission; then our immune system takes over and clears out the infection. “You can take tetracycline until the cows come home,” Rice says. “All it does is stop most bacteria from growing. It doesn’t kill them.” The problem is that the antibiotics also shock much of the other bacteria in our bodies — our natural bacterial flora — into submission, and so the more often we go on antibiotics and the longer we stay on them, the more likely we’ll rid ourselves of harmless bacteria, too, and bugs resistant to the antibiotics will take the opportunity to fill the void.

This means that if we can avoid using antibiotics or shorten the therapy when we do, we may be safer in the long run, even if it seems we’re running risks in the short run. Indeed, a 2006 study from the University of California–San Francisco found that even abscesses infected by MSRA will do just as well, with or without antibiotics, if they’re properly lanced and drained. The surgical treatment is necessary regardless; the antibiotics don’t seem to make any difference. Rice and other infectious disease specialists have recently been lobbying the National Institutes of Health to fund more of these kinds of clinical trials, hoping to get some definitive evidence about the length of time a patient really needs to be on antibiotics — if the drugs help at all.

Although several new antibiotics are coming along in the next few years that should be effective against MRSA and other bacteria like it, infectious disease specialists think these will only delay the inevitable. “Bacteria have been around for three billion years. They know how to deal with toxic substances in their environment,” says one pharmaceutical company researcher. “It doesn’t matter if it’s something naturally occurring or some new-generation antibiotic. Becoming resistant is easy for them.” Resistance happens.

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How the NFL Is Beating MRSA

Over the past three years, infection rates have dropped — and what the pros are doing can help any athlete avoid the bug. Because of the toll MRSA has taken on NFL players, the league has made a concerted effort to reduce the number of outbreaks — with notable success. According to a recent survey conducted by Dr. Andrew Tucker, president of the NFL Physicians Society, the rate of infection among players has decreased by nearly 50 percent since 2005, when there were 60 reported cases. “I see more infections in high school and collegiate athletes than I see in the pros,” says Tucker. “All athletes are predisposed to the bug because they have close contact with one another in locker rooms. They share equipment, and, of course, collision sports lead to abrasions and open the skin, which provides
a portal of entry for bacteria.”

What the NFL has done to mitigate the spread of MRSA is fairly simple but requires vigilance: “The training staff cleans and bandages an injury right away,” says Tucker. “Hand antiseptic is regularly available, and we make sure athletes always get cuts checked out — no matter what they look like.” Another thing the NFL could do to further reduce infections is adopt a measure the NBA took many years ago: When a player is cut in that league, officials make them come out of the game. “When someone is injured in the NFL,” says Tucker, “he usually has to come out for a play.” It stands to reason, then, that a player who is cut should also leave the game to protect themselves and others.

This issue originally appeared in the April issue of Men’s Journal