Association between Contact Sports and Colonization with Methicillin-Resistant Staphylococcus aureus in a Prospective Cohort of Collegiate Athletes
Athletes have higher risk of infection with Staphylococcus aureus than the general population. Most studies in athletes have included primarily male contact sports participants and have not assessed staphylococcal carriage, which increases the risk of infection. The natural history of staphylococcal carriage across sports is poorly understood and limits strategies to prevent infections in athletes. We aimed to examine the epidemiology and risk factors of staphylococcal carriage in a cohort of collegiate athletes.
We enrolled a cohort of 377 varsity collegiate athletes who were followed from August 2008 to April 2010. A baseline, self-administered questionnaire ascertained risk factors for colonization. Nasal and oropharyngeal swabs were obtained at enrollment and monthly thereafter to detect staphylococcal colonization, both with methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA). We used American Academy of Pediatrics definitions of contact and noncontact sports. Secondary outcomes included time to colonization with S. aureus and carriage profile (e.g., noncarriers, intermittent carriers, and persistent carriers). A parametric survival model, multinomial mixed models, logistic regression, and multinomial logistic regression were used, as appropriate.
Overall, 224 contact sports and 153 noncontact sports athletes were enrolled. Compared to noncontact sports athletes, those in contact sports had higher risk of carrying S. aureus over time. Contact sports participants had higher odds of being colonized with MRSA [odds ratio (OR), 2.36; 95% confidence interval (CI), 1.13-4.93], they tended to carry S. aureus for longer periods of time (intermittent carriage OR, 3.60; 95% CI, 2.02-6.40; persistent carriage OR, 2.39; 95% CI, 1.21-4.72), and acquired S. aureus more quickly [hazard ratio (HR), 1.61; 95% CI, 1.02-2.55].
Staphylococcal carriage was common in contact sports athletes, particularly for football team members. These findings suggest that efforts to prevent transmission of S. aureus among athletes should be focused on contact sports teams.
Figure 1. Time to becoming colonized with S. aureus in 186 college athletes
Figure 2. Percentage of staphylococcal carrier profiles in athletes
N. Soper, None
B. Saville, None
I. Thomsen, None
K. Edwards, Novartis: Grant Investigator and Scientific Advisor, Research grant
C. B. Creech, None