A clone of methicillin-resistant Staphylococcus aureus among professional football players

N Engl J Med. 2005 Feb 3;352(5):468-75. doi: 10.1056/NEJMoa042859.


Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of infections outside of health care settings. We investigated an outbreak of abscesses due to MRSA among members of a professional football team and examined the transmission and microbiologic characteristics of the outbreak strain.

Methods: We conducted a retrospective cohort study and nasal-swab survey of 84 St. Louis Rams football players and staff members. S. aureus recovered from wound, nasal, and environmental cultures was analyzed by means of pulsed-field gel electrophoresis (PFGE) and typing for resistance and toxin genes. MRSA from the team was compared with other community isolates and hospital isolates.

Results: During the 2003 football season, eight MRSA infections occurred among 5 of the 58 Rams players (9 percent); all of the infections developed at turf-abrasion sites. MRSA infection was significantly associated with the lineman or linebacker position and a higher body-mass index. No MRSA was found in nasal or environmental samples; however, methicillin-susceptible S. aureus was recovered from whirlpools and taping gel and from 35 of the 84 nasal swabs from players and staff members (42 percent). MRSA from a competing football team and from other community clusters and sporadic cases had PFGE patterns that were indistinguishable from those of the Rams' MRSA; all carried the gene for Panton-Valentine leukocidin and the gene complex for staphylococcal-cassette-chromosome mec type IVa resistance (clone USA300-0114).

Conclusions: We describe a highly conserved, community-associated MRSA clone that caused abscesses among professional football players and that was indistinguishable from isolates from various other regions of the United States.

MeSH terms

  • Abscess / epidemiology
  • Abscess / microbiology*
  • Adult
  • Clone Cells
  • Cohort Studies
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / microbiology
  • Disease Outbreaks
  • Electrophoresis, Gel, Pulsed-Field
  • Football
  • Gels
  • Humans
  • Hydrotherapy
  • Male
  • Methicillin Resistance*
  • Microbial Sensitivity Tests
  • Nose / microbiology
  • Retrospective Studies
  • Risk Factors
  • Skin / injuries
  • Skin / microbiology
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / microbiology
  • Staphylococcal Skin Infections / epidemiology
  • Staphylococcal Skin Infections / microbiology*
  • Staphylococcal Skin Infections / transmission
  • Staphylococcus aureus / classification
  • Staphylococcus aureus / genetics*
  • Staphylococcus aureus / isolation & purification
  • United States / epidemiology


  • Gels