National MRSA rates run along with fair play of national football teams: a cross-national data analysis of the European Football Championship, 2008.

BACKGROUND: We aimed to assess the relationship between national methicillin-resistant Staphylococcus aureus (MRSA) proportions and indicators for fair play in the European Football Championship, 2008. FINDING: We obtained methicillin resistance data for S. aureus from the European Antimicrobial Resistance Surveillance System (EARSS) project. All teams which qualified for the final tournament and had reported data to the EARSS were included in the analysis. Hosting countries were excluded. The number of yellow and red cards was calculated per 100 min as an indicator for fair play. Red cards were weighted like yellow cards. We calculated correlations between antibiotic resistance and use using two-tailed Spearman's coefficient (r) for non-parametric correlations. In 2008, 16 countries qualified for the European Football Championship. Five countries (Turkey, Switzerland, Croatia, Russia and Austria) did not report MRSA data to the EARSS and/or were hosting countries. The correlation of national MRSA proportions and the fair play indicator was highly significant (p = 0.038), with a correlation coefficient of 0.632.
CONCLUSION: This study shows that national MRSA proportions increase with more unfair play of the national teams: Sweden and the Netherlands played the fairest and had the lowest MRSA proportions. However, it remains to be proven (e.g. in the European Football Championship, 2012) whether this fair play indicator, indeed, can serve as an indicator for adherence with MRSA guidelines or whether this correlation cannot be substantiated.