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Hospital-acquired infections following the 1999 Marmara earthquake
1Department of Infectious Diseases, GATA Haydarpaşa Training Hospital, 81327 Usküdar, Istanbul, Turkey. oraloncul@hotmail.com
Abstract:
In this study, medical records of all casualties admitted to our hospital following the Marmara earthquake, which struck northwest Turkey and resulted in the destruction of several towns in the Marmara region, were evaluated retrospectively. The time buried under the rubble, demographic data, type of medical and surgical therapies performed, type of injury and data on infection were analysed. Between 17 August and 25 September 1999, 630 trauma victims were received at our hospital and 532 (84%) of them were hospitalized. The mean age of hospitalized patients (312 males, 220 females) was 32 years (2-90 years). Two hundred and twenty patients were hospitalized for more than 48 h. Forty-one of them (18.6%) had 43 hospital-acquired infection (HAI) episodes, which were mostly wound infections (46.5%). A total of 143 culture specimens was collected and 48 yielded the following potential pathogens: 15 Acinetobacter baumanii (31.2%), nine Staphylococcus aureus (18.7%), seven Pseudomonas aeruginosa (14.6%), six Escherichia coli (12.5%), six Klebsiella pneumoniae (12.5%), two Stenotrophomonas maltophilia (4.2%) and three various Pseudomonas spp. (6.3%). All S. aureus strains were found to be resistant to methicillin in vitro. Two strains of A. baumannii and one P. aeruginosa were found to be resistant to all antimicrobials including carbapenems. Fifty-three victims died (10%) and 36 of those died during the first 48 h because of severe injuries and multi-organ failure. After 48 h of hospitalization, the mortality rate was significantly higher in those patients with HAI (14/41) than those without (3/179) (34.1% vs. 1.7%, P<0.05). In conclusion, trauma is the significant factor associated with HAI and a high incidence of Acinetobacter strains was responsible for HAI in trauma patients.
Insights
Hospital-acquired infections (HAIs) were common in Marmara earthquake trauma victims. Acinetobacter strains were a major cause of HAI, significantly increasing mortality in these patients.
Area of Science:
- Medical Research
- Public Health
- Infectious Diseases
Background:
- The Marmara earthquake in 1999 caused widespread destruction and numerous casualties.
- Trauma patients admitted to hospitals require intensive care and are susceptible to infections.
Purpose of the Study:
- To analyze the incidence and characteristics of hospital-acquired infections (HAIs) in trauma victims of the Marmara earthquake.
- To identify the etiological agents of HAIs and their antimicrobial resistance patterns.
- To determine the impact of HAIs on mortality rates in trauma patients.
Main Methods:
- Retrospective evaluation of medical records of 630 trauma victims admitted between August 17 and September 25, 1999.
- Analysis of demographic data, injury types, treatments, and infection data for 532 hospitalized patients.
- Microbiological cultures and antimicrobial susceptibility testing for identified pathogens.
Main Results:
- Of 532 hospitalized patients, 220 stayed longer than 48 hours, with 41 (18.6%) experiencing 43 HAI episodes, primarily wound infections.
- Acinetobacter baumannii (31.2%) was the most frequent pathogen, followed by Staphylococcus aureus (18.7%) and Pseudomonas aeruginosa (14.6%).
- Multidrug-resistant strains, including methicillin-resistant Staphylococcus aureus and carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, were identified.
- Mortality was significantly higher in patients with HAI (34.1%) compared to those without (1.7%) after 48 hours of hospitalization.
Conclusions:
- Trauma is a significant risk factor for developing hospital-acquired infections in mass casualty events.
- Acinetobacter strains were a predominant cause of HAI in this trauma cohort, exhibiting high levels of antimicrobial resistance.
- Effective infection control strategies and antimicrobial stewardship are crucial in managing trauma patients during and after major disasters.
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