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Infectious complications after mass disasters: the Marmara earthquake experience
Kenan Keven1, Kenan Ates, Mehmet Sukru Sever
1Department of Nephrology, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey. keven@medicine.ankara.edu.tr
Abstract:
The Marmara earthquake occurred on 17 August 1999. There were 639 renal victims, of whom 477 needed some form of renal replacement therapy. Although several medical complications have been reported in the literature, there has been no detailed description of infectious complications in patients with crush syndrome after earthquakes. Data from 35 hospitals considering clinical and laboratory findings, as well as infectious complications and the results of microbiological examinations, were analysed. 223 out of 639 (34.9%) patients had infectious complications, which comprised the most frequent medical problem in the renal victims. The patients who suffered from infections had a higher mortality rate than those who did not (p = 0.03). Sepsis and wound infection were the main presentation of the infectious complications. 121 (18.9%) patients suffered from sepsis; the mortality rate was higher in these patients (27.3%) than in victims who did not suffer from sepsis (12.4%, p < 0.0001). In a multivariate model, sepsis was associated with increased mortality (p = 0.0002, odds ratio 2.45, 95% confidence interval 1.52-3.96). 53 (8.2%) and 41 (6.4%) patients had wound and pulmonary infections, respectively. Most of the infections were nosocomial in origin and caused by Gram-negative aerobic bacteria and Staphylococcus spp. Infectious complications are common in renal victims of catastrophic earthquakes and are associated with increased mortality when complicated by sepsis.
Insights
Infectious complications, particularly sepsis, were frequent in earthquake victims needing renal replacement therapy. These infections significantly increased mortality rates, highlighting a critical post-disaster health concern.
Area of Science:
- Nephrology
- Infectious Diseases
- Disaster Medicine
Background:
- The 1999 Marmara earthquake affected numerous individuals, with a significant portion requiring renal replacement therapy.
- While various medical issues were noted, infectious complications in crush syndrome patients post-earthquake lacked detailed investigation.
Purpose of the Study:
- To investigate the incidence and types of infectious complications in renal victims following the Marmara earthquake.
- To determine the association between infectious complications, particularly sepsis, and mortality rates in these patients.
Main Methods:
- Analysis of clinical and laboratory data from 35 hospitals concerning 639 renal victims.
- Detailed examination of infectious complications, microbiological findings, and patient outcomes.
Main Results:
- Infectious complications occurred in 34.9% of renal victims, representing the most common medical issue.
- Sepsis was a major complication (18.9%), associated with significantly higher mortality (27.3% vs. 12.4%).
- Wound and pulmonary infections were also reported; most infections were nosocomial, caused by Gram-negative bacteria and Staphylococcus spp.
Conclusions:
- Infectious complications are prevalent among renal victims of major earthquakes.
- Sepsis significantly elevates mortality risk in this patient population, underscoring the need for vigilant infection control and management in disaster settings.