Infections in crush syndrome: a retrospective observational study after the Wenchuan earthquake

To investigate the characteristics of infections in the casualties with crush syndrome after the Wenchuan earthquake.

The clinical data of patients during their first 2 months of hospitalisation were analysed retrospectively. 58 crush syndrome patients were included. Demographic data, physical and laboratory findings, treatment and outcome were recorded.

The mean age of these patients was 32.8±20.7 years and the average duration under the rubble was 23.7±19.3 h. Fasciotomy and amputation were performed in 29 (50%) and 34 (58.6%) patients, respectively. Renal replacement therapies were administered to 47 patients (81%). Four patients died while all the others restored their renal function. Microbial pathogens were detected in the samples from 39 patients (67.2%), 26 of whom developed sepsis. The most vulnerable sites for infection were wounds (55.2%) and lungs (37.9%). Acinetobacter baumanii and Pseudomonas aeruginosa were the most common bacterial isolates from wound infections. 26 of 39 patients (66.7%) became infected after 48 h of admission. The infected group had a longer duration under the rubble (39.2 h vs 30.1 h, p=0.000) and more fasciotomies (61.5% vs 26.3%, p=0.012) compared with those without infections. Multivariate analysis indicated that duration under the rubble (p=0.012, OR 1.061), duration of renal impairment (p=0.015, OR 1.096) and fasciotomy (p=0.024, OR 5.470) were risk factors for infection.

Infectious complications are common in crush syndrome. In order to improve patient outcomes, vigorous care and strict surveillance are required.