Distribution and antibiotic resistance of pathogens in post-earthquake traumatic infections: a systematic review and...

Following an earthquake, differences in antibiotic resistance of pathogens may arise due to environmental changes, human activities, and the inherent characteristics of pathogens. To systematically analyze the incidence and resistance profiles of pathogens following earthquakes, aiming to provide a basis for the rational use of antimicrobial agents aimed at drug-resistent pathogens in earthquake-affected patients.

A comprehensive literature search was conducted using PubMed, Web of Science, Embase, CNKI, and Wanfang databases from January 1, 2002, to May 10, 2025. Data were extracted on earthquake locations, mean age of patients, number of isolated strains, and types of strains. Two researchers independently conducted the literature search and data extraction. The quality of the included studies was assessed using the JBI Case Series Appraisal Tool. Data analysis was performed using Stata 17.0 software to calculate the incidence rates of pathogens and their 95% confidence intervals (CIs), as well as the resistance rates and their 95% CIs for the five most prevalent pathogens.

Sixteen single-arm studies involving 2974 pathogen strains were included. The meta-analysis revealed that the five most prevalent pathogens were Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter cloacae, and Staphylococcus aureus, with detection rates of 14.5% [95% CI (10.8%, 18.9%)], 12.1% [95% CI (6.4%, 19.7%)], 10.5% [95% CI (7.6%, 13.8%)], 9.6% [95% CI (4.6%, 16.3%)], and 7.4% [95% CI (5.2%, 9.9%)] respectively.The highest resistance rates were found against Imipenem in Escherichia coli (79.8% [95% CI (29.6%, 99.5%)]), Cefazolin in Acinetobacter baumannii (85.1% [95% CI (30.0%, 95.9%)]), Piperacillin in Pseudomonas aeruginosa (45.5% [95% CI (25.1%, 66.2%)]), Cefazolin in Enterobacter cloacae (85.8% [95% CI (30.0%, 95.5%)]), and Ceftriaxone in Staphylococcus aureus(87.9% [95% CI (55.0%, 99.9%)]).

This study shows that there is limited research on the pathogens and their drug resistance after the earthquake disaster, and the data is concentrated in one region. The distribution of pathogens in earthquake-affected patients shows specific patterns, with a higher incidence and common resistance observed in Gram-negative rods. These pathogens exhibited the lowest resistance to Imipenem/Cilastatin and were less likely to develop resistance to quinolone antibiotics such as Netilmicin and Amikacin.

This work was supported by the Emergency General Hospital Medical Development Research Fund(No.K202109). This study was registered in the Prospective Register of Systematic Reviews (CRD42024553074).