Soft tissue infections during a climate emergency: Impact of the october 2024 cut-off low (DANA) event in Valencia

The objective of this study is to provide an epidemiological description of soft tissue infections caused by traumatic injuries treated at a tertiary hospital in Valencia during the floods resulting from the cut-off low (depresión aislada en niveles altos [DANA]) that occurred in October 2024. The study also addresses the therapeutic approach and associated complications.

We conducted a retrospective, single-center, descriptive study evaluating musculoskeletal soft tissue infections in patients with an emergency department diagnosis of "DANA-related injury" who required hospitalization in the Department of Orthopedic Surgery and Traumatology of a tertiary care hospital. The study period extended from October 30th to November 14th, 2024. A total of 41 admissions (14%) were recorded out of the 289 patients treated in the trauma emergency department for wounds and closed fractures. Patients who were admitted with fractures only, without associated wounds, were excluded, resulting in a final sample of 31 patients. All patients underwent emergency surgical intervention, including wound debridement in the operating room, with intraoperative collection of multiple samples sent to the Microbiology Department for etiological identification of micro organisms, as well as analysis of their antibiotic susceptibility and resistance patterns. Until antibiogram results were available, all patients received empirical broad-spectrum intravenous antibiotic therapy.

Of the 41 admitted patients, 10 were excluded due to the absence of open wounds (closed fractures), resulting in a final cohort of 31 patients with soft tissue injuries, 10 of whom (32%) also presented with long bone fractures. Among the 31 patients, 21 were male (67%) and 10 female, with a mean age of 54.7 years. The most frequent anatomical location of the wounds was the lower extremities. The most commonly isolated microorganisms in culture were Aeromonas hydrophila (7 cases), Escherichia coli (7 cases), and Klebsiella pneumoniae (5 cases), with 56.5% of cases presenting polymicrobial infections.

Soft tissue infections secondary to traumatic injuries sustained during the flooding caused by the October 2024 DANA event posed a significant clinical challenge to Orthopedic and Trauma Surgery Services. Flood-related soft tissue infections are characterized by a high prevalence of polymicrobial infections, frequently involving Gram-negative and multidrug-resistant pathogens. These findings underscore the need for early diagnosis and the initiation of broad-spectrum antimicrobial therapy to reduce the risk of complications and the need for multiple surgical interventions. This study highlights the importance of prompt, multidisciplinary, and protocol-driven responses to extreme weather events that carry a high risk of serious infections in contaminated environments associated with traumatic wounds.