Does Antibiotic Choice for Prophylaxis Affect the Outcome of Wound Infections in Earthquake Victims?

Wound infections represent a major concern among earthquake survivors. Antibacterial prophylaxis is standard care for this population. However, there is no clear consensus guidelines regarding the choice of prophylactic agents. This study aimed to examine whether the spectrum of antibacterial prophylaxis affects wound infection rates in hospitalized survivors of the February 2023 earthquake in south-eastern Türkiye who were transferred to a tertiary care center outside the disaster zone.

This retrospective study included patients with uninfected wounds upon hospital admission. Clinical characteristics, prophylaxis regimens, and microbiological data were analyzed to identify factors associated with subsequent infection.

The study included 83 patients. Post-admission wound infections developed in 13 patients (15.6%). These patients were more likely to require intensive care unit (ICU) admission, hemodialysis, and recurrent surgeries than those without infections. Notably, infected patients had received broader-spectrum prophylaxis (84.6% vs. 31.4%, p < 0.001), yet wound contamination with soil or debris was not significantly different between groups. Multivariable analysis identified ICU requirement as an independent risk factor for infection (adjusted odds ratio [aOR] 44.81; 95% confidence interval [CI] 6.55-306.51; p < 0.001), while prior antibiotic exposure before admission was associated with a lower risk of infection (aOR 0.10; 95% CI 0.01-0.69; p = 0.019). Among isolated bacteria, 76.5% were either extensively drug-resistant or multidrug-resistant, with Acinetobacter baumannii and Klebsiella pneumoniae being the predominant pathogens.

The findings suggest that broad-spectrum prophylaxis alone is insufficient to prevent infections caused by highly resistant pathogens in disaster settings. The study highlights the critical need for strict adherence to infection prevention and control (IPC) measures. Overwhelming patient burden can diminish compliance with IPC practices and lead to prophylaxis failure. To manage difficult-to-treat infections, it is vital to implement additional protocols that ensure IPC integrity even under extreme workload conditions.

Graphical Abstract.