Do we need to change empiric antibiotic use following natural disasters? A reflection on the Townsville flood.

INTRODUCTION: Skin and soft tissue infections have the potential to affect every patient admitted to a surgical service. Changes to the microbiota colonizing wounds during natural disasters, such as the Townsville floods of 2019, could impact empiric antibiotic choice and need for return to theatre. METHODS: This retrospective observational cohort study reviews culture data and demographics for patients undergoing surgical debridement of infected wounds over a six-month period starting in November 2018 to May 2019 at the Townsville Hospital. RESULTS: Of the 408 patients requiring operative intervention, only 61 patients met the inclusion criteria. The groups were comparative in terms of age and gender, but a greater proportion of patients (40.5% versus 29.1%, P = 0.368) in the post-flood group were diabetic. Common skin commensals, such as Staphylococcus aureus, were the most common pathogen in both groups, however the post-flood group had a higher proportion of atypical organisms (14 versus 8 patients), and an increased need for repeated debridement for infection control (24 versus 14 patients). CONCLUSION: Wound swabs and tissue culture are imperative during surgical debridement and may guide the use of more broad-spectrum coverage following a significant flooding event.

Conservative Management of Suspected Emphysematous Gastritis.

Emphysematous gastritis is a rare surgical condition. Although there is a lack of a common definition, the key features of its presentation include gastric emphysema on imaging and the presence of gas-forming organisms in the gastric mucosa. In this study, we report the case of an 80-year-old Caucasian male who presented with abdominal pain; a computed tomography scan demonstrated gastric emphysema (intra-mural air within the stomach). After upper gastrointestinal endoscopy excluded gross perforation, ulcer, and malignancy, the patient recovered to baseline with conservative management consisting of gastric rest (nil by mouth and nasogastric tube decompression), intravenous antibiotics, and intravenous proton pump inhibitor. Given the wide pathogenic mechanisms for gastric emphysema, we recommend a conservative but cautious approach if the patient does not demonstrate clinical features of hemodynamic instability, sepsis, and peritonitis.