ABSTRACT
OBJECTIVE: To analyze the results of clinical and bacteriological examinations in patients with crush syndrome who suffered infectious complications after an earthquake in Sichuan, China. METHODS: A total of 313 bacteriological samples among 147 patients with crush syndrome were collected. Infectious complications, results of microbiological examinations, potential risk factors of infection and mortality were analyzed statistically. RESULTS: In the obtained database, 112 out of the 147 (75.7%) patients had infectious complications, in which, wound infection, pulmonary infection, and sepsis were most common. The time under the rubble and the time from injury to treatment were related to the occurrence of wound infection (P equal to 0.013, odds ratio 2.25; P equal to 0.017, odds ratio 2.31). Sepsis and wound infection were more common in patients who underwent fasciotomy or amputation than in those who did not (P equal to 0.001). CONCLUSION: Quick rescue and injury treatment can decrease the infection risk in crush syndrome patients. It is better to obtain microorganic proofs before applying antibiotics, and bacteriological and drug sensitivity data should be taken into account, especially considering that most of these infections are hospital-acquired and drug resistance. Emphasizing the accuracy and efficiency of wound management in emergency situations, cautiously assessing the indications for fasciotomy to avoid open wounds from unnecessary osteofascial compartment decompression incisions may decrease the incidence of infection and ameliorate the prognosis.
Subject(s)
Bacterial Infections/etiology , Crush Syndrome/complications , Earthquakes , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , China , Crush Syndrome/microbiology , Female , Humans , Male , Middle Aged , Risk FactorsABSTRACT
To improve the treatment of infectious diseases in patients with crush syndrome, we analyzed the results of bacteriological examinations, including antimicrobial susceptibility patterns, of samples taken from patients with crush syndrome admitted to West China Hospital, Sichuan University, after the Wenchuan earthquake. A total of 210 non-replicate clinical isolates were recovered from 42 of the 66 earthquake victims with crush syndrome. Their mean age was 26.9 +/- 15.7 y and 40 of them were male. The length of hospital stay was 14.0 days. Wound, blood, sputa, urine and catheter sample specimens were examined. Gram-negative bacilli, Gram-positive bacteria and fungi accounted for 72.4%, 20.0% and 7.6% of the isolates, respectively. Acinetobacter baumannii and Pseudomonas aeruginosa were the major isolates from wounds. Of the isolated strains, 92.8% occurred at >48 h following admission to the hospital, and most of these agents were common isolates in our hospital. Furthermore, 40.9% of these patients were carriers of multidrug-resistant (MDR) microorganisms. Therefore, we can conclude that patients with crush syndrome may have an increased risk of hospital-acquired infection (HAI), suggesting that it is important to select effective antibiotics to control HAI in a timely manner according to the microbiological data.
Subject(s)
Cross Infection/microbiology , Crush Syndrome/microbiology , Adolescent , Adult , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , China/epidemiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Crush Syndrome/epidemiology , Drug Resistance, Multiple, Bacterial , Earthquakes , Female , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/epidemiology , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacteria/drug effects , Gram-Positive Bacteria/isolation & purification , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Humans , Male , Microbial Sensitivity Tests , Middle AgedABSTRACT
OBJECTIVE: To analyze the results of clinical and bacteriological examinations of crush syndrome patients admitted to our institute after the Marmara earthquake. METHODS: Data were collected retrospectively from patients' files. Forty patients are included. Their mean age was 31.5 +/- 13.5 years and 18 were male. Their mean time under the rubble was 13.1 +/- 14.4 h. Fasciotomies were performed on 41 extremities of 30 patients. One hundred and twelve (mean 2.9 +/- 1.9 samples/patient) bacteriological samples were collected from wounds (51), blood (23), urine (25) and catheters (13). RESULTS: Microbial growth was detected in 67 samples from 38 (95%) patients. Non-fermenting Gram-negative bacilli, Gram-positive cocci, Enterobacteriaciace and yeast-like fungi were isolated in 67%, 17%, 12% and 4% of the samples, respectively. Acinetobacter (36%) and Pseudomonas aeruginosa (21%), the major bacterial isolates from wound infections, were resistant to carbapenems and sensitive to quinolones. As the hospitalization period increased, other infections supervened. Gram-positive cocci and non-fermenting Gram-negative bacilli were detected in six blood and seven catheter samples and methicillin-resistant Staphylococcus aureus was the major isolate. Nine (22%) of the patients died due to sepsis despite all supportive therapies. CONCLUSIONS: Infections are still major factors in crush syndrome-related deaths.
Subject(s)
Crush Syndrome/complications , Crush Syndrome/microbiology , Gram-Negative Bacterial Infections/complications , Gram-Positive Bacterial Infections/complications , Mycoses/complications , Adolescent , Adult , Child , Disasters , Drug Resistance, Bacterial , Female , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/microbiology , Humans , Male , Middle Aged , Sepsis/complications , Sepsis/microbiology , Sepsis/mortality , TurkeyABSTRACT
The data on the composition of wound microflora, as well as changes in the contamination index over the course of treatment of patients with the syndrome of prolonged compression, who were brought to the institute after the earthquake in Armenia, are presented. The authors characterize the structure of the causative agents of wound infection in the patients treated at the traumatological department of the institute over several years. The epidemiological situation in the hospital in the period when the earthquake victims were treated there is analyzed.
