Infections and treatment of wounds in survivors of the 2004 Tsunami in Thailand

Abstract

On 26 December 2004, a tsunami devastated the west coast of Thailand and caused 8457 injuries and 5395 deaths. Data were collected from 26 December 2004 to 31 January 2005 at four public hospitals to describe the character and treatment of wounds of 523 persons who were injured during tsunami and sought medical treatment. Wounds were contaminated with mud, sand, debris and sea water and had an infection rate of 66.5% (674/1013). Most wounds (45%) had poly-microbial infection with gram-negative rods such as Escherichia coli, Klebsiella pneumoniae, Proteus and Pseudomonas species. The risk of wound infection increased with size of the wound and presence of an open fracture. Infections occurred more frequently on the lower than upper trunk of the body. Early treatment with antibiotics was protective against wound infection. Many patients asked to have their wounds sutured so that they could return to their village to look for their families and to repair damage. This report suggests that wounds should be aggressively debrided and suturing postponed if possible. Patients should be given broad spectrum antibiotics to assist with wound healing.

Disaster response in a pediatric field hospital: lessons learned in Haiti

“…Doung-Ngern et al [1] described "sufficiency of care" in a report on mass casualties after the 2004 tsunami. In our hands, the scarcity of critical care meant that ICU beds were preserved for patients who could be quickly stabilized and extubated.…”

Wound Management in Disaster Settings

“…For example, delayed initial wound care more than 24 h after injury and primary wound closure were independent predictors of secondary wound infection among tsunami victims [6]. Environmental pathogens and contaminated water used for cleaning wounds were the usual causes.…”

“…>70 % of patients had polymicrobial infection Spreading of infection due to underestimation, delay in wound care, extensive contamination, and skin lossKang et al [3]Earthquake, Wenchuan County, Sichuan, China, 2008725 clinical isolates from 2,002 culture samples (36.2 % culture positive)Organisms, n  = 725 (%) Acinetobacter baumannii 130 (17.9 %); E. coli 119 (16.4 %); S. aureus 90 (12.4 %); P. aeruginosa 67 (9.2 %); E. cloacae 64 (8.8 %); K. pneumoniae 47 (6.5 %); Candida albicans 43 (5.9 %); Stenotrophomonas (Xanthomonas) maltophilia 22 (3 %); Aeromonas hydrophila 14 (1.9 %)Gram-negative bacilli 71.3 % Gram-positive bacteria 18.9 %Edsander-Nord [4]Indian Ocean tsunami, Thailand, 2004; Karolinska University HospitalOrganism examples (no data on numbers) Acinetobacter Aeromonas hydrophila Allescheriasis ( Scedosporium apiospermum ) Bergeyella zoohelcum; Candida ( Candida tropicalis ) Chryseobacterium meningosepticum E. coli, Enterobacter faecium/E. cloacae Coagulase-negative staphylococci Microsporum gypseum (dermatophytes) Pseudomonas Zygomycosis ( Saksenaea vasiformis )Doung-Ngern et al [6]Indian Ocean tsunami, Thailand; Takuapa Hospital (177 beds); Vachira Phuket Hospital (500 beds), Talang Hospital (60 beds); Patong Hospital (30 beds), 2004523 patients with 1,013 wounds; 674/1,013 wounds (66.5 %) became infected; 2 people progressed to septic shock and acute renal failure; 56 of 84 people (66.7 %) followed up had wound infectionOrganisms, n  = 155 (%) E. coli 26 (16.8 %) K. pneumoniae 19 (12.3 %) S. aureus 18 (11.6 %) P. vulgaris 14 (9 %) P. aeruginosa 14 (9 %) Proteus mirabilis 9 (5.8 %) Enterobacter spp. 7 (4.5 %) Klebsiella ozaenae 6 (3.9 %) Enterobactor aerogenes 6 (3.9 %) E. cloacae 6 (3.9 %)Polymicrobial wound infections 45 %; 75/92 (81.5 %) cases were culture positive; mixed organisms 43.5 %; single organism 38 % Most isolates were Gram-negative bacteriaKiani et al [7]Earthquake, Pakistan; Shifa International Hospital, 200556/171 patients had wound infections (32.7 %); 103/129 cultures positiveOrganisms, n  = 108 (%) P. aeruginosa (30.5 %) Enterobacter spp.…”

“…Aeromonas was the single most common pathogen identified among tsunami survivors, accounting for over 20 % of infections [14]. Other, mostly Gram-negative bacteria [6] were also common, particularly E. coli and Klebsiella pneumoniae , as well as S. aureus , Proteus vulgaris , and P. aeruginosa [6]. …”

Мікрофлора З Органів Системи Дихання, Ран, Отриманих Під Час Повеней, Тривалого Знаходження У Воді

“…Також ризик інфікування рани збільшувався залежно від розміру рани і наявності відкритого перелому. Інфікування ран частіше зустрічалися на нижній, ніж на верхній, частині тіла [5]. Ризик інфікування рани збільшувався із збільшенням розмірів рани і при наявності відкритого перелому.…”