[EngO7-1] Characteristics of wound infections among patients injured during torrential rain and landslides, in the 2018 disaster in west Japan
Background
A major disaster involving landslides and flooding caused by heavy rainfall occurred in west Japan on July 6 and 7, 2018, killing over 100 people in the greater Hiroshima area. Many patients suffered skin and soft tissue damage as a direct result of the disaster or during the process of evacuation. Delays in initiating treatment, severe wound contamination due to mud, and longer durations of compression of the wound site may have increased the risks of wound infection. Furthermore, atypical bacteria present in mud may represent causative pathogens. However, studies on wound infections in such disaster settings have been scarce. This study aimed to investigate the clinical characteristics and treatment of wound infections during this disaster.
Methods
We retrospectively investigated the medical records of all injured patients admitted to six designated disaster medical centers in the greater Hiroshima area between July 6 and 8, 2018. Information on the patients’ characteristics, wound status, primary wound care, use of prophylactic and therapeutic antibiotics, presence of wound infection, and duration of hospitalization were collected.
Results
Thirty-three patients (69 wounds) were enrolled in the study, including 11 patients (33%) with wound infections (12 infected wounds). The average age was 58 years, and 20 (60%) patients were male. There were no significant differences in age, sex, past medical history, and revised trauma score between the infected and uninfected groups. Infected patients tended to have had longer periods from injury to hospital arrival (13.5 vs 9.0 h, p=0.085), receive more surgery (91% vs 9.5%, p<0.001), have longer hospitalization (45 vs 15 days, p<0.001), and have a longer period of antibiotic treatment (18 vs 2 days, p<0.001). Infected wounds were deeper and more likely to be contaminated by mud (58% vs.9%, p<0.001, and 92% vs. 48% p<0.001, respectively). A total of 29 species of bacteria were isolated from infected wounds, and 82% of wounds were polymicrobial. Bacillus cereus (n=6), Enterobacter species (n=4), Enterococcus species (n=8), Aeromonas species (n=3), Serratia marcescens (n=5), and Acinetobacter baumannii (n=2) were the predominant pathogens.
Conclusions
In this observational study, 33% of patients hospitalized due to injuries sustained during landslides and flooding had wound infections. Patients with infected wounds had longer durations of hospitalization and antibiotic treatment. Infected wounds were more likely to have been contaminated by mud.
A major disaster involving landslides and flooding caused by heavy rainfall occurred in west Japan on July 6 and 7, 2018, killing over 100 people in the greater Hiroshima area. Many patients suffered skin and soft tissue damage as a direct result of the disaster or during the process of evacuation. Delays in initiating treatment, severe wound contamination due to mud, and longer durations of compression of the wound site may have increased the risks of wound infection. Furthermore, atypical bacteria present in mud may represent causative pathogens. However, studies on wound infections in such disaster settings have been scarce. This study aimed to investigate the clinical characteristics and treatment of wound infections during this disaster.
Methods
We retrospectively investigated the medical records of all injured patients admitted to six designated disaster medical centers in the greater Hiroshima area between July 6 and 8, 2018. Information on the patients’ characteristics, wound status, primary wound care, use of prophylactic and therapeutic antibiotics, presence of wound infection, and duration of hospitalization were collected.
Results
Thirty-three patients (69 wounds) were enrolled in the study, including 11 patients (33%) with wound infections (12 infected wounds). The average age was 58 years, and 20 (60%) patients were male. There were no significant differences in age, sex, past medical history, and revised trauma score between the infected and uninfected groups. Infected patients tended to have had longer periods from injury to hospital arrival (13.5 vs 9.0 h, p=0.085), receive more surgery (91% vs 9.5%, p<0.001), have longer hospitalization (45 vs 15 days, p<0.001), and have a longer period of antibiotic treatment (18 vs 2 days, p<0.001). Infected wounds were deeper and more likely to be contaminated by mud (58% vs.9%, p<0.001, and 92% vs. 48% p<0.001, respectively). A total of 29 species of bacteria were isolated from infected wounds, and 82% of wounds were polymicrobial. Bacillus cereus (n=6), Enterobacter species (n=4), Enterococcus species (n=8), Aeromonas species (n=3), Serratia marcescens (n=5), and Acinetobacter baumannii (n=2) were the predominant pathogens.
Conclusions
In this observational study, 33% of patients hospitalized due to injuries sustained during landslides and flooding had wound infections. Patients with infected wounds had longer durations of hospitalization and antibiotic treatment. Infected wounds were more likely to have been contaminated by mud.