Analysis of wound infections among pediatric patients following the 2023 Türkiye–Syria earthquakes
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In brief
In brief
Retrospective analysis of 180 pediatric earthquake victims identifies blood transfusion requirement as strongest predictor of wound infection (OR=9.9), with 81% gram-negative pathogens showing multidrug resistance. Laboratory thresholds for CK, liver enzymes, and inflammatory markers demonstrate high negative predictive value for infection risk stratification in mass-casualty scenarios.
- 12.2% of pediatric earthquake injury patients developed wound infections, with blood transfusion need being the strongest predictor (OR=9.9).
- Gram-negative pathogens caused 81% of wound infections, with 75% showing multidrug or extensive drug resistance patterns.
- Normal lab values (CK<810, CRP<45.8, AST<32) had high negative predictive value (93-100%) for ruling out wound infection development.
- Crush syndrome, fasciotomy, amputation, and invasive devices significantly increased wound infection risk in trapped pediatric patients.
- Broad-spectrum empiric antibiotics should target resistant gram-negatives in high-risk pediatric disaster victims with collapse exposure.
Written by the GCMD Library team from the article.
Abstract
Purpose
On February 6, 2023, two earthquakes of magnitude 7.7 and 7.6 occurred consecutively in Turkey and Syria. This study aimed to investigate the predisposing factors for wound infection (WI) and the microbiological characteristics of wounds after earthquake-related injuries.
Methods
This descriptive study evaluated pediatric patients’ frequency of WI, and the clinical and laboratory parameters associated with the development of WI were investigated.
Results
The study included 180 patients (91 female). The mean age of the patients was 123.9 ± 64.9 months and 81.7% (n = 147) of them had been trapped under rubble. Antibiotic treatment to prevent WI had been administered to 58.8% (n = 106) of all patients. WI was observed in 12.2% (n = 22) of the cases. In patients who developed WI, the incidence of exposure to a collapse, crush syndrome, compartment syndrome, multiple extremity injury, fasciotomy, amputation, peripheral nerve injury, thoracic compression, blood product use, intubation, and the use of central venous catheters, urinary catheters, and thoracic tubes were more frequent (p < 0.05). The need for blood product transfusion was associated with the development of WI (OR = 9.878 [95% CI: 2.504–38.960], p = 0.001). The negative predictive values of not developing WI at values of white blood cell count of < 11,630/mm3, creatine kinase < 810 U/L, potassium < 4.1 mEq/L, ALT < 29 U/L, AST < 32 U/L, and CRP < 45.8 mg/L were 93.7%, 96.8%, 90.8%, 93.3%, 100%, and 93.5%, respectively. Gram-negative pathogens (81%) were detected most frequently in cases of WI. Seventy-five percent of patients were multidrug- and extensively drug-resistant.
Conclusion
This study leans empirical approach of our disaster circumstances. In cases with risk factors predisposing to the development of WI, it may be rational to start broad-spectrum antibiotics while considering the causative microorganisms and resistance profile to prevent morbidity.