Infecting organisms in victims from the tsunami disaster: experiences from Bangkok Phuket Hospital, Thailand
 Authors: Dr. Kongkiat Kespechara, CEO - Bangkok Hospital Phuket , Bangkok Hospital Hat-Yai, Bangkok Hospital Samui.
Objectives: To study the pattern of wound infections in the victims of the tsunami disaster treated in a hospital in the disaster zone in Thailand with regard to incidence, development and characteristics of infections, microbiological flora and bacterial sensitivity to antibiotics.
Methods: The incidence of infections and the intervals between injury and infection were registered for all patients from the disaster submitted to the hospital during the first 8 days after the disaster, and the clinical course and characteristics of infections were documented. Bacterial samples were taken from patients with clinical signs of purulent infections and cultured on blood, McConkey and TCBS agar. The results of cultures and determinations of sensitivity were reported within 48–72hours. The bacterial specimens were frozen to permit re?investigation.
Results: Both the clinical pattern of infection and the microbiological flora in the studied tsunami victims were different from those in conventional trauma patients, and also from those previously reported in disasters and mass casualty situations. In spite of generous use of preventive antibiotics and careful cleaning of wounds, 18% of the submitted patients developed infections, many as early as 24hours after the injury. Many of the infections showed an aggressive course. In all, 70% of the infected patients needed repeated surgical revision of the wounds, some of these with deep tissue involvement after small wounds, and 10% developed septicaemia, in one patient leading to multi?organ failure and death. In many cases the bacterial cultures and determinations of sensitivity showed resistance to conventional antibiotics and induced changed strategy in both antibiotic treatment and clinical management of wounds.
Conclusions: The results illustrate the importance of considering both the specific mechanisms of injury, the sources and extent of contamination, the exposure of wounds to environmental factors and the delay in treatment, all factors that may induce specific patterns of infection and should influence the treatment strategy. Bacterial sampling with rapid analysis of cultures and sensitivity is valuable to identify variations in microbiological flora and facilitate effective use of antibiotics.
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