title: Infectious complications after mass disasters: the Marmara earthquake experience.
abstract: The Marmara earthquake occurred on 17 August 1999. There were 639 renal victims, of whom 477 needed some form of renal replacement therapy. Although several medical complications have been reported in the literature, there has been no detailed description of infectious complications in patients with crush syndrome after earthquakes. Data from 35 hospitals considering clinical and laboratory findings, as well as infectious complications and the results of microbiological examinations, were analysed. 223 out of 639 (34.9%) patients had infectious complications, which comprised the most frequent medical problem in the renal victims. The patients who suffered from infections had a higher mortality rate than those who did not (p = 0.03). Sepsis and wound infection were the main presentation of the infectious complications. 121 (18.9%) patients suffered from sepsis; the mortality rate was higher in these patients (27.3%) than in victims who did not suffer from sepsis (12.4%, p < 0.0001). In a multivariate model, sepsis was associated with increased mortality (p = 0.0002, odds ratio 2.45, 95% confidence interval 1.52-3.96). 53 (8.2%) and 41 (6.4%) patients had wound and pulmonary infections, respectively. Most of the infections were nosocomial in origin and caused by Gram-negative aerobic bacteria and Staphylococcus spp. Infectious complications are common in renal victims of catastrophic earthquakes and are associated with increased mortality when complicated by sepsis.
authors.affiliation: Department of Nephrology, Ankara University Medical School, Ibni Sina Hospital, Ankara, Turkey. keven@medicine.ankara.edu.tr
authors.forename: Kenan
authors.initials: K
authors.lastname: Keven
authors.forename: Kenan
authors.initials: K
authors.lastname: Ates
authors.forename: Mehmet Sukru
authors.initials: MS
authors.lastname: Sever
authors.forename: Mujdat
authors.initials: M
authors.lastname: Yenicesu
authors.forename: Basol
authors.initials: B
authors.lastname: Canbakan
authors.forename: Turgay
authors.initials: T
authors.lastname: Arinsoy
authors.forename: Nurhan
authors.initials: N
authors.lastname: Ozdemir
authors.forename: Murat
authors.initials: M
authors.lastname: Duranay
authors.forename: Bulent
authors.initials: B
authors.lastname: Altun
authors.forename: Ekrem
authors.initials: E
authors.lastname: Erek
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology; D003444:Crush Syndrome / Q000453:epidemiology* / Q000209:etiology; D004190:Disasters; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011336:Probability; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014421:Turkey / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology