Antimicrobial therapy for water-associated wound infections in a disaster setting: gram-negative bacilli in an aquatic environment and lessons from Banda Aceh.
BACKGROUND
As members of the Japan Disaster Relief (JDR) team in Banda Aceh, three of the authors treated 1,891 patients following the tsunami of 2004. Of the 367 cases with traumatic injuries, 216 cases required antimicrobial therapy. The medical services were continued by the Japan Self-Defense (JSD) Medical Team until mid-March 2005. Of the 216 cases initially treated by JDR, 54 required prolonged antimicrobial therapy for persistent symptoms despite repeated debridement. The aim of this study is to recommend an appropriate antimicrobial therapy for water-associated wound infections in the absence of laboratory services in disaster settings following tsunami.


METHODS
The JDR and JSD treatment records were analyzed retrospectively. In August 2006, 19 months after the tsunami, the authors investigated pathogens in natural aquatic habitats in the affected area in Banda Aceh. At the same time, interviews with tsunami survivors were performed to determine the influential factors that facilitated wound infections after the tsunami.


RESULTS
From the 49 water samples tested, Aeromonas sp., Vibrio sp., Klebsiella sp., and Proteus sp. were isolated from 24, 16, 15, and six samples, respectively. Regardless of the genus, almost all of the isolated gram-negative bacilli were sensitive to ciprofloxacin and gentamicin.


CONCLUSIONS
From the microbiological test results and analyses of the medical records and interviews, the researchers recommend the following regimen when clinical microbiological tests are not available: initial treatment with beta"lactam penicillins for three days, followed, if the first antimicrobial is not effective, by ciprofloxacin or any other relevant new quinolones, with the addition of gentamicin if necessary.
Okumura
Junko
J
Department of Drug Management and Policy, Faculty of Pharmacy, Institute of Medical Pharmaceutical, and Health Sciences, Kanazawa, Japan. jugu3desu@yahoo.co.jp
Kai
Tatsurou
T
Hayati
Zinatul
Z
Karmil
Fadrial
F
Kimura
Kazuko
K
Yamamoto
Yasushiro
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use; D016001:Confidence Intervals; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012066:Relief Work; D012189:Retrospective Studies; D057192:Tsunamis; D014867:Water; D014871:Water Microbiology; D014947:Wounds and Injuries / Q000150:complications* / Q000382:microbiology; D055815:Young Adult
D000890:Anti-Infective Agents; D005839:Gentamicins; D014867:Water; D002939:Ciprofloxacin