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Antimicrobial Therapy for Water-Associated Wound Infections in a Disaster Setting: Gram-Negative Bacilli in an Aquatic Environment and Lessons from Banda Aceh

Published online by Cambridge University Press:  28 June 2012

Junko Okumura ,
Tatsurou Kai ,
Zinatul Hayati ,
Fadrial Karmil ,
Kazuko Kimura  and
Yasuhiro Yamamoto
Junko Okumura*
Affiliation:
Department of Drug Management and Policy, Faculty of Pharmacy, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa, Japan
Tatsurou Kai
Affiliation:
Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
Zinatul Hayati
Affiliation:
Faculty of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
Fadrial Karmil
Affiliation:
Faculty of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
Kazuko Kimura
Affiliation:
Department of Drug Management and Policy, Faculty of Pharmacy, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa, Japan
Yasuhiro Yamamoto
Affiliation:
Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
*
Department of Drug Management and PolicyFaculty of PharmacyInstitute of Medical, Pharmaceutical, and Health SciencesKanazawa UniversityKakuma-machi, Kanazawa-city, Ishikawa 920-1192Japan E-mail: jugu3desu@yahoo.co.jp
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Abstract

Introduction:

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.

Keywords

aquatic environmentantimicrobialantimicrobial resistantBanda Acehgram-negative bacillitsunamiwaterassociated wound infection
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 24 , Issue 3 , June 2009 , pp. 189 - 196
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

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