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CLINICAL MANIFESTATIONS AND CAUSATIVE PATHOGENS OF INFECTIOUS COMPLICATIONS AMONG TSUNAMI VICTIMS FROM SOUTH SEA THAILAND: CASES SERIES OF SAMITIVEJ SRINAKARIN HOSPITAL BANGKOK THAILAND

Samitivej Srinakarin Hospital, Bangkok, Thailand

PURPOSE: According to disaster from tsunami on December 26, 2004. The victims who were suffered from the submersion injuries developed infectious complications that were related to aspiration and exposure of seawater or sewage. Clinical presentations and causative pathogens were summarized for recognition and appropriate management.

METHODS: The series of cases were collected from medical records including clinical and microbiological data during hospitalization in medical and surgical service after evacuation from southern Thailand.

RESULTS: Thirty cases were hospitalized. Mean age was 44 years (12 to 77 years) .Soft tissue and musculoskeletal infections (infected wound and opened fracture) were diagnosed in 27 cases (90 %). Respiratory tract infections (pneumonia associated with near drowning and sinusitis) were diagnosed in 10 cases (33%). Six cases (20%) had multiple sites of infection. The most common pathogens isolated from clinical specimens (wound swab in operating room, sputum, and lavage fluid) were Aeromonas sobria (20 %).One third of cases had polymicrobial gram negative infection. Commonly used antibiotics before obtaining microbiological result were amoxicillin-clavulanate (40 %), fluoroqiunolones (21%) and third generation cephalosporins (14%) respectively. Combination antibiotics were used in one third of patients. Pneumonia patient with lobar atelectasis underwent flexible bronchoscopy for removal of foreign material. All of patients with infected wound and opened fracture were treated by immediate surgical debridement and tetanus immunization. Nasal endoscopies and irrigations were performed in sinusitis patients. Average total length of stay was 4 days (1 to14 days). There was no mortality of our cases.

CONCLUSION: The incidence of soft tissue and musculoskeletal infections is more common than respiratory tract infections among survivors from tsunami. Enteric gram negative bacilli were common pathogens encountered in infectious complications.

CLINICAL IMPLICATIONS: The effective antimicrobial treatment of infectious complication related to submersion injuries from seawater are either beta lactam antibiotics or fluoroquinolones. Surgical debridement and endoscopy with lavage for removal of foreign material are necessary part of treatments.

DISCLOSURE: Theerasuk Kawamatawong, None.