Superficial and invasive infections following flooding disasters

Abstract

Objectives: Given the loss of laboratory infrastructure following flooding disasters, the objectives of this review were (1) to describe current practices in the treatment of aquatic injuries and infections in nondisaster scenarios; (2) to describe how lessons learned from the management of superficial and invasive infections in survivors of the 2004 Indian Ocean tsunami could improve current management practices; (3) to stratify waterborne infections by causative agents and preferred saline levels; and (4) to recommend initial wound and empiric antibiotic management strategies for specific aquatic infections.

Design: Retrospective systematic review.

Setting: Not applicable.

Participants: References were selected to provide clinicians with a broader knowledge of causative aquatic pathogens and their antimicrobial susceptibilities.

Interventions: Internet search engines were queried with key words to identify salient case reports, retrospective series, observational studies, and additional references on wound and antimicrobial management from Southeast Asian and other countries providing intensive care to tsunami survivors and from other similar series on the management of flooding and near-drowning victims.

Main outcome measures: Identify causative pathogens of aquatic infections and their antimicrobial susceptibilities in flooding disaster victims and recommend effective arsenals of empiric antimicrobial therapies.

Results: The causative pathogens of wound and systemic infections in near-drowning and tsunami survivors ranged from typical human skin and enteric contaminants to aquatic organisms and soil contaminants, including fungi. There was an early predominance of polymicrobial Gram-negative causative organisms in wound infections, Unanticipated, delayed mycobacterial and fungal infections occurred frequently, even after traumatic wounds healed.

Conclusions: Clinicians who care for victims of flooding disasters and near-drowning can apply lessons learned from the management of tsunami survivors to selecting initial antimicrobials for empiric therapy of aquatic injuries based on their sources and distributions of aquatic exposures.