An outbreak analysis of wound infection due to Acinetobacter baumannii in earthquake-trauma patients

Esma Eryilmaz-Eren; Suleyman Yalcin; Firat Ozan; Esma Saatci; Serap Suzuk-Yildiz; Zeynep Ture; Aysin Kilinc-Toker; Ilhami Celik

doi:10.1016/j.ajic.2023.12.005

An outbreak analysis of wound infection due to Acinetobacter baumannii in earthquake-trauma patients

Am J Infect Control. 2024 May;52(5):599-604. doi: 10.1016/j.ajic.2023.12.005. Epub 2023 Dec 14.

Authors

Esma Eryilmaz-Eren¹, Suleyman Yalcin², Firat Ozan³, Esma Saatci⁴, Serap Suzuk-Yildiz², Zeynep Ture⁵, Aysin Kilinc-Toker⁶, Ilhami Celik⁶

Affiliations

¹ Department of Infectious Disease and Clinical Microbiology, Kayseri City Trainig and Research Hospital, University of Health Sciences, Kayseri, Turkey; Department of Clinical Bacteriology and Infectious Diseases, Preventing Hospital Infections Doctorate Programme, Institute of Health Sciences, Erciyes University, Kayseri, Turkey. Electronic address: esmaereneryilmaz@gmail.com.
² Department of Microbiology Reference Laboratories, General Directorate of Public Health, Ministry of Health, Ankara, Turkey.
³ Department of Orthopedics and Traumatology, Kayseri City Training and Research Hospital, University of Health Sciences, Kayseri, Turkey.
⁴ Department of Medical Microbiology, Kayseri City Training and Research Hospital, Kayseri, Turkey.
⁵ Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
⁶ Department of Infectious Disease and Clinical Microbiology, Kayseri City Trainig and Research Hospital, University of Health Sciences, Kayseri, Turkey.

PMID: 38103648
DOI: 10.1016/j.ajic.2023.12.005

Abstract

Background: Multidrug-resistant Acinetobacter baumannii is still a major contributor to outbreaks and infections health care-associated infections. This study aimed to investigate an outbreak of wound infection due to A baumannii in trauma patients injured in the Kahramanmaraş earthquake.

Methods: This retrospective case-control study was conducted on an outbreak of wound infection caused by A. baumannii in trauma patients affected by the February 6 Turkey earthquake. Among the patients who underwent at least one extremity surgery due to earthquake-related crush-trauma injury, patients with wound infection due to A baumannii were included in the case group and without infection were included in the control group. Multivariate analysis and logistic regression were performed to identify risk factors. Environmental cultures were taken to identify the source of the outbreak. Molecular typing by pulsed-field gel electrophoresis was used to confirm the relationships of the wound infection agent A. baumannii strains.

Results: A total of 44 patients were included in the case group and 62 patients in the control group. Time under the debris; 22.0 versus 35.7 (odds ratio [OR]:1.02, 95% confidence interval [CI]: 1.00-1.04) and hemodialysis (OR: 6.09, 95% CI: 1.64-22.66) were identified as risk factors for in the multivariate analysis. Performing the first intervention in a fully equipped tertiary hospital was seen as an infection-reducing factor compared to performing it in a field hospital (OR: 0.21, 95% CI: 0.06-0.68). Dressing trolleys and scissors were identified as the source of the outbreak.

Conclusions: After devastating earthquakes, a large number of patients are admitted and require emergency interventions due to life-threatening conditions. Organ failure often develops and requires the use of invasive catheters and procedures. Compliance with infection control measures and clean surgical interventions reduce wound site infections and allow extremities to heal, while problems in adhering to infection control measures can lead to many problems such as outbreaks of gram-negative bacteria. This highlights the importance of infection control measures.

Keywords: Earthquake; Pulse field gel electrophoresis.