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LİBYA İÇ SAVAŞ YARALANMALARININ ÇOKLU DİRENÇLİ BAKTERİLERLE OLAN İNFEKSİYONLARI: NE ÖĞRENDİK?

Year 2020, Volume: 83 Issue: 3, 267 - 274, 29.06.2020

Abstract

Amaç: Savaş yaralanmalarında gelişen yara yeri enfeksiyonlarında; geç dönemde nozokomiyal bulaş ve empirik uygulanan geniş spektrumlu antibiyoterapiler nedeniyle dirençli gram negatif mikroorganizmalar sorumlu etken olarak karşımıza çıkmaktadır. Çalışmamızda Libya’dan hastanemize transfer edilen 45 sivil savaş yaralanmalı olgunun demografik, klinik ve mikrobiyolojik özelliklerinin retrospektif olarak araştırılması amaçlanmıştır. Gereç ve Yöntem: Dirençli bakteri kolonizasyonlarını saptamak amacı ile sürveyans kültürleri (burun, rektal, idrar, yara, endotrakeal aspirat, kan kültürü) alınmış ve üreyen mikroorganizmalar ve antibiyotik duyarlılıkları VITEK® 2 (bioMérieux, Marcy l’Etoile, Fransa) otomatize sistemi ile tanımlanmıştır. Bulgular: Toplam 45 hastanın ortalama yaşı 30,7±12,9 olup, 44’ü (%97,8) erkekti. Yaralanmaların çoğunluğu (%66,7) ateşli silah yaralanmasıydı ve 22’si (%48,9) alt ekstremitedeydi. Hastaların 30’unda (%66) açık kemik kırığı ve 28’inde (%62,2) primer yara yeri infeksiyonu vardı. Surveyans kültürlerinde 29 hastada 40 mikroorganizma üremesi saptandı ve bunların 22’si (%55) gram-negatif çomak, 17’si (%42,5) gram-pozitif kok ve 1’i (%2,5) mantardı. İzole edilen mikroorganizmaların 13’ünde (%32,5) direnç saptanmazken; 10’unda (%22,2) çoklu ilaç direnci (ÇİD), 13’ünde (%28,9) ise genişletilmiş ilaç direnci (GİD) saptandı. Hiçbir hastada mortalite gelişmedi. Sonuç: Çalışmamızda; savaş yaralanması nedeni ile kabul edilen olgulara ait tek merkez deneyimimiz paylaşıldı. Çoğu hastanın ÇİD/GİD bakterilerle infekte veya kolonize oldukları görüldü. Olgularımızın genç ve komorbiditelerinin bulunmaması, tedavide uzun süreli antibiyoterapilerin kullanımına olanak sağlarken, sık yara debritmanı ve negatif basınçlı yara kapama tedavisinin de iyi sonuçlarımıza katkıda bulunduğu düşünüldü. Savaş yaralanmalarında; erken cerrahi debritman, uygun doz ve spektrumda antibiyotik uygulamaları, gerekli durumlarda yara yeri ve surveyans kültürlerinin alımı ile sonuçlar yüz güldürücü olabilmektedir.

References

  • 1. Murray CK, Obremskey WT, Hsu JR, Andersen RC, Calhoun JH, Clasper JC, et al. Prevention of infections associated with combat-related extremity injuries. J Trauma 2011;71(2 suppl 2):S235-57. [CrossRef]
  • 2. Merrens A, Rapp C, Delaune D, Danis J, Berger F, Michel R. Prevention of combat-related infections: Antimicrobial therapy in battlefield and barrier measures in French military medical treatment facilities. Travel Med Infect Dis 2014;12(4):318-29. [CrossRef]
  • 3. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984;24(8):742-6. [CrossRef]
  • 4. Hudzicki J. Kirby-Bauer Disk Diffusion Susceptibility Test Protocol. Am Soc Microbiol 2013;(December 2009):1-23.
  • 5. The Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing CLSI Supplement M 100S;2016.
  • 6. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drugresistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268-81. [CrossRef]
  • 7. Bodalal Z, Mansor S. Gunshot injuries in BenghaziLibya in 2011: The Libyan conflict and beyond. Surgeon 2013;11(5):258-63. [CrossRef]
  • 8. Aras M, Altaş M, Yilmaz A, Serarslan Y, Yilmaz N, Yengil E, et al. Being a neighbor to Syria: A retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war. Clin Neurol Neurosurg 2014;125:222-8. [CrossRef]
  • 9. Geiger S, McCormick F, Chou R, Wandel AG. War wounds: Lessons learned from operation iraqi freedom. Plast Reconstr Surg 2008;122(1):146-53. [CrossRef]
  • 10. Kumar G, Narayan B. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. retrospective and prospective analyses. Class Pap Orthop 2014:527-30. [CrossRef]
  • 11. Hospenthal DR, Murray CK, Andersen RC, Bell RB, Calhoun JH, Cancio LC, et al. Guidelines for the prevention of infections associated with combat-related injuries: 2011 Update. J Trauma 2011;71:S210-34. [CrossRef]
  • 12. Calhoun JH, Murray CK, Manring MM. Multidrug-resistant organisms in military wounds from Iraq and Afghanistan. Clin Orthop Relat Res 2008;466(6):1356-62. [CrossRef]
  • 13. Hawley JS, Murray CK, Griffith ME, McElmeel ML, Fulcher LC, et al. Susceptibility of Acinetobacter strains isolated from deployed U.S. military personnel. Antimicrob Agents Chemother 2007;51(1):376-8. [CrossRef]
  • 14. Franka EA, Shembesh MK, Zaied AA, El-Turki E, Zorgani A, Elahmer OR, et al. Multidrug resistant bacteria in wounds of combatants of the Libyan uprising. J Infect 2012;65(3):27981. [CrossRef]
  • 15. Pollak AN. Use of negative pressure wound therapy with reticulated open cell foam for lower extremity trauma. J Orthop Trauma 2008;22(10):S142-5. [CrossRef]
  • 16. Powell ET. The role of negative pressure wound therapy with reticulated open cell foam in the treatment of war wounds. J Orthop Trauma 2008;22(10):S138-S141. [CrossRef]
  • 17. Leininger BE, Rasmussen TE, Smith DL, Jenkins DH, Coppola C. Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq. J Trauma 2006;61(5):1207-11. [CrossRef]
  • 18. Sebeny PJ, Riddle MS, Petersen K. Acinetobacter baumannii skin and soft-tissue infection associated with war trauma. Clin Infect Dis 2008;47(4):444-9. [CrossRef]
  • 19. Dallo SF, Weitao T. Insights into Acinetobacter war-wound infections, biofilms, and control. Adv Skin Wound Care 2010;23(4):169-74. [CrossRef]
  • 20. Gaddy JA, Actis LA. Regulation of Acinetobacter baumannii biofilm formation Jennifer. Futur Microbiol 2009;4:273-8. [CrossRef]
  • 21. Deveci Ö, Dal T, Tekin R, Bozkurt F, Tekin A, Dayan S. Carbapenem resistance in Acinetobacter baumannii: where is it heading? Infez Med 2013;21(3):211-5.
  • 22. Moran KA, Murray CK, Anderson EL. Bacteriology of blood, wound, and sputum cultures from non-US casualties treated in a combat support hospital in Iraq. Infect Control Hosp Epidemiol 2008;29(10):981-4. [CrossRef]
  • 23. Koole K, Ellerbroek PM, Lagendijk R, Leenen LPH, Ekkelenkamp MB. Colonization of Libyan civil war casualties with multidrug-resistant bacteria. Clin Microbiol Infect 2013;19(7):E285-7. [CrossRef]
  • 24. Elramalli A, Almshawt N, Ahmed MO. Current problematic and emergence of carbapenemase-producing bacteria: A brief report from a libyan hospital. Pan Afr Med J 2017;26:180. [CrossRef]
  • 25. Buzaid N, Elzouki AN, Taher I, Ghenghesh KS. Methicillinresistant Staphylococcus aureus (MRSA) in a tertiary surgical and trauma hospital in Benghazi, Libya. J Infect Dev Ctries 2011;5(10):723-6. [CrossRef]
  • 26. Ordooei Javan A, Shokouhi S, Sahraei Z. A review on colistin nephrotoxicity. Eur J Clin Pharmacol 2015;71(7):80110. [CrossRef]
  • 27. Hartzell JD, Neff R, Ake J, Howard R, Olson S, Paolino K, et al. Nephrotoxicity Associated with Intravenous Colistin (Colistimethate Sodium) Treatment at a Tertiary Care Medical Center. Clin Infect Dis 2009;48(12):1724-8.

MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?

Year 2020, Volume: 83 Issue: 3, 267 - 274, 29.06.2020

Abstract

Objective: Complicated by nosocomial infections and wide spectrum antibiotherapy, combat related injuries (CRI) are associated with resistant gram-negative microorganisms, especially at the later stage. The aim of this study is to retrospectively investigate demographic, clinical and microbiologic characteristics of 45 CRI patients transferred from Libya and hospitalized in a private clinic. Material and Method: Surveillance cultures (nasal, rectal, wound swabs, trakeal aspirates, urine and blood cultures) were obtained and isolated bacteria and their antibiotic susceptibility were identified using VITEK® 2 system (bioMérieux, Marcy l’Etoile, France). Results: The median age of 45 patients (44 [97.8%] male) was 30.7±12.9 years. The majority of the injuries were due to firearms (66.7%) and 22 (48.9%) patients were injured on the lower extremities. Open bone fractures were present in 30 (66.6%) patients. Primary wound site infection was present in 28 (62.2%) patients. Surveillance cultures revealed 40 microorganisms from the samples of 29 patients, which were gram-negative rods in 22 (55%), gram-positive cocci in 17 (42.5%) and fungus in 1 (2.5%) patients). Of the 40 isolated microorganisms, 13 (32.5%) were non-resistant, 10 (22.2%) were MDR, and 13 (28.9%) were XDR. None of the patients died in the study period. Conclusion: Despite the limited number of cases, this study presents the characteristics of the Libyan combat victims treated by a multidisciplinary team at a single center. Surveillance cultures revealed many victims to be infected or colonised by MDR/ XDR bacteria. Early surgical wound debridement, early initiation of antibiotic therapy in the proper dose and spectrum, and obtaining wound site cultures whenever necessary may help to provide more favorable outcomes in CRI victims.

References

  • 1. Murray CK, Obremskey WT, Hsu JR, Andersen RC, Calhoun JH, Clasper JC, et al. Prevention of infections associated with combat-related extremity injuries. J Trauma 2011;71(2 suppl 2):S235-57. [CrossRef]
  • 2. Merrens A, Rapp C, Delaune D, Danis J, Berger F, Michel R. Prevention of combat-related infections: Antimicrobial therapy in battlefield and barrier measures in French military medical treatment facilities. Travel Med Infect Dis 2014;12(4):318-29. [CrossRef]
  • 3. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984;24(8):742-6. [CrossRef]
  • 4. Hudzicki J. Kirby-Bauer Disk Diffusion Susceptibility Test Protocol. Am Soc Microbiol 2013;(December 2009):1-23.
  • 5. The Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing CLSI Supplement M 100S;2016.
  • 6. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drugresistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268-81. [CrossRef]
  • 7. Bodalal Z, Mansor S. Gunshot injuries in BenghaziLibya in 2011: The Libyan conflict and beyond. Surgeon 2013;11(5):258-63. [CrossRef]
  • 8. Aras M, Altaş M, Yilmaz A, Serarslan Y, Yilmaz N, Yengil E, et al. Being a neighbor to Syria: A retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war. Clin Neurol Neurosurg 2014;125:222-8. [CrossRef]
  • 9. Geiger S, McCormick F, Chou R, Wandel AG. War wounds: Lessons learned from operation iraqi freedom. Plast Reconstr Surg 2008;122(1):146-53. [CrossRef]
  • 10. Kumar G, Narayan B. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. retrospective and prospective analyses. Class Pap Orthop 2014:527-30. [CrossRef]
  • 11. Hospenthal DR, Murray CK, Andersen RC, Bell RB, Calhoun JH, Cancio LC, et al. Guidelines for the prevention of infections associated with combat-related injuries: 2011 Update. J Trauma 2011;71:S210-34. [CrossRef]
  • 12. Calhoun JH, Murray CK, Manring MM. Multidrug-resistant organisms in military wounds from Iraq and Afghanistan. Clin Orthop Relat Res 2008;466(6):1356-62. [CrossRef]
  • 13. Hawley JS, Murray CK, Griffith ME, McElmeel ML, Fulcher LC, et al. Susceptibility of Acinetobacter strains isolated from deployed U.S. military personnel. Antimicrob Agents Chemother 2007;51(1):376-8. [CrossRef]
  • 14. Franka EA, Shembesh MK, Zaied AA, El-Turki E, Zorgani A, Elahmer OR, et al. Multidrug resistant bacteria in wounds of combatants of the Libyan uprising. J Infect 2012;65(3):27981. [CrossRef]
  • 15. Pollak AN. Use of negative pressure wound therapy with reticulated open cell foam for lower extremity trauma. J Orthop Trauma 2008;22(10):S142-5. [CrossRef]
  • 16. Powell ET. The role of negative pressure wound therapy with reticulated open cell foam in the treatment of war wounds. J Orthop Trauma 2008;22(10):S138-S141. [CrossRef]
  • 17. Leininger BE, Rasmussen TE, Smith DL, Jenkins DH, Coppola C. Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq. J Trauma 2006;61(5):1207-11. [CrossRef]
  • 18. Sebeny PJ, Riddle MS, Petersen K. Acinetobacter baumannii skin and soft-tissue infection associated with war trauma. Clin Infect Dis 2008;47(4):444-9. [CrossRef]
  • 19. Dallo SF, Weitao T. Insights into Acinetobacter war-wound infections, biofilms, and control. Adv Skin Wound Care 2010;23(4):169-74. [CrossRef]
  • 20. Gaddy JA, Actis LA. Regulation of Acinetobacter baumannii biofilm formation Jennifer. Futur Microbiol 2009;4:273-8. [CrossRef]
  • 21. Deveci Ö, Dal T, Tekin R, Bozkurt F, Tekin A, Dayan S. Carbapenem resistance in Acinetobacter baumannii: where is it heading? Infez Med 2013;21(3):211-5.
  • 22. Moran KA, Murray CK, Anderson EL. Bacteriology of blood, wound, and sputum cultures from non-US casualties treated in a combat support hospital in Iraq. Infect Control Hosp Epidemiol 2008;29(10):981-4. [CrossRef]
  • 23. Koole K, Ellerbroek PM, Lagendijk R, Leenen LPH, Ekkelenkamp MB. Colonization of Libyan civil war casualties with multidrug-resistant bacteria. Clin Microbiol Infect 2013;19(7):E285-7. [CrossRef]
  • 24. Elramalli A, Almshawt N, Ahmed MO. Current problematic and emergence of carbapenemase-producing bacteria: A brief report from a libyan hospital. Pan Afr Med J 2017;26:180. [CrossRef]
  • 25. Buzaid N, Elzouki AN, Taher I, Ghenghesh KS. Methicillinresistant Staphylococcus aureus (MRSA) in a tertiary surgical and trauma hospital in Benghazi, Libya. J Infect Dev Ctries 2011;5(10):723-6. [CrossRef]
  • 26. Ordooei Javan A, Shokouhi S, Sahraei Z. A review on colistin nephrotoxicity. Eur J Clin Pharmacol 2015;71(7):80110. [CrossRef]
  • 27. Hartzell JD, Neff R, Ake J, Howard R, Olson S, Paolino K, et al. Nephrotoxicity Associated with Intravenous Colistin (Colistimethate Sodium) Treatment at a Tertiary Care Medical Center. Clin Infect Dis 2009;48(12):1724-8.
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section RESEARCH
Authors

Zehra Çağla Karakoç This is me 0000-0002-1618-740X

Taner Bekmezci This is me 0000-0003-3962-2491

Ahmet Başel This is me 0000-0002-9681-074X

Binnur Pınarbaşı Şimşek This is me 0000-0003-3412-3976

Publication Date June 29, 2020
Submission Date September 8, 2019
Published in Issue Year 2020 Volume: 83 Issue: 3

Cite

APA Karakoç, Z. Ç., Bekmezci, T., Başel, A., Pınarbaşı Şimşek, B. (2020). MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?. Journal of Istanbul Faculty of Medicine, 83(3), 267-274.
AMA Karakoç ZÇ, Bekmezci T, Başel A, Pınarbaşı Şimşek B. MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?. İst Tıp Fak Derg. June 2020;83(3):267-274.
Chicago Karakoç, Zehra Çağla, Taner Bekmezci, Ahmet Başel, and Binnur Pınarbaşı Şimşek. “MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?”. Journal of Istanbul Faculty of Medicine 83, no. 3 (June 2020): 267-74.
EndNote Karakoç ZÇ, Bekmezci T, Başel A, Pınarbaşı Şimşek B (June 1, 2020) MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?. Journal of Istanbul Faculty of Medicine 83 3 267–274.
IEEE Z. Ç. Karakoç, T. Bekmezci, A. Başel, and B. Pınarbaşı Şimşek, “MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?”, İst Tıp Fak Derg, vol. 83, no. 3, pp. 267–274, 2020.
ISNAD Karakoç, Zehra Çağla et al. “MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?”. Journal of Istanbul Faculty of Medicine 83/3 (June 2020), 267-274.
JAMA Karakoç ZÇ, Bekmezci T, Başel A, Pınarbaşı Şimşek B. MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?. İst Tıp Fak Derg. 2020;83:267–274.
MLA Karakoç, Zehra Çağla et al. “MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?”. Journal of Istanbul Faculty of Medicine, vol. 83, no. 3, 2020, pp. 267-74.
Vancouver Karakoç ZÇ, Bekmezci T, Başel A, Pınarbaşı Şimşek B. MULTIDRUG-RESISTANT BACTERIAL INFECTIONS OF THE LIBYAN CIVIL WAR VICTIMS: WHAT DID WE LEARN?. İst Tıp Fak Derg. 2020;83(3):267-74.

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