Treatment of sepsis secondary to blast injuries

Abstract

Blast injuries are an important cause of morbidity and mortality due to ongoing conflicts, especially among young patients. Due to the adversities of warfare, the first interventions for these patients are performed in unsuitable environments. Patients generally do not receive further treatment in their own country, but in other countries as wounded war refugees. Local and systemic infections in patients with associated polytrauma, soft tissue damage, and blast effects cause mortality and morbidity. All of the patients were injured during the Libyan civil war and the first intervention was performed in hospitals in their own country or in Tunisia. The patients were transferred to our clinic by ambulance plane. All patients presented bone-soft tissue infection and sepsis. Bone-soft tissue and blood cultures were obtained from the patients. The first interventions for the patients were performed multidisciplinarily in orthopedics, general surgery, infection, and intensive care clinics. The patients were followed in our clinic for one year including intensive care, service, and outpatient monitoring. Sixteen patients with a mean age of 28.8 years were included in the study. All patients were wounded by explosives or missiles. The patients were admitted to our clinic at a mean of approximately 24.4 days after these events. The patients were followed in the intensive care unit for an average of 7.9 days. The mean followup was 4 months. After the service follow-up, each patient continued outpatient follow-up for a total of 12 months. Antibiotics were given according to the causative infectious agent during the intensive care and service follow-up. Three patients had lung infections. Colistin-induced renal failure or hepatotoxicity developed due to resistant infections in 4 patients. After colistin was ceased, this situation resolved. Two of the 16 patients died. The sepsis and bone-soft tissue infections were controlled in all other patients. Four patients had femoral nonunion and one patient had short femoral healing. While 2 patients were able to walk without support and 11 patients could walk using support and one patient who was Quadriplegic was unable to walk. The treatment of bone-soft tissue infections accompanied by sepsis should be multidisciplinary. This should be kept in mind for patients with systemic injuries due to explosion effects. The infectious agents in these patients are often drug-resistant and there may be complications secondary to the antibiotics used during treatment.

Keywords

• Libyan civil war
• polytrauma
• blast injury
• sepsis