Infections and treatment modalities in pediatric victims of the Kahramanmaraş/Türkiye earthquake

Abstract

Background: Data on infections in children are scarce in the context of earthquakes. Here, we describe our clinical experiences regarding infections in pediatric victims after the earthquakes in Kahramanmaraş/Türkiye.

Methods: Trauma patients after the Kahramanmaraş earthquakes, aged under 18 years and admitted to our hospital, were evaluated retrospectively. The patients' demographic data, pathogen distribution, drug resistance, and antibiotic treatments were analyzed.

Results: Thirty pediatric patients were admitted to our hospital from disaster areas. The median duration under the rubble of patients was 24 h (range: 0.3-120 h). The median time for these patients to arrive our hospital was 5 days (range: 2-18 h). All of them had wound infections, 3.3% of patients had both wound infection and urinary tract infection, and 13.3% had both a bloodstream infection and a wound infection. Seventy-nine positive cultures were detected in repeated samples of 19 patients, of which polymicrobial infections accounted for 50.6% and monomicrobial infections constituted 49.4%. Of these, 107 were Gram-negative bacilli (79.9%), and 27 were Gram-positive cocci (20.1%). Pan-drug-resistant (PDR) and extensively drug-resistant (XDR) possible PDR bacteria constituted 73.6% of total Gram-negative bacteria. Carbapenem-based treatments (n = 14, 46.7%) were the commonly preferred antimicrobial regimen. Fasciotomy was performed in 53.3% of the patients (n = 16) and amputation in 30% of the patients (n= 9). All of our patients survived.

Conclusion: Factors that reduced mortality and morbidity in the earthquake victims were broad-spectrum antibiotic therapy targeting highly resistant bacteria, and complementary surgical management. In other words, the multidisciplinary approaches of pediatricians and surgical departments were life saving after the earthquake.

Keywords: bacteria; carbapenem; children; disaster; fosfomycin.