Antimicrobial Therapy for Wound Infections after Catastrophic Earthquakes

Abstract

During the past 12 years, five catastrophic earthquakes have occurred. Most overwhelmed local medical capacity and caused widespread destruction, injury, and loss of life. Medical teams were dispatched both from within the country and from abroad to treat the surfeit of patients and to bridge the gap in resources until local health services recovered. Because of the delay between injury and treatment, most of the injured presented with infected wounds, necessitating empirical antimicrobial treatment. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have proposed guidelines for managing this scenario, primarily by targeting gram-positive pathogens (see Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org).^1,2 We examined the appropriateness of the section of the guidelines addressing empirical treatment for infection with pathogens isolated at the scene of earthquakes (see the Methods section in the Supplementary Appendix).