Health Care-Associated Wound Infections and Antimicrobial Resistance in Earthquake Victims with Musculoskeletal Soft-Tissue Injuries: Experience from a Tertiary-Care Hospital

Background and Objectives: Natural disasters increase the risk of wound infections due to factors such as trauma, invasive interventions, and delayed access to care. This study aimed to assess the epidemiology of health care-associated wound infections in earthquake victims and to identify risk factors for infection development. Method: This study was conducted in a 4,050-bed tertiary-care hospital. Adult hospitalized patients (≥18 years) with trauma-related soft tissue injuries and entrapment history were included. Active health care-associated infection surveillance was implemented. Data were collected using standardized forms. Clinical characteristics and risk factors for wound infection were analyzed. Results: Of 584 patients, 139 (23.8%) developed wound infections. Patients with wound infections had longer entrapment times under rubble (16 vs. 5 hours, p < 0.001), delayed hospital admission (120 vs. 72 hours, p = 0.003), and higher crush syndrome (42.4% vs. 20.0%, p < 0.001) and tissue necrosis (26.6% vs. 9.2%, p < 0.001). In multivariable analysis, prolonged time under rubble (odds ratio [OR]:1.010, 95% confidence interval [CI]:1.002–1.018; p = 0.016), delayed surgical intervention (OR:1.130, 95% CI:1.041–1.227; p = 0.004), and tissue necrosis (OR:2.372, 95% CI:1.260–4.467; p = 0.007) were independently associated with wound infection. Gram-negative bacilli predominated (88.1%) in wound cultures; Acinetobacter spp. (31.5%), Klebsiella spp. (19.0%), and Pseudomonas spp. (18.7%) were the most common pathogens. High carbapenem resistance among Acinetobacter spp. (99%) and substantial carbapenem resistance among Klebsiella spp. (46.1%) were identified. Conclusion: Wound infections were common among earthquake victims and were associated with prolonged entrapment, tissue necrosis, and delayed surgical intervention. The predominance of resistant Gram-negative pathogens underscores the need for early infection control measures, antimicrobial resistance surveillance, and antimicrobial stewardship in disaster settings.