Study on rational antimicrobial use through activities of a medical relief team after the Indian Ocean Tsunami

进一步分析第一年的结果和回顾以往的研究创伤性伤口感染。根据印度尼西亚大学的一份报告（2004年），从雅加达感染伤口中分离出的常见细菌之一是金黄色葡萄球菌（14%）。日本灾难救援（JDR）医疗队在假设伤口感染的病原菌主要是金黄色葡萄球菌的情况下，选择了β -内酰胺青霉素作为一线抗菌剂。相反，有几项研究报告说，浸泡在水中的创伤伤口病例感染了气单胞菌。然而，在日本医生开始对此类病例进行实证治疗时，很少将气单胞菌视为感染源之一。这种做法困难的主要原因是：气单胞菌引起的伤口感染与金黄色葡萄球菌相似，并且大多数气单胞菌对-内酰胺类青霉素具有耐药性。因此，通过使革兰氏染色可用，将有可能在早期提供适当的抗菌治疗。此外，对从水生环境中收集的水样和从班达亚齐海啸幸存者那里获得的定性数据进行分析的结果表明，幸存者在避难所洗澡时多次暴露于病原体，如气单胞菌、克雷伯氏菌和弧菌。通过这项研究，研究人员推荐了一种经验性治疗，即在没有临床微生物学资料的情况下：对于金黄色葡萄球菌，最初使用β -内酰胺青霉素3天，如果假定病原是革兰氏阴性杆菌或β -内酰胺青霉素耐药菌，第一种抗菌药物无效，则使用新的喹诺酮类药物。最后，强烈建议JDR等医疗救援团队配备革兰氏染色设备，并保留足够数量的新喹诺酮类药物。

Further analyses of the 1st year results and reviews of the previous studies on traumatic wound infection were done. According to a report by Indonesia University (2004), one of commonly isolated bacteria from infected wounds in Jakarta was Staphylococcus aureus (14%). Japan Disaster Relief (JDR) medical team selected beta-lactam penicillins as 1st line antimicrobials under an assumption that the causative bacteria of wound infections were mainly S. aureus. On the contrary, there were several studies reported that traumatic wound cases submerged in water were infected with Aeromonads. However, Aeromonads are rarely considered as one of infectious agents when Japanese doctors start empirical therapy for such cases. Major reasons for the difficulty in such practice are: wound infections caused by Aeromonas spp. Are similar to those by S. aureus, and most of Aeromonads are resistant to beta-lactam penicillins. Therefore, by making Gram staining available, it will be possible to provide appropriate antimicrobial therapy at early timing. Further, the result of analyses of water samples collected from aquatic environment and qualitative data obtained from tsunami survivors at Banda Aceh suggested that the survivors been repeatedly exposed to pathogens, Aeromonas spp., Klebsiela spp., Vibrio spp. When they were bathing at shelters.Through this study researchers recommend a empirical therapy, i.e., where clinical microbiological are not available: the initial use of beta-lactam penicillins for 3 days for S. aureus, followed by new quinolones if the first antimicrobial is not effective under an assumption that the etiological agents are Gram-negative bacilli or beta-lactam penicillins resistant bacteria. Finally it is highly recommended that medical relief team such as JDR should equip for Gram staining and keep enough amounts of new quinolones.