“If we had treated the wounds of people injured in the Haiti earthquake according to current recommendations, we would have had high percentage of failure,” said Dr. Ian Miskin of Hadassah's Department of Clinical Microbiology & Infectious Diseases and an infectious diseases consultant for Clalit Health Services, Israel's largest health organization. Dr. Miskin was a member of the Israel Defense Forces (IDF) medical mission in Haiti and worked directly with the microbiology laboratory of the IDF field hospital they set up there.
In a letter published last week in the New England Journal of Medicine, the research team he headed recommended that the current protocols for treating infected wounds of natural disaster victims be reconsidered. Their conclusions have already received a complimentary reference in the prestigious magazine Nature.
The research team included Prof. Colin Block and Dr. Ran Nir-Paz of Hadassah's Department of Clinical Microbiology and Infectious Diseases and other members of the IDF mission that set up and operated a field hospital in Haiti. Their research was based on the cultures they plated and identified on site from patients with infected wounds.
Upon their return to Israel, the research team further evaluated the cultures and determined that most of the infections were caused by Gram-negative rather than Gram-positive bacteria. They found that 77 percent of the wounds they sampled contained more than one type of bacteria and that 89 percent of the isolated bacteria were Gram-negative.
The World Health Organization (WHO) and the U.S. Centers for Disease Control (CDC) recommend using antibiotics that target Gram-positive bacteria to treat the wounds of natural disaster survivors. In Haiti, and apparently in previous natural disasters, the organisms identified in infected wounds were Gram-negative bacteria and thus resistant to the antibiotics recommended by the WHO and CDC, the researchers wrote in their letter to the New England Journal of Medicine.
“Skin and soft tissue wound infections are usually caused by Gram-positive bacteria; this is the basis of the current treatment guidelines,” Dr. Miskin said. “In Haiti, people lay in the rubble for hours and days after the earthquake. It appears that the source of their wound infections was contamination by fecal material containing the Gram-negative bacteria.