Predictors of Mortality in Skin and Soft-tissue Infections Caused by Vibrio vulnificus

Tsai-Nung Kuo Chou; Wai-Nang Chao; Cheng Yang; Ruey-Hong Wong; Kwo-Chang Ueng; Shiuan-Chih Chen
July 2010
World Journal of Surgery;Jul2010, Vol. 34 Issue 7, p1669
Academic Journal
Vibrio vulnificus infection can progress rapidly in skin or soft tissue, and it is potentially life-threatening. The purpose of the present study was to explore the predictors of mortality in patients with V. vulnificus infections of skin or soft tissue. The medical records of 119 consecutive patients aged ≥18 years, hospitalized for V. vulnificus infections of skin or soft tissue between January 2000 and December 2007 were reviewed. Co-morbidities, clinical manifestations, laboratory studies, treatments, and outcomes were analyzed. Multiple logistic regression with the exact method was performed. The mean age of the patients was 63.7 ± 12.0 years. Twenty-four patients died, yielding an overall case fatality rate of 20%. Of the 24 deaths, 20 (83%) occurred within 72 h after hospital admission. Of 119 patients, 45 patients had primary septicemia, and 74 patients had wound infection. Multivariate analysis revealed that the following factors were associated with mortality: hemorrhagic bullous skin lesions/necrotizing fasciitis ( p = 0.003), primary septicemia ( p = 0.042), a greater organ dysfunction and/or infection score ( p = 0.005), absence of leukocytosis ( p = 0.0001), and hypoalbuminemia ( p = 0.003). Treatment with surgical intervention plus antibiotics ( p = 0.038) and surgical intervention within 24 h after admission ( p = 0.017) were protective factors. This study demonstrates that the presence of hemorrhagic bullous skin lesions/necrotizing fasciitis, primary septicemia, a greater severity-of-illness, absence of leukocytosis, and hypoalbuminemia were the significant risk factors for mortality in these patients. Moreover, patients treated with surgery plus antibiotics, especially those receiving a prompt surgical evaluation within 24 h after hospital admission, may have a better prognosis.


Related Articles

  • In Vivo Efficacy of the Combination of Ciprofloxacin and Cefotaxime against Vibrio vulnificus Sepsis. Jang, Hee-Chang; Choi, Su-Mi; Kim, Hee Kyung; Kim, Sung-Eun; Kang, Seung-Ji; Park, Kyung-Hwa; Ryu, Phil Youl; Lee, Tae-Hoon; Kim, Young Ran; Rhee, Joon Haeng; Jung, Sook-In; Choy, Hyon E // PLoS ONE;Jun2014, Vol. 9 Issue 6, p1 

    Objectives: The invivo efficacy of a cefotaxime-ciprofloxacin combination against Vibrio vulnificus and the effects on rtxA1 expression of commonly used antibiotics are unknown. Methods: In vitro time-kill studies were performed to evaluate synergism. Female BALB/c mice were injected...

  • Factors Predicting and Reducing Mortality in Patients with Invasive Staphylococcus aureus Disease in a Developing Country. Nickerson, Emma K.; Wuthiekanun, Vanaporn; Wongsuvan, Gumphol; Limmathurosakul, Direk; Srisamang, Pramot; Mahavanakul, Weera; Thaipadungpanit, Janjira; Shah, Krupal R.; Arayawichanont, Arkhom; Amornchai, Premjit; Thanwisai, Aunchalee; Day, Nicholas P.; Peacock, Sharon J. // PLoS ONE;2009, Vol. 4 Issue 8, p1 

    Background: Invasive Staphylococcus aureus infection is increasingly recognised as an important cause of serious sepsis across the developing world, with mortality rates higher than those in the developed world. The factors determining mortality in developing countries have not been identified....

  • Syndromes of Vibrio vulnificus Infections. Klontz, Karl C.; Lieb, Spencer; Schreiber, Minnie; Janowski, Henry T.; Baldy, Linda M.; Gunn, Robert A. // Annals of Internal Medicine;8/15/88, Vol. 109 Issue 4, p318 

    Describes the clinical and epidemiologic features of Vibrio vulnificus infections. Health risk posed by Vibrio vulnificus infection; Indication of the possibility of asymptomatic intestinal infection with Vibrio vulnificus; Factor which emphasizes the importance of beginning aggressive...

  • In vitro time-kill activities of ciprofloxacin alone and in combination with the iron chelator deferasirox against Vibrio vulnificus. Neupane, G. P.; Kim, D.-M. // European Journal of Clinical Microbiology & Infectious Diseases;Apr2010, Vol. 29 Issue 4, p407 

    Iron plays a major role in the growth and virulence of ferrophilic organisms like Vibrio vulnificus. People who reside in the coastal areas with raw fish eating habits have a high risk of Vibrio infection and aggressive therapy can only reduce their mortality. We investigated the in vitro...

  • Antibiotic therapy for necrotizing fasciitis caused by Vibrio vulnificus: retrospective analysis of an 8 year period. Chen, Shiuan-Chih; Lee, Yuan-Ti; Tsai, Shih-Jei; Chan, Khee-Siang; Chao, Wai-Nang; Wang, Po-Hui; Lin, Ding-Bang; Chen, Chun-Chieh; Lee, Meng-Chih // Journal of Antimicrobial Chemotherapy (JAC);Feb2012, Vol. 67 Issue 2, p488 

    Objectives To compare the effectiveness of a third-generation cephalosporin alone, a third-generation cephalosporin plus minocycline, and a fluoroquinolone in patients with necrotizing fasciitis (NF) caused by Vibrio vulnificus. Methods A retrospective review of case notes was performed for 89...

  • Vibrio vulnificus Infection: Diagnosis and Treatment. Bross, Michael H.; Soch, Kathleen; Morales, Robert; Mitchell, Rayford B. // American Family Physician;8/15/2007, Vol. 76 Issue 4, p539 

    Vibrio vulnificus infection is the leading cause of death related to seafood consumption in the United States. This virulent, gram-negative bacterium causes two distinct syndromes. The first is an overwhelming primary septicemia caused by consuming raw or undercooked seafood, particularly raw...

  • Multi-site Analysis Reveals Widespread Antibiotic Resistance in the Marine Pathogen Vibrio vulnificus. Baker-Austin, Craig; McArthur, J. V.; Lindell, Angela H.; Wright, Meredith S.; Tuckfield, R. Cary; Gooch, Jan; Warner, Liza; Oliver, James; Stepanauskas, Ramunas // Microbial Ecology;Jan2009, Vol. 57 Issue 1, p151 

    Vibrio vulnificus is a serious opportunistic human pathogen commonly found in subtropical coastal waters, and is the leading cause of seafood-borne mortality in the USA. This taxon does not sustain prolonged presence in clinical or agricultural settings, where it would undergo human-induced...

  • Prognostic factor of mortality and its clinical implications in patients with necrotizing fasciitis caused by Vibrio vulnificus. Lee, Yao-Chou; Hor, Lien-I; Chiu, Haw-Yen; Lee, Jing-Wei; Shieh, Shyh-Jou // European Journal of Clinical Microbiology & Infectious Diseases;Jun2014, Vol. 33 Issue 6, p1011 

    In Taiwan, the aquatic environment and endemic hepatitis contribute to the high susceptibility of Vibrio vulnificus infection. A multidisciplinary treatment protocol for necrotizing fasciitis caused by V. vulnificus was developed in our institute, namely, ceftriaxone or ceftazidime combined with...

  • Erratum / Erratum. Vickery, Michael C.L; Panicker, Gitika; Bej, Asim K // Canadian Journal of Microbiology;May2007, Vol. 53 Issue 5, p671 

    A correction to the article "Multiplex PCR detection of clinical and environmental strains of Vibrio vulnificus in shellfish" that was published in the November 2004 issue is presented.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics