 |
|
Prognostic Factors and Antibiotics in Vibrio vulnificus Septicemia
Jien-Wei Liu, MD;
Ing-Kit Lee, MD;
Hung-Jen Tang, MD;
Wen-Chien Ko, MD;
Hsin-Chun Lee, MD;
Yung-Ching Liu, MD;
Po-Ren Hsueh, MD;
Yin-Ching Chuang, MD
Arch Intern Med. 2006;166:2117-2123.
Background Immunocompromised patients with Vibrio vulnificus septicemia are at high risk for fatality. When a hemorrhagic bullous necrotic cutaneous lesion (HBNCL) and decreased blood pressure develop, approximately 50% of V vulnificus septicemic patients die within 48 hours. This study aimed to evaluate the risk factor(s) for fatality among patients with V vulnificus septicemia, emphasizing the role of prescribed antimicrobial agents in general and the therapeutic efficacy of the combination of a third-generation cephalosporin and tetracycline or its analogue in particular.
Methods Patients with the diagnosis of V vulnificus infection admitted to 5 large medical centers in Taiwan between 1995 and 2003 were included in this retrospective study. Patients were divided into 2 groups: those with HBNCLs and those without HBNCLs. Patients were further divided into subgoups without fatalities (fatal subgroup) and those without fatalities (nonfatal subgroup).
Results A total of 93 patients participated in the study. In group 1, the fatal subgroup had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (P = .006) and a higher proportion of shock at arrival at the medical center (P = .015) than the nonfatal subgroup. In group 2, the effect of a first- or second-generation cephalosporin plus an aminoglycoside was negative (P = .01) and that of combined third-generation cephalosporin and tetracycline or its analogue was positive (P<.001); significant differences were found between the fatal and nonfatal subgroups in the APACHE II score (P<.001), number who were in shock at arrival at the medical center (P = .02), delayed surgical intervention (P = .03), and peripheral leukocytosis (P = .03). Shock at arrival at the medical center (odds ratio [OR], 19.25; 95% confidence interval [CI], 1.768-209.54; P = .02) was an independent risk factor for fatality in patients without HBNCLs. Use of a third-generation cephalosporin and tetracycline or its analogue significantly reduced fatality rates in patients with HBNCLs (OR, 0.037; 95% CI, 0.007-0.192; P<.001).
Conclusion Septic shock is a determinant of fatality in patients with V vulnificus septicemia without HBNCLs; our data suggest that the combination of a third-generation cephalosporin and tetracycline or its analogue may be a better choice in antimicrobial treatment of V vulnificus septicemic patients with HBNCLs.
Author Affiliations: Division of Infectious Diseases, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung (Drs J.-W. Liu and I.-K. Lee), Departments of Medicine (Drs Tang and Chuang) and Medical Research (Dr Chuang), Chi-Mei Medical Center, Tainan, Division of Infectious Diseases, National Cheng Kung University Hospital, Tainan (Drs Ko and H.-C. Lee), Section of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung (Dr Y.-C. Liu), and Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, Taipei (Dr Hsueh), Taiwan.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
In Vitro Activities of Tigecycline against Clinical Isolates of Aeromonas, Vibrio, and Salmonella Species in Taiwan
Liu et al.
Antimicrob. Agents Chemother. 2008;52:2677-2679.
ABSTRACT
| FULL TEXT
Reducing the Mortality of Vibrio vulnificus Infections
Journal Watch Dermatology 2006;2006:1-1.
FULL TEXT
|
