Prognostic factor of mortality and its clinical implications in patients with necrotizing fasciitis caused by Vibrio vulnificus

• Published in: European journal of clinical microbiology & infectious diseases 2014-06, Vol.33 (6), p.1011-1018
• Main Authors: Lee, Yao-Chou, Hor, Lien-I, Chiu, Haw-Yen, Lee, Jing-Wei, Shieh, Shyh-Jou
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Aquatic environment; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Child; Clinical outcomes; Debridement; Dissection; Emergency medical care; Fasciitis, Necrotizing - microbiology; Fasciitis, Necrotizing - mortality; Fasciitis, Necrotizing - pathology; Fasciitis, Necrotizing - therapy; Female; Gangrene; Hepatitis; Hospitalization; Human bacterial diseases; Humans; Infections; Infectious diseases; Intensive care; Internal Medicine; Laboratories; Male; Medical Microbiology; Medical sciences; Medicine; Middle Aged; Mortality; Multivariate analysis; Necrotizing fasciitis; Patients; Prognosis; Retrospective Studies; Sepsis; Surveillance; Survival Analysis; Taiwan; Treatment Outcome; Vibrio Infections - microbiology; Vibrio Infections - mortality; Vibrio Infections - pathology; Vibrio Infections - therapy; Vibrio vulnificus; Vibrio vulnificus - isolation & purification; Young Adult
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-013-2039-x

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 doxycycline or minocycline followed by an emergency fasciotomy and intensive care unit admission. We retrospectively reviewed 100 cases to evaluate the effectiveness of our treatment protocol and identify independent predictors of mortality to improve clinical outcomes. Cases of culture-confirmed V. vulnificus infection between January 1996 and December 2011 were reviewed. Necrotizing fasciitis was surgically diagnosed if these criteria were met: necrotic fascia, “dishwater discharge”, and loss of resistance while doing finger dissection along the fascia plane. One hundred cases met these criteria and were included for analysis. Eighteen patients died (18 % mortality). Unknown injury events, presence of multiple skin lesions, leukocytes