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

• Published in: World journal of surgery 2010-07, Vol.34 (7), p.1669-1675
• Main Authors: Kuo Chou, Tsai-Nung, Chao, Wai-Nang, Yang, Cheng, Wong, Ruey-Hong, Ueng, Kwo-Chang, Chen, Shiuan-Chih
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Biological and medical sciences; Cardiac Surgery; Case Fatality Rate; Comorbidity; Diabetes Mellitus - epidemiology; Early Surgical Intervention; Epidemiology; Fasciitis; Fasciitis, Necrotizing - epidemiology; Fasciotomy; Female; General aspects; General Surgery; Humans; Leukocytosis - epidemiology; Liver Diseases - epidemiology; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Minocycline; Multivariate Analysis; Necrotizing Fasciitis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Shock, Septic - epidemiology; Skin Diseases, Bacterial - drug therapy; Skin Diseases, Bacterial - epidemiology; Skin Diseases, Bacterial - microbiology; Skin Diseases, Bacterial - mortality; Soft Tissue Infections - drug therapy; Soft Tissue Infections - epidemiology; Soft Tissue Infections - microbiology; Soft Tissue Infections - mortality; Surgery; Thoracic Surgery; Vascular Surgery; Vibrio Infections - epidemiology; Vibrio Infections - mortality; Vibrio vulnificus
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0455-y

Background 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. Methods 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. Results 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. Conclusions 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.