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

Yao-Chou Lee, Lien I. Hor, Haw Yen Chiu, Jing-Wei Lee, Shyh-Jou Shieh

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15 Citations (Scopus)

Abstract

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<10,000 cells/mm 3, platelets<100,000/mm3, serum creatinine ≥1.3 mg/dL, serum albumin<2.5 mg/dL, and delayed treatment beyond 3 days post-injury or symptom onset were associated with significantly higher mortality. Multivariate analysis showed that treatment delayed beyond 3 days is an independent factor indicating a poor prognosis (OR 10.75, 95% CI 1.02-113.39, p=0.048). Early diagnosis and prompt treatmentwithin 3 days post-injury or symptom onset should be the goal for treating patients with necrotizing fasciitis caused by V. vulnificus. Additional investigations to rescue patients with a prolonged disease course of necrotizing fasciitis (≥3 days)may be important.

Original languageEnglish
Pages (from-to)1011-1018
Number of pages8
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume33
Issue number6
DOIs
Publication statusPublished - 2014 Jan 1

Fingerprint

Vibrio vulnificus
Necrotizing Fasciitis
Mortality
Fascia
Clinical Protocols
Wounds and Injuries
Minocycline
Ceftazidime
Ceftriaxone
Doxycycline
Emergency Medical Services
Taiwan
Serum Albumin
Hepatitis
Fingers
Intensive Care Units
Dissection
Early Diagnosis
Creatinine
Leukocytes

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "Prognostic factor of mortality and its clinical implications in patients with necrotizing fasciitis caused by Vibrio vulnificus",
abstract = "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<10,000 cells/mm 3, platelets<100,000/mm3, serum creatinine ≥1.3 mg/dL, serum albumin<2.5 mg/dL, and delayed treatment beyond 3 days post-injury or symptom onset were associated with significantly higher mortality. Multivariate analysis showed that treatment delayed beyond 3 days is an independent factor indicating a poor prognosis (OR 10.75, 95{\%} CI 1.02-113.39, p=0.048). Early diagnosis and prompt treatmentwithin 3 days post-injury or symptom onset should be the goal for treating patients with necrotizing fasciitis caused by V. vulnificus. Additional investigations to rescue patients with a prolonged disease course of necrotizing fasciitis (≥3 days)may be important.",
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AU - Hor, Lien I.

AU - Chiu, Haw Yen

AU - Lee, Jing-Wei

AU - Shieh, Shyh-Jou

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AB - 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<10,000 cells/mm 3, platelets<100,000/mm3, serum creatinine ≥1.3 mg/dL, serum albumin<2.5 mg/dL, and delayed treatment beyond 3 days post-injury or symptom onset were associated with significantly higher mortality. Multivariate analysis showed that treatment delayed beyond 3 days is an independent factor indicating a poor prognosis (OR 10.75, 95% CI 1.02-113.39, p=0.048). Early diagnosis and prompt treatmentwithin 3 days post-injury or symptom onset should be the goal for treating patients with necrotizing fasciitis caused by V. vulnificus. Additional investigations to rescue patients with a prolonged disease course of necrotizing fasciitis (≥3 days)may be important.

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