Prognostic factors and antibiotics in Vibrio vulnificus septicemia

Jien Wei Liu, Ing Kit Lee, Hung Jen Tang, Wen Chien Ko, Hsin Chun Lee, Yung Ching Liu, Po Ren Hsueh, Yin Ching Chuang

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Abstract

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 secondgeneration 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 thirdgeneration 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.

Original languageEnglish
Pages (from-to)2117-2123
Number of pages7
JournalArchives of Internal Medicine
Volume166
Issue number19
DOIs
Publication statusPublished - 2006 Oct 23

All Science Journal Classification (ASJC) codes

  • Internal Medicine

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    Liu, J. W., Lee, I. K., Tang, H. J., Ko, W. C., Lee, H. C., Liu, Y. C., Hsueh, P. R., & Chuang, Y. C. (2006). Prognostic factors and antibiotics in Vibrio vulnificus septicemia. Archives of Internal Medicine, 166(19), 2117-2123. https://doi.org/10.1001/archinte.166.19.2117