The studies of prognostic factor of mortality in patients with necrotizing fasciitis caused by Vibrio vulnificus and its mechanisms of pathogenesis: from clinical to basic

Abstract

Background: In Taiwan the aquatic environment and endemic hepatitis contribute to the high susceptibility of V vulnificus infection Successful treatments depend on early diagnosis adequate antibiotics aggressive surgical interventions and hemodynamic supports However two main challenges and debates exist regarding the timing of operation and the use of immunomodulatory agents In this study we tried to clarify the role of surgical intervention and to investigate the therapeutic effects of TNF-? inhibitor Methods: In clinical study cases of culture-confirmed V vulnificus infection between January 1996 to December 2011 in NCKUH were reviewed Patients with surgically confirmed necrotizing fasciitis were further analyzed to identify the prognostic factors In animal study we verified a mouse model to mimic V vulnificus soft tissue infection and then investigated the role of surgical intervention and the therapeutic effects of etanercept Results: In clinical study we identified the prolonged disease course longer than 3 days was an independent factor indicating a poor prognosis (OR: 10 75; 95% CI: 1 02-113 39 p = 0 048) In animal study we demonstrated early operation had a better survival outcome compared with delayed group Pretreatment with etanercept can not only improve the survival of the infected control group but also the delayed operation group Conclusions: Early diagnosis and prompt treatment within 3 days post-injury or symptom onset should be the goal for treating patients with necrotizing fasciitis caused by V vulnificus Adjunctive treatment to rescue patients with a prolonged disease course of necrotizing fasciitis (≧3 days) by using TNF-? inhibitor may warrant further investigation

Date of Award	2014 Sept 1
Original language	English
Supervisor	Shyh-Jou Shieh (Supervisor)