Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention.
Necrotizing fasciitis is a soft-tissue infection with a high risk of fatality. Infection with Vibrio vulnificus can lead to development of necrotizing fasciitis and primary septicemia, and occurs mostly in immunocompromised host-associated diseases such as hepatic disease, diabetes mellitus, chronic renal insufficiency, and adrenal insufficiency. Early recognition and treatment of the infection, which are unclear, are vital to patient welfare. We studied the disease epidemiology and reviewed the prognosis and clinical features of patients treated using our developed protocol. Clinical manifestations and outcomes were retrospectively analyzed for 67 patients with V. vulnificus-mediated necrotizing fasciitis and sepsis. All patients who had contacted seawater or raw seafood with positive culture for vibrio were included. Patients were divided into two groups based on the timing of first fasciotomy and injury; within 24 h (group A) and beyond 24 h (group B). Twenty-three of the 67 patients (40%) had hepatic disease, 17 (25.4%) had chronic renal insufficiency, and 12 (17.9%) exhibited adrenal insufficiency. The most common site of infection was the upper extremity (74.7%). Group B presented with more clinical symptoms including fever (p = 0.02), hemorrhagic bullae (p < 0.0001), and shock (p = 0.007). Group A patients exhibited enhanced survival compared to group B (in hospital mortality: 4.9% vs. 23%; p = 0.005). We conclude that early and appropriate diagnosis for V. vulnificus infection should be made, especially in patients presenting with atypical clinical findings. Early fasciotomy within 24 h remains the highest priority and decreases the mortality rate.
Kuo
Y-L
YL
Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, Dou-Liou Branch, 345 Chuang-Ching Road, Dou-Liou, 640, Taiwan.
Shieh
S-J
SJ
Chiu
H-Y
HY
Lee
J-W
JW
D000328:Adult; D000368:Aged; D001132:Arm; D048909:Diabetes Complications; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D040521:Subcutaneous Tissue / Q000601:surgery; D013624:Taiwan / Q000453:epidemiology; D014735:Vibrio Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology; D041261:Vibrio vulnificus / Q000302:isolation & purification*