title: Necrotizing soft-tissue infections and primary sepsis caused by Vibrio vulnificus and Vibrio cholerae non-O1.
abstract: BACKGROUND
  Vibrio species are a rare cause of necrotizing soft-tissue infections and primary septicemia, which are likely to occur in patients with hepatic disease, diabetes, adrenal insufficiency, and immunocompromised conditions. These organisms thrive in warm seawater and are often present in raw oysters, shellfish, and other seafood. This study examined fulminating clinical characteristics of Vibrio vulnificus and Vibrio cholerae non-O1 soft-tissue infections and identified outcome predictors.
  
  
  METHODS
  Thirty patients with necrotizing fasciitis and sepsis caused by Vibrio species were retrospectively reviewed. Twenty-eight patients had a history of contact with seawater or raw seafood. Eight patients had hepatic disease such as hepatitis or liver cirrhosis, and seven patients had diabetes mellitus. Nine patients had hepatic dysfunction combined with diabetes mellitus. Microbiology laboratory culture studies confirmed V. vulnificus in 23 patients and V. cholerae non-O1 in seven patients.
  
  
  RESULTS
  Surgical debridement or immediate limb amputation was initially performed in all patients with necrotizing soft-tissue infections. Eleven patients (37%) died within several days of admission and 19 survived. The mortality of V. cholerae non-O1 group (57%) is higher than that of the V. vulnificus group (30%). A significantly higher mortality rate was noted in patients with initial presentations of a systolic blood pressure of < or =90 mm Hg, leukopenia, decreased platelet counts, and a combination of hepatic dysfunction and diabetes mellitus.
  
  
  CONCLUSIONS
  Vibrio necrotizing soft-tissue infections should be suspected in patients with appropriate clinical findings and history of contact with seawater or seafood. V. cholerae non-O1 may cause bacteremia more often than V. vulnificus in patients with liver cirrhosis. Early fasciotomy and culture-directed antimicrobial therapy are aggressively recommended in patients with hypotensive shock, leukopenia, high band forms of white blood cells, decreased platelet counts, severe hypoalbuminemia, and underlying chronic illness, such as hepatic dysfunction and diabetes mellitus.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, at Chia-Yi, Chang Gung University College of Medicine, Taiwan, Republic of China. orma2244@adm.cgmh.org.tw
authors.forename: Yao-Hung
authors.initials: YH
authors.lastname: Tsai
authors.forename: Tsung-Jen
authors.initials: TJ
authors.lastname: Huang
authors.forename: Robert Wen-Wei
authors.initials: RW
authors.lastname: Hsu
authors.forename: Yi-Jan
authors.initials: YJ
authors.lastname: Weng
authors.forename: Wei-Hsiu
authors.initials: WH
authors.lastname: Hsu
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Huang
authors.forename: Kuo-Ti
authors.initials: KT
authors.lastname: Peng
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001431:Bacteriological Techniques; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology* / Q000601:surgery; D015996:Survival Rate; D014735:Vibrio Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology* / Q000601:surgery; D044163:Vibrio cholerae non-O1; D041261:Vibrio vulnificus