Predictors of mortality in skin and soft-tissue infections caused by Vibrio vulnificus.
BACKGROUND
Vibrio vulnificus infection can progress rapidly in skin or soft tissue, and it is potentially life-threatening. The purpose of the present study was to explore the predictors of mortality in patients with V. vulnificus infections of skin or soft tissue.


METHODS
The medical records of 119 consecutive patients aged > or =18 years, hospitalized for V. vulnificus infections of skin or soft tissue between January 2000 and December 2007 were reviewed. Co-morbidities, clinical manifestations, laboratory studies, treatments, and outcomes were analyzed. Multiple logistic regression with the exact method was performed.


RESULTS
The mean age of the patients was 63.7 +/- 12.0 years. Twenty-four patients died, yielding an overall case fatality rate of 20%. Of the 24 deaths, 20 (83%) occurred within 72 h after hospital admission. Of 119 patients, 45 patients had primary septicemia, and 74 patients had wound infection. Multivariate analysis revealed that the following factors were associated with mortality: hemorrhagic bullous skin lesions/necrotizing fasciitis (p = 0.003), primary septicemia (p = 0.042), a greater organ dysfunction and/or infection score (p = 0.005), absence of leukocytosis (p = 0.0001), and hypoalbuminemia (p = 0.003). Treatment with surgical intervention plus antibiotics (p = 0.038) and surgical intervention within 24 h after admission (p = 0.017) were protective factors.


CONCLUSIONS
This study demonstrates that the presence of hemorrhagic bullous skin lesions/necrotizing fasciitis, primary septicemia, a greater severity-of-illness, absence of leukocytosis, and hypoalbuminemia were the significant risk factors for mortality in these patients. Moreover, patients treated with surgery plus antibiotics, especially those receiving a prompt surgical evaluation within 24 h after hospital admission, may have a better prognosis.
Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., Taichung, 40201, Taiwan.
Tsai-Nung
TN
Kuo Chou
Wai-Nang
WN
Chao
Cheng
C
Yang
Ruey-Hong
RH
Wong
Kwo-Chang
KC
Ueng
Shiuan-Chih
SC
Chen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D019115:Fasciitis, Necrotizing / Q000453:epidemiology; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007964:Leukocytosis / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012772:Shock, Septic / Q000453:epidemiology; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D014735:Vibrio Infections / Q000453:epidemiology / Q000401:mortality*; D041261:Vibrio vulnificus
D000900:Anti-Bacterial Agents