title: Antibiotic therapy for necrotizing fasciitis caused by Vibrio vulnificus: retrospective analysis of an 8 year period.
abstract: OBJECTIVE
  To compare the effectiveness of a third-generation cephalosporin alone, a third-generation cephalosporin plus minocycline, and a fluoroquinolone in patients with necrotizing fasciitis (NF) caused by Vibrio vulnificus.
  
  
  METHODS
  A retrospective review of case notes was performed for 89 patients who presented with NF caused by V. vulnificus and underwent surgical intervention within 24 h of admission between 2003 and 2010. Data on comorbidities, clinical manifestations, laboratory studies, treatments and outcomes were extracted for analysis. These patients were grouped according to the antimicrobials prescribed: those who received only a third-generation cephalosporin (Group 1; n = 18); a third-generation cephalosporin plus minocycline (Group 2; n = 49); or a fluoroquinolone with/without minocycline (Group 3; n = 22).
  
  
  RESULTS
  The mean age of the 89 patients included in the study was 64.0 ± 12.0 years (range 33-89 years); 55% of the patients were male. There were no differences in age, sex or clinical characteristics among the three groups except that patients in Group 3 had a higher frequency of underlying chronic renal insufficiency than those in Groups 1 and 2 (P = 0.009). Groups 2 and 3 each had a significantly lower case fatality rate than Group 1 (61% in Group 1 versus 14% in Group 2, P = 0.0003; 61% in Group 1 versus 14% in Group 3, P = 0.0027), while no difference in case fatality rate was noted between Groups 2 and 3.
  
  
  CONCLUSIONS
  Our data suggested that, in addition to primary surgery, fluoroquinolones or third-generation cephalosporins plus minocycline are the best option for antibiotic treatment of NF caused by V. vulnificus.
authors: Institute of Medicine, Chung Shan Medical University, 110, Sec. 1, Jianguo N. Rd, Taichung 40201,  Taiwan.
authors: Shiuan-Chih
authors: SC
authors: Chen
authors: Yuan-Ti
authors: YT
authors: Lee
authors: Shih-Jei
authors: SJ
authors: Tsai
authors: Khee-Siang
authors: KS
authors: Chan
authors: Wai-Nang
authors: WN
authors: Chao
authors: Po-Hui
authors: PH
authors: Wang
authors: Ding-Bang
authors: DB
authors: Lin
authors: Chun-Chieh
authors: CC
authors: Chen
authors: Meng-Chih
authors: MC
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002511:Cephalosporins / Q000008:administration & dosage; D004359:Drug Therapy, Combination / Q000379:methods; D019115:Fasciitis, Necrotizing / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage; D016896:Treatment Outcome; D014735:Vibrio Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000601:surgery; D041261:Vibrio vulnificus / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D008911:Minocycline