title: Antibiotic use for Vibrio infections: important insights from surveillance data.
abstract: BACKGROUND
  There is a paucity of data on the in vivo efficacy of antibiotics for lethal Vibrio species. Analyses of long-term surveillance datasets may provide insights into use of antibiotics to decrease mortality.
  
  
  METHODS
  The United States Centers for Disease Control and Prevention (CDC) Cholera and Other Vibrio Illness Surveillance (COVIS) dataset from 1990 to 2010, with 8056 records, was analysed to ascertain trends in antibiotics use and mortality.
  
  
  RESULTS
  Two-thirds of patients (5243) were prescribed antibiotics - quinolones (56.1 %), cephalosporins (24.1 %), tetracyclines (23.5 %), and penicillins (15.4 %). Considering all Vibrio species, the only class of antibiotic associated with reduced odds of mortality was quinolone (odds ratio 0.56, 95 % CI 0.46-0.67). Patients with V. vulnificus treated according to CDC recommendations had lower mortality (quinolone alone: 16.7 %, 95 % CI 10.2-26.1; tetracycline plus cephalosporin: 21.7 %, 16.8-27.5; no antibiotic: 51.1 %, 45.6-56.7; each p < 0.001). Cephalosporin alone was associated with higher mortality (36.8 %, 28.2-46.3). For V. cholerae non-O1, non-O139, mortality rates were lower for quinolone (0 %, 0-2.0) or tetracycline (4.3 %, 1.2-14.5) compared to no antibiotic (9.3 %, 6.4-13.3). For all Vibrio species, mortality rates increased with number of antibiotics in the treatment regimen (p < 0.001). Treatment regimens that included quinolone were associated with lower mortality rates regardless of the number of antibiotics used. The main clinical syndromes of patients with V. vulnificus infection were septicaemia (53.1 %) and wound infections (30.6 %). Mortality among V. vulnificus patients with septicaemia was significantly higher than for other clinical syndromes (p < 0.001). In a multivariate regression model, mortality in cases with V. vulnificus was associated with presence of pre-existing conditions (ORs ranged from 4.52 to 10.30), septicaemia (OR 2.64, 95 % CI 1.92-3.63) and no antibiotic treatment (OR 7.89, 95 % CI 3.94-15.80).
  
  
  CONCLUSIONS
  In view of the lack of randomized control trials, surveillance data may inform treatment decisions for potentially lethal Vibriosis. Considering all Vibrio species, use of quinolones is associated with lower mortality and penicillin alone is not particularly effective. For the most lethal species, V. vulnificus, treatment that includes either quinolone or tetracycline is associated with lower mortality than cephalosporin alone. We recommend treating patients who present with a clinical syndrome suggestive of V. vulnificus infection with a treatment regimen that includes a quinolone.
authors.affiliation: Bathurst Rural Clinical School, School of Medicine, University of Western Sydney, PO Box 9008, Bathurst, NSW, 2795, Australia. k.wong@uws.edu.au.|School of Rural Health, Sydney Medical School, University of Sydney, PO Box 1191, Orange, 2800, NSW, Australia. k.wong@uws.edu.au.
authors.forename: Kam Cheong
authors.initials: KC
authors.lastname: Wong
authors.affiliation: School of Rural Health, Sydney Medical School, University of Sydney, PO Box 1191, Orange, 2800, NSW, Australia. tony.brown@sydney.edu.au.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Brown
authors.affiliation: School of Rural Health, Sydney Medical School, University of Sydney, PO Box 1191, Orange, 2800, NSW, Australia. georgina.luscombe@sydney.edu.au.
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Luscombe
authors.affiliation: Bathurst Rural Clinical School, School of Medicine, University of Western Sydney, PO Box 9008, Bathurst, NSW, 2795, Australia. shin_jie91@hotmail.com.
authors.forename: Shin Jie
authors.initials: SJ
authors.lastname: Wong
authors.affiliation: Bathurst Rural Clinical School, School of Medicine, University of Western Sydney, PO Box 9008, Bathurst, NSW, 2795, Australia. k.mendis@uws.edu.au.
authors.forename: Kumara
authors.initials: K
authors.lastname: Mendis
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010406:Penicillins / Q000627:therapeutic use; D015363:Quinolones / Q000627:therapeutic use; D016019:Survival Analysis; D013752:Tetracycline / Q000627:therapeutic use; D014481:United States; D014733:Vibrio / Q000302:isolation & purification*; D014735:Vibrio Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D015363:Quinolones; D013752:Tetracycline