Abstract | BACKGROUND: Immunocompromised patients with Vibrio vulnificus septicemia are at high risk for fatality. When a hemorrhagic bullous necrotic cutaneous lesion (HBNCL) and decreased blood pressure develop, approximately 50% of V vulnificus septicemic patients die within 48 hours. This study aimed to evaluate the risk factor(s) for fatality among patients with V vulnificus septicemia, emphasizing the role of prescribed antimicrobial agents in general and the therapeutic efficacy of the combination of a third-generation cephalosporin and tetracycline or its analogue in particular. METHODS: Patients with the diagnosis of V vulnificus infection admitted to 5 large medical centers in Taiwan between 1995 and 2003 were included in this retrospective study. Patients were divided into 2 groups: those without [corrected] HBNCLs (group 1) [corrected] and those with [corrected] HBNCLs (group 2) [corrected]Patients were further divided into subgoups with [corrected] fatalities (fatal subgroup) and those without fatalities (nonfatal subgroup). RESULTS: A total of 93 patients participated in the study. In group 1, the fatal subgroup had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (P = .006) and a higher proportion of shock at arrival at the medical center (P = .015) than the nonfatal subgroup. In group 2, the effect of a first- or second-generation cephalosporin plus an aminoglycoside was negative (P = .01) and that of combined third-generation cephalosporin and tetracycline or its analogue was positive (P<.001); significant differences were found between the fatal and nonfatal subgroups in the APACHE II score (P<.001), number who were in shock at arrival at the medical center (P = .02), delayed surgical intervention (P = .03), and peripheral leukocytosis (P = .03). Shock at arrival at the medical center (odds ratio [OR], 19.25; 95% confidence interval [CI], 1.768-209.54; P = .02) was an independent risk factor for fatality in patients without HBNCLs. Use of a third-generation cephalosporin and tetracycline or its analogue significantly reduced fatality rates in patients with HBNCLs (OR, 0.037; 95% CI, 0.007-0.192; P<.001). CONCLUSION:
|
Authors | Jien-Wei Liu, Ing-Kit Lee, Hung-Jen Tang, Wen-Chien Ko, Hsin-Chun Lee, Yung-Ching Liu, Po-Ren Hsueh, Yin-Ching Chuang |
Journal | Archives of internal medicine
(Arch Intern Med)
Vol. 166
Issue 19
Pg. 2117-23
(Oct 23 2006)
ISSN: 0003-9926 [Print] United States |
PMID | 17060542
(Publication Type: Comparative Study, Journal Article, Multicenter Study)
|
Chemical References |
|
Topics |
- APACHE
- Aged
- Anti-Bacterial Agents
(therapeutic use)
- Bacteremia
(drug therapy, microbiology)
- Drug Therapy, Combination
- Female
- Humans
- Male
- Microbial Sensitivity Tests
- Middle Aged
- Multivariate Analysis
- Prognosis
- Retrospective Studies
- Risk Factors
- Taiwan
(epidemiology)
- Treatment Outcome
- Vibrio Infections
(drug therapy, microbiology)
- Vibrio vulnificus
(isolation & purification)
|