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World Journal of Surgery

, Volume 34, Issue 7, pp 1669–1675 | Cite as

Predictors of Mortality in Skin and Soft-tissue Infections Caused by Vibrio vulnificus

  • Tsai-Nung Kuo Chou
  • Wai-Nang Chao
  • Cheng Yang
  • Ruey-Hong Wong
  • Kwo-Chang Ueng
  • Shiuan-Chih Chen
Article

Abstract

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 ≥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.

Keywords

Minocycline Fasciitis Necrotizing Fasciitis Case Fatality Rate Early Surgical Intervention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We gratefully acknowledge the help of Professor H.-S. Lee, School of Public Health, Chung Shan Medical University, in medical statistics.

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Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Tsai-Nung Kuo Chou
    • 1
    • 4
  • Wai-Nang Chao
    • 3
  • Cheng Yang
    • 3
  • Ruey-Hong Wong
    • 1
    • 5
  • Kwo-Chang Ueng
    • 2
    • 6
  • Shiuan-Chih Chen
    • 1
    • 2
    • 7
  1. 1.Institute of MedicineChung Shan Medical UniversityTaichungTaiwan
  2. 2.School of MedicineChung Shan Medical UniversityTaichungTaiwan
  3. 3.Department of SurgeryChi Mei Medical CenterTainanTaiwan
  4. 4.Department of Geriatric MedicineYuan-Lin Kuo HospitalChanghuaTaiwan
  5. 5.School of Public HealthChung Shan Medical UniversityTaichungTaiwan
  6. 6.Department of Internal MedicineChung Shan Medical University HospitalTaichungTaiwan
  7. 7.Department of Family and Community MedicineChung Shan Medical University HospitalTaichungTaiwan

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