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



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.


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.


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.


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.


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.



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


  1. 1.
    Hollis DG, Weaver RE, Baker CN et al (1976) Halophilic Vibrio species isolated from blood cultures. J Clin Microbiol 3:425–431PubMedGoogle Scholar
  2. 2.
    Klontz KC, Lieb S, Schreiber M et al (1988) Syndromes of Vibrio vulnificus infections. Clinical and epidemiologic features in Florida cases, 1981–1987. Ann Intern Med 109:318–323PubMedGoogle Scholar
  3. 3.
    Chuang YC, Yuan CY, Liu CY et al (1992) Vibrio vulnificus infection in Taiwan: report of 28 cases and review of clinical manifestations and treatment. Clin Infect Dis 15:271–276PubMedGoogle Scholar
  4. 4.
    Howard RJ, Bennett NT (1993) Infections caused by halophilic marine Vibrio bacteria. Ann Surg 217:525–530CrossRefPubMedGoogle Scholar
  5. 5.
    Hlady WG, Klontz KC (1996) The epidemiology of Vibrio infections in Florida, 1981–1993. J Infect Dis 173:1176–1183PubMedGoogle Scholar
  6. 6.
    Hsueh PR, Lin CY, Tang HJ et al (2004) Vibrio vulnificus in Taiwan. Emerg Infect Dis 10:1363–1368PubMedGoogle Scholar
  7. 7.
    Liu JW, Lee IK, Tang HJ et al (2006) Prognostic factors and antibiotics in Vibrio vulnificus septicemia. Arch Intern Med 166:2117–2123CrossRefPubMedGoogle Scholar
  8. 8.
    Chung PH, Chuang SK, Tsang T et al (2006) Cutaneous injury and Vibrio vulnificus infection. Emerg Infect Dis 12:1302–1303PubMedGoogle Scholar
  9. 9.
    Inoue Y, Ono T, Matsui T et al (2008) Epidemiological survey of Vibrio vulnificus infection in Japan between 1999 and 2003. J Dermatol 35:129–139CrossRefPubMedGoogle Scholar
  10. 10.
    Blake PA, Merson MH, Weaver RE et al (1979) Disease caused by a marine Vibrio. Clinical characteristics and epidemiology. N Engl J Med 300:1–5PubMedCrossRefGoogle Scholar
  11. 11.
    Johnston JM, Becker SF, McFarland LM (1985) Vibrio vulnificus. Man and the sea. JAMA 253:2850–2853CrossRefPubMedGoogle Scholar
  12. 12.
    Howard RJ, Lieb S (1988) Soft-tissue infections caused by halophilic marine Vibrios. Arch Surg 123:245–249PubMedGoogle Scholar
  13. 13.
    Penman AD, Lanier DC Jr, Avara WT III et al (1995) Vibrio vulnificus wound infections from the Mississippi Gulf coastal waters: June to August 1993. South Med J 88:531–533PubMedGoogle Scholar
  14. 14.
    Halow KD, Harner RC, Fontenelle LJ (1996) Primary skin infections secondary to Vibrio vulnificus: the role of operative intervention. J Am Coll Surg 183:329–334PubMedGoogle Scholar
  15. 15.
    Tsai YH, Hsu RW, Huang TJ et al (2007) Necrotizing soft-tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species. J Bone Joint Surg Am 89:631–636CrossRefPubMedGoogle Scholar
  16. 16.
    Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med 29:530–538PubMedGoogle Scholar
  17. 17.
    Fagon JY, Chastre J, Novara A et al (1993) Characterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection: the ODIN model. Intensive Care Med 19:137–144CrossRefPubMedGoogle Scholar
  18. 18.
    Abbott SL, Janda JM, Johnson JA (2007) Vibrio and related organisms. In: Murray PR, Baron EJ, Jorgensen JH et al (eds) Manual of clinical microbiology, vol I, 9th edn. ASM Press, Washington, pp 723–733Google Scholar
  19. 19.
    Mehta CR, Patel NR (1995) Exact logistic regression: theory and examples. Stat Med 14:2143–2160CrossRefPubMedGoogle Scholar
  20. 20.
    Park SD, Shon HS, Joh NJ (1991) Vibrio vulnificus septicemia in Korea: clinical and epidemiologic findings in seventy patients. J Am Acad Dermatol 24:397–403CrossRefPubMedGoogle Scholar
  21. 21.
    Schultz MJ, Olszyna DP, de Jonge E et al (2000) Reduced ex vivo chemokine production by polymorphonuclear cells after in vivo exposure of normal humans to endotoxin. J Infect Dis 182:1264–1267CrossRefPubMedGoogle Scholar
  22. 22.
    Annane D, Bellissant E, Cavaillon JM (2005) Septic shock. Lancet 365:63–78CrossRefPubMedGoogle Scholar
  23. 23.
    Hor LI, Chang TT, Wang ST (1999) Survival of Vibrio vulnificus in whole blood from patients with chronic liver diseases: association with phagocytosis by neutrophils and serum ferritin levels. J Infect Dis 179:275–278CrossRefPubMedGoogle Scholar
  24. 24.
    Shin SH, Shin DH, Ryu PY et al (2002) Proinflammatory cytokine profile in Vibrio vulnificus septicemic patients’ sera. FEMS Immunol Med Microbiol 33:133–138CrossRefPubMedGoogle Scholar
  25. 25.
    Powell JL, Strauss KA, Wiley C et al (2003) Inflammatory cytokine response to Vibrio vulnificus elicited by peripheral blood mononuclear cells from chronic alcohol users is associated with biomarkers of cellular oxidative stress. Infect Immun 71:4212–4216CrossRefPubMedGoogle Scholar
  26. 26.
    Kim HR, Rho HW, Jeong MH et al (1993) Hemolytic mechanism of cytolysin produced from Vibrio vulnificus. Life Sci 53:571–577CrossRefPubMedGoogle Scholar
  27. 27.
    Biosca EG, Amaro C (1996) Toxic and enzymatic activities of Vibrio vulnificus biotype 2 with respect to host specificity. Appl Environ Microbiol 62:2331–2337PubMedGoogle Scholar
  28. 28.
    Chiang SR, Chuang YC (2003) Vibrio vulnificus infection: clinical manifestations, pathogenesis, and antimicrobial therapy. J Microbiol Immunol Infect 36:81–88PubMedGoogle Scholar
  29. 29.
    de Araujo MRE, Aquino C, Scaramal E et al (2007) Vibrio vulnificus infection in São Paulo, Brazil: case report and literature review. Braz J Infect Dis 11:302–305PubMedGoogle Scholar
  30. 30.
    Bowdre JH, Hull JH, Cocchetto DM (1983) Antibiotic efficacy against Vibrio vulnificus in the mouse: superiority of tetracycline. J Pharmacol Exp Ther 225:595–598PubMedGoogle Scholar
  31. 31.
    Morris JG Jr, Tenney J (1985) Antibiotic therapy for Vibrio vulnificus infection. JAMA 253:1121–1122CrossRefPubMedGoogle Scholar
  32. 32.
    Hsueh PR, Chang JC, Chang SC et al (1995) In vitro antimicrobial susceptibility of Vibrio vulnificus isolated in Taiwan. Eur J Clin Microbiol Infect Dis 14:151–153CrossRefPubMedGoogle Scholar
  33. 33.
    Chuang YC, Liu JW, Ko WC et al (1997) In vitro synergism between cefotaxime and minocycline against Vibrio vulnificus. Antimicrob Agents Chemother 41:2214–2217PubMedGoogle Scholar
  34. 34.
    Tang HJ, Chang MC, Ko WC et al (2002) In vitro and in vivo activities of newer fluoroquinolones against Vibrio vulnificus. Antimicrob Agents Chemother 46:3580–3584CrossRefPubMedGoogle Scholar
  35. 35.
    Chuang YC, Ko WC, Wang ST et al (1998) Minocycline and cefotaxime in the treatment of experimental murine Vibrio vulnificus infection. Antimicrob Agents Chemother 42:1319–1322PubMedGoogle Scholar

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

Personalised recommendations