In-hospital mortality associated with necrotizing soft tissue infection due to Vibrio vulnificus: a matched-pair cohort study

Abstract

Background It remains unclear whether Vibrio vulnificus necrotizing soft tissue infection (NSTI) is associated with higher mortality compared with non-Vibrio NSTI. This study’s objective was to compare outcomes including in-hospital mortality and prognosis between patients with V. vulnificus NSTI and those with non-Vibrio NSTI. Method A retrospective 1:2 matched-pair cohort study of hospitalized patients with NSTI diagnosed by surgical finding was conducted in two tertiary hospitals in southern Taiwan between January 2015 and January 2020. In-hospital outcomes (mortality, length of stay) were compared between patients with and without V. vulnificus infection. We performed multiple imputation using chained equations followed by multivariable regression analyses fitted with generalized estimating equations to account for clustering within matched pairs. All-cause in-hospital mortality and length of stay during hospitalization were compared for NSTI patients with and without V. vulnificus. Result A total of 135 patients were included, 45 in V. vulnificus NSTI group and 90 in non-Vibrio group. The V. vulnificus NSTI patients had higher mortality and longer hospital stays. Multivariable logistic regression analysis revealed that V. vulnificus NSTI was significantly associated with higher in-hospital mortality compared with non-Vibrio NSTI (adjusted odds ratio = 1.52; 95% confidence interval 1.36–1.70; p < 0.01). Conclusion Vibrio vulnificus NSTI was associated with higher in-hospital mortality and longer hospital stay which may increase health care costs, suggesting that preventing V. vulnificus infection is essential.

Unreliable diagnostic accuracy of laboratory risk indicator for necrotizing fasciitis (LRINEC) score but good outcome predictor in necrotizing fasciitis due to Vibrio vulnificus: A retrospective and matched-pair study

“…Prior research has evidenced that hyperlactatemia holds a significant correlation with in-hospital mortality in NF patients, even after adjusting for acidosis. [26][27][28] This outcome was echoed in the current study, even in the case of V vulnificus infections. Given that NF and its swiftly advancing infections are consistently linked to high mortality, the LRINEC score, which was devised by Wong and colleagues [10] using readily accessible lab markers, has been persistently evaluated for its effectiveness in multiple studies.…”

Initial skin necrosis presentation at emergency room was associated with fulminant clinical course and mortality in patients with Vibrio necrotizing fasciitis

“…Vibrio species are the most frequent causative organisms of monomicrobial NF, and were proved to occur more rapidly progressive and fulminant clinical courses than other pathogens in our institution 12 – 20 , 22 . According to our report, 58 patients (80.6%) with Vibrio infections had a recent history of contact with seawater or raw seafood, which we could early suspect Vibrio NF at ER, and ceftriaxone with/without other appropriate antibiotics under the supervision of infectious doctors appears to have a clinical effectiveness for the treatment of Vibrio NF 12 – 20 .…”

“…Kiat et al had reviewed that the most reliable cutaneous signs were swelling (79–80.8%) and erythema (69.6–70.7%), but they could delay the diagnosis of NF because the skin lesions of involved limbs presented as similar as cellulitis at ER 8 , 9 , 11 . Serous or hemorrhagic bullae formation was considered the key sign to distinguish early and late stages of NF; however, not all patients with NF could demonstrate bullae formation initially 9 – 15 , 22 , 23 .…”

Identifying patients with difficult-to-treat acute bacterial skin infections

“…or Vibrio spp. [3,4 ▪ ,31,32]. A recent comparison suggests a worse prognosis of monomicrobial infections versus polymicrobial infection, mostly due to Streptococcus pyogenes [33 ▪ ].…”

“…The poor prognosis of infections with Vibrio vulnificus and Aeromonas spp. is mainly reported in patients who previously had wounds exposed to seawater or brackish water in warm coastal regions (American and Asian countries), especially in cases of flooding or storm surges [3,32]. Staphylococcus aureus infections also have the risk of inducing severe necrotizing infections in the case of Panton-Valentine leucocidin (PVL)-producing strains [3,4 ▪ ,31,35 ▪ ].…”