Necrotizing fasciitis and sepsis caused by Vibrio vulnificus and Klebsiella pneumoniae in diabetic patients

Abstract

Background: Vibrio vulnificus related necrotizing fasciitis is a fatal, rapidly progressive soft-tissue infection. Necrotizing fasciitis caused by Klebsiella pneumoniae is rare, which is indistinguishable from V. vulnificus infection in the emergency room. The purpose of this study was to compare the clinical characteristics and outcome between these two pathogens in diabetic patients. Methods:Thirty diabetic patients were retrospectively reviewed over an 8-year period. Necrotizing fasciitis caused by V. vulnificus was found in 19 patients and by K. pneumoniae in 11 patients. The demographic, clinical, and laboratory characteristics, and the outcome between diabetic patients with V. vulnificus and K. pneumoniae infections were compared. Results:Two patients in the V. vulnificus group (10.5%) and three patients in the K. pneumoniae group (27.3%) died. Fourteen patients in the V. vulnificus group (73.6%) had a history of exposure to seawater or raw seafood, and eight patients in the K. pneumoniae group (72.8%) had abrasions or chronic ulcers over the site of infection. We found that the time interval between onset of illness and presentation to the hospital was significantly shorter in the V. vulnificus group than in the K. pneumoniae group (2.47 days vs. 5.45 days, p < 0.001). Conclusions:The exposure history and the time from exposure to hospital presentation with severe sepsis syndromes should alert clinicians to distinguish between necrotizing soft-tissue infections with V. vulnificus (contact with seawater or raw seafood) and K. pneumoniae (abrasions or chronic ulcers) in diabetic patients. Infection with V. vulnificus progresses more rapidly than infection with K. pneumoniae during the initial clinical course. (Biomed J 2015;38:136-142) Key words: klebsiella pneumonia, necrotizing fasciitis, Vibrio vulnificus At a Glance Commentary Scientific background of the subjectThe purpose of this study was to compare the specific characteristics and clinical outcomes between V. vulnificus and K. pneumoniae necrotizing fasciitis.

Bacteriology and mortality of necrotizing fasciitis in a tertiary coastal hospital with comparing risk indicators of methicillin-resistant Staphylococcus aureus and Vibrio vulnificus infections: a prospective study

“…The Chiayi Chang Gung Memorial Hospital is a tertiary hospital which situated on the western coast of southern Taiwan, and V. vulnificus are the most frequent causative organism of monomicrobial NF. The residents’ occupations were fishermen or farmers who were frequently associated with handling raw seafood, exposure to seawater, and contact with brackish water or soil [ 6 , 16 , 16 , 17 , 19 ]. However, Vibrio spp.…”

“…Hyperbaric oxygen (HBO) therapy and vacuum assisted closure (VAC) therapy was administered in stable NF patients for improving wound healing. Soft tissue reconstructions, such as skin grafts and flap reconstruction, were done until the infected necrotic tissue was controlled and stabilized [ 6 , 16 , 19 ] (Fig. 1 ).…”

Respiratory Burst Process in Diabetic Children

“…Patients with DM constitute to 20.1% - 22.7% of all patients with sepsis ( 4 , 5 ). Distinct infections are more common in these patients, including necrotizing fasciitis, diabetic foot, mucormycosis, emphysematous infections of the gall bladder, kidney and urinary bladder, and invasive otitis externa ( 6 - 8 ). In a year round prospective cohort study, 705 adult patients who had type 1 DM, 6,712 adult patients who had type 2 DM and 18911 control patients who had hypertension without diabetes were compared regarding the incidence of infection.…”

Vibrio Vulnificus Necrotizing Fasciitis Associated with Acupuncture

“…A group of authors from Taiwan addressed this issue by comparing the clinical characteristics, laboratory findings, and outcome of patients suffering from NF caused by V. vulnificus to NF caused by S. aureus , 18 Aeromonas spp., 19 and K. pneumoniae . 20 They concluded that NF caused by V. vulnificus progresses more rapidly than NF caused by S. aureus or K. pneumonia e.…”