Vibrio necrotizing soft-tissue infection of the upper extremity: Factors predictive of amputation and death

Huang, Kuo‐Chin; Hsieh, Pang‐Hsin; Huang, Kuo-Chung; Tsai, Yao-Hung

doi:10.1016/j.jinf.2008.07.009

Cited by 25 publications

(32 citation statements)

References 42 publications

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“…Based on previous small series and case reports of 34 patients with Vibrio necrotizing fasciitis, 13 died and 21 survived, resulting in a mortality rate of 38% [15,16,[26][27][28][29]. Hypotensive shock, leukopenia, higher counts of band forms of leukocytes, decreased platelet counts, and severe hypoalbuminemia at the time of presentation were associated with mortality in patients with Vibrio necrotizing fasciitis [15,[27][28][29].…”

Section: Introductionmentioning

confidence: 97%

“…In 2004, we reported a treatment algorithm for patients with suspected Vibrio necrotizing soft tissue infections that includes emergency fasciotomy or amputation, antibiotic therapy with a third-generation cephalosporin plus tetracycline, and admission to the intensive care unit [28]. However, our mortality rates of patients with Vibrio infections were still as much as 35% to 44% [15,27,29]. The lack of specific disease characteristics and diagnostic tools during the initial examination might have delayed the diagnosis and resulted in failure to initiate early aggressive surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Hypotensive shock, leukopenia, higher counts of band forms of leukocytes, decreased platelet counts, and severe hypoalbuminemia at the time of presentation were associated with mortality in patients with Vibrio necrotizing fasciitis [15,[27][28][29]. However, there are no known laboratory parameters that specifically can detect and make an early diagnosis of Vibrio necrotizing fasciitis.…”

Section: Introductionmentioning

confidence: 99%

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Laboratory Indicators for Early Detection and Surgical Treatment of Vibrio Necrotizing Fasciitis

Tsai

Hsu

Huang

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Laboratory Indicators for Early Detection and Surgical Treatment of Vibrio Necrotizing Fasciitis

Tsai

Hsu

Huang

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…and Aeromonas spp. have been regarded as the most important gram-negative bacteria causing NF since 2004 [8,9,[11][12][13][17][18][19][20][21][22], and Vibrio cholerae non-O1 keratitis [23]. Our team, "Vibrio NSSTIs Treatment and Research (VTR) Group," at CGMH-Chiayi consists of professional medical staff working in various departments, namely, emergency medicine, orthopedic surgery, infectious diseases, intensive care unit, and hyperbaric oxygen treatment center.…”

Section: Introductionmentioning

confidence: 99%

Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan

et al. 2020

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Background: Necrotizing fasciitis (NF) is a rare and life-threatening necrotizing skin and soft-tissue infection. Infectious pathogens of NF must be detected early and treated rapidly to prevent loss of limb or a fatal outcome. This study aimed to detect more reliable predictors between gram-negative and gram-positive monomicrobial NF of limbs. Methods: A total of 100 patients with limb monomicrobial NF were diagnosed prospectively from April 2015 to July 2018. These monomicrobial NF pathogens can be divided into gram-negative and gram-positive groups according to the result of Gram staining and final bacterial reports. Data such as demographics, seawater or seafood contact history, infectious location, comorbidities, presenting signs and symptoms, and laboratory findings were recorded and compared. Results: A total of 55 patients were infected with gram-negative organisms and 45 patients with gram-positive organisms. Among the 55 cases of monomicrobial gram-negative NF, 48 (87.3%) were caused mainly by Vibrio spp. (38, 69.1%) and Aeromonas spp. (10, 18.2%). A higher incidence of chronic kidney disease, cerebrovascular accident, tachypnea, and septic shock; a higher rate of band forms of leukocytes of more than 3%, serum lactate of more than 20 mg/dL, and C-reactive protein level of less than 150 mg/dL; prolonged prothrombin time; and a lower fibrinogen level were observed in patients with gram-negative infection. In a multivariate analysis, a higher incidence of seawater or seafood contact history (odds ratio [OR]: 66.301; 95% confidence interval [CI]: 7.467-588.702), a higher rate of hyperlactatemia (OR: 7.904; 95% CI: 1.231-50.744), and a low fibrinogen level (OR: 1.013; 95% CI: 1.004-1.023) indicated gram-negative infection. Conclusions: In southern Taiwan, NF of limbs mainly affected the lower limbs, exhibited monomicrobial infection, and was predominated by gram-negative bacteria. Gram-negative monomicrobial NF of limbs often occurred in individuals with the more seawater or seafood contact history, hyperlactatemia, and low fibrinogen levels.

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“…Of these cases, 14 (82%) were caused by V. vulnificus , and three resulted in death . In Huang et al 's study of factors that are predictive of amputation and death in Vibrio necrotising soft‐tissue infections (VNSTIs) of the upper extremity, 16 patients with upper extremity VNSTIs were studied during this 5‐year longitudinal study. All patients had undergone the same treatment protocol that included specific combination antibiotic therapy, aggressive resuscitation and prompt radical debridement.…”

Section: Discussionmentioning

confidence: 99%

Successful salvage and reconstruction of a finger threatened by Vibrio vulnificus necrotising fasciitis using fenestrated‐type artificial dermis and three steps of topical negative pressure wound therapy

Wang

Chiao

Chou

et al. 2017

International Wound Journal

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Vibrio vulnificus can cause severe skin and soft tissue infection (SSTI). The pathogen is an opportunistic marine bacterium that is likely to infect patients with chronic liver disease, patients in an immunocompromised state, and those in end-stage renal disease. V. vulnificus gains entry through soft tissues by direct penetration of a wound by infected marine organisms, such as raw oysters, shellfish and other seafood, or by exposing a wound to contaminated water. Despite its ease of entry, V. vulnificus necrotising fasciitis with compartment syndrome has rarely been described. We report a case of an elderly patient with end-stage renal disease undergoing haemodialysis, who developed necrotising fasciitis following infection by V. vulnificus through a puncture injury while cleaning fish. A successful salvage and reconstruction surgery was performed using fenestrated-type artificial dermis followed by negative pressure wound therapy. This case presents a reasonable treatment option for threatening V. vulnificus necrotising fasciitis with compartment syndrome.

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Vibrio necrotizing soft-tissue infection of the upper extremity: Factors predictive of amputation and death

Cited by 25 publications

References 42 publications

Laboratory Indicators for Early Detection and Surgical Treatment of Vibrio Necrotizing Fasciitis

Laboratory Indicators for Early Detection and Surgical Treatment of Vibrio Necrotizing Fasciitis

Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan

Successful salvage and reconstruction of a finger threatened by Vibrio vulnificus necrotising fasciitis using fenestrated‐type artificial dermis and three steps of topical negative pressure wound therapy

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