https://scholars.lib.ntu.edu.tw/handle/123456789/201954
Title: | Prognostic Factors and Antibiotics in Vibrio Vulnificus Septicemia | Authors: | LIU, JIEN-WEI TANG, HUNG-JEN KO, WEN-CHIEN LEE, HSIN-CHUN LIU, YUNG-CHIN HSUEH, PO-REN CHUANG, YIN-CHING |
Issue Date: | 2006 | Journal Volume: | v.166 | Journal Issue: | n.19 | Start page/Pages: | 2117-2123 | Source: | ARCHIVES OF INTERNAL MEDICINE | Abstract: | Background: Immunocompromised patients with Vibrio vulnificus septicemia are at high risk for fatality. When a hemorrhagic bullous necrotic cutaneous lesion (HBNCL) and decreased blood pressure develop, approximately 50% of V vulnificus septicemic patients die within 48 hours. This study aimed to evaluate the risk factor(s) for fatality among patients with V vulnificus septicemia, emphasizing the role of prescribed antimicrobial agents in general and the therapeutic efficacy of the combination of a third- generation cephalosporin and tetracycline or its analogue in particular. Methods: Patients with the diagnosis of V vulnificus infection admitted to 5 large medical centers in Taiwan between 1995 and 2003 were included in this retrospective study. Patients were divided into 2 groups: those with HBNCLs and those without HBNCLs. Patients were further divided into subgoups without fatalities (fatal subgroup) and those without fatalities (nonfatal subgroup). Results: A total of 93 patients participated in the study. In group 1, the fatal subgroup had higher Acute Physiology and Chronic Health Evaluation II ( APACHE II) scores (P=.006) and a higher proportion of shock at arrival at the medical center (P=.015) than the nonfatal subgroup. In group 2, the effect of a first- or second-generation cephalosporin plus an aminoglycoside was negative (P=.01) and that of combined third-generation cephalosporin and tetracycline or its analogue was positive (P <.001); significant differences were found between the fatal and nonfatal subgroups in the APACHE II score (P <.001), number who were in shock at arrival at the medical center (P=.02), delayed surgical intervention (P=. 03), and peripheral leukocytosis (P=.03). Shock at arrival at the medical center (odds ratio [OR], 19. 25; 95% confidence interval [CI], 1.768-209. 54; P=.02) was an independent risk factor for fatality in patients without HBNCLs. Use of a third-generation cephalosporin and tetracycline or its analogue significantly reduced fatality rates in patients with HBNCLs (OR, 0.037; 95% CI, 0.007-0. 192; P <.001). Conclusion: Septic shock is a determinant of fatality in patients with V vulnificus septicemia without HBNCLs; our data suggest that the combination of a third- generation cephalosporin and tetracycline or its analogue may be a better choice in antimicrobial treatment of V vulnificus septicemic patients with HBNCLs. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/89396 |
Appears in Collections: | 醫學系 |
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