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• W2007202363 abstract "<h3>Background</h3> Immunocompromised patients with<i>Vibrio vulnificus</i>septicemia are at high risk for fatality. When a hemorrhagic bullous necrotic cutaneous lesion (HBNCL) and decreased blood pressure develop, approximately 50% of<i>V vulnificus</i>septicemic patients die within 48 hours. This study aimed to evaluate the risk factor(s) for fatality among patients with<i>V vulnificus</i>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. <h3>Methods</h3> Patients with the diagnosis of<i>V vulnificus</i>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). <h3>Results</h3> 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 (<i>P</i> = .006) and a higher proportion of shock at arrival at the medical center (<i>P</i> = .015) than the nonfatal subgroup. In group 2, the effect of a first- or second-generation cephalosporin plus an aminoglycoside was negative (<i>P</i> = .01) and that of combined third-generation cephalosporin and tetracycline or its analogue was positive (<i>P</i><.001); significant differences were found between the fatal and nonfatal subgroups in the APACHE II score (<i>P</i><.001), number who were in shock at arrival at the medical center (<i>P</i> = .02), delayed surgical intervention (<i>P</i> = .03), and peripheral leukocytosis (<i>P</i> = .03). Shock at arrival at the medical center (odds ratio [OR], 19.25; 95% confidence interval [CI], 1.768-209.54;<i>P</i> = .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;<i>P</i><.001). <h3>Conclusion</h3> Septic shock is a determinant of fatality in patients with<i>V vulnificus</i>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<i>V vulnificus</i>septicemic patients with HBNCLs." @default.
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• W2007202363 date "2006-10-23" @default.
• W2007202363 modified "2023-10-18" @default.
• W2007202363 title "Prognostic Factors and Antibiotics in Vibrio vulnificus Septicemia" @default.
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• W2007202363 doi "https://doi.org/10.1001/archinte.166.19.2117" @default.
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