Skip to main content
Top
Published in: World Journal of Emergency Surgery 1/2022

Open Access 01-12-2022 | Necrotizing Fasciitis | Research

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

Authors: Chih-Yao Chang, Kai-Hsiang Wu, Po-Han Wu, Shang-Kai Hung, Cheng-Ting Hsiao, Shu-Ruei Wu, Chia-Peng Chang

Published in: World Journal of Emergency Surgery | Issue 1/2022

Login to get access

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.
Literature
1.
go back to reference Wong C-H, Chang H-C, Pasupathy S, Khin L-W, Tan J-L, Low C-O. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Jt Surg Am. 2003;85-A:1454–60.CrossRef Wong C-H, Chang H-C, Pasupathy S, Khin L-W, Tan J-L, Low C-O. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Jt Surg Am. 2003;85-A:1454–60.CrossRef
2.
go back to reference Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Phys. 2003;68:323–8. Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Phys. 2003;68:323–8.
3.
go back to reference Ozalay M, Ozkoc G, Akpinar S, Hersekli MA, Tandogan RN. Necrotizing soft-tissue infection of a limb: clinical presentation and factors related to mortality. Foot Ankle Int. 2006;27:598–605.CrossRef Ozalay M, Ozkoc G, Akpinar S, Hersekli MA, Tandogan RN. Necrotizing soft-tissue infection of a limb: clinical presentation and factors related to mortality. Foot Ankle Int. 2006;27:598–605.CrossRef
4.
go back to reference Roje Z, Roje Z, Matić D, Librenjak D, Dokuzović S, Varvodić J. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World J Emerg Surg. 2011;6:46.CrossRef Roje Z, Roje Z, Matić D, Librenjak D, Dokuzović S, Varvodić J. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World J Emerg Surg. 2011;6:46.CrossRef
5.
go back to reference Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51:344–62.CrossRef Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51:344–62.CrossRef
6.
go back to reference Chang C-P, Hsiao C-T, Lin C-N. Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study. World J Emerge Surg. 2018;13:1–1.CrossRef Chang C-P, Hsiao C-T, Lin C-N. Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study. World J Emerge Surg. 2018;13:1–1.CrossRef
7.
go back to reference Hsu JC, Shen SH, Yang TY, Chen PH, Huang KC, Tsai YH. Necrotizing fasciitis and sepsis caused by Vibrio vulnificus and Klebsiella pneumoniae in diabetic patients. Biomed J. 2015;38:136–42.CrossRef Hsu JC, Shen SH, Yang TY, Chen PH, Huang KC, Tsai YH. Necrotizing fasciitis and sepsis caused by Vibrio vulnificus and Klebsiella pneumoniae in diabetic patients. Biomed J. 2015;38:136–42.CrossRef
8.
go back to reference Lee YC, Hor LI, Chiu HY, Lee JW, Shieh SJ. Prognostic factor of mortality and its clinical implications in patients with necrotizing fasciitis caused by Vibrio vulnificus. Eur J Clin Microbiol Infect Dis. 2014;33:1011–8.CrossRef Lee YC, Hor LI, Chiu HY, Lee JW, Shieh SJ. Prognostic factor of mortality and its clinical implications in patients with necrotizing fasciitis caused by Vibrio vulnificus. Eur J Clin Microbiol Infect Dis. 2014;33:1011–8.CrossRef
9.
go back to reference Tsai YH, Huang TY, Chen JL, Hsiao CT, Kuo LT, Huang KC. 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. BMC Infect Dis. 2021;21(1):771.CrossRef Tsai YH, Huang TY, Chen JL, Hsiao CT, Kuo LT, Huang KC. 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. BMC Infect Dis. 2021;21(1):771.CrossRef
10.
go back to reference Tsai YH, Wen-Wei Hsu R, Huang KC, Huang TJ. Comparison of necrotizing fasciitis and sepsis caused by Vibrio vulnificus and Staphylococcus aureus. J Bone Jt Surg Am. 2011;93:274–84.CrossRef Tsai YH, Wen-Wei Hsu R, Huang KC, Huang TJ. Comparison of necrotizing fasciitis and sepsis caused by Vibrio vulnificus and Staphylococcus aureus. J Bone Jt Surg Am. 2011;93:274–84.CrossRef
11.
go back to reference Koh THB, Tan JHJ, Hong CC, Wang W, Nather A. Early clinical manifestations of vibrio necrotising fasciitis. Singap Med J. 2018;59(4):224e7.CrossRef Koh THB, Tan JHJ, Hong CC, Wang W, Nather A. Early clinical manifestations of vibrio necrotising fasciitis. Singap Med J. 2018;59(4):224e7.CrossRef
12.
go back to reference Tsai YH, Hsu RW, Huang TJ, Hsu WH, Huang KC, Li YY, et al. Necrotizing soft tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species. J Bone Jt Surg Am. 2007;89:631–6.CrossRef Tsai YH, Hsu RW, Huang TJ, Hsu WH, Huang KC, Li YY, et al. Necrotizing soft tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species. J Bone Jt Surg Am. 2007;89:631–6.CrossRef
13.
go back to reference Chuang YC, Yuan CY, Liu CY, Lan CK, Huang AH. Vibrio vulnificus infection in Taiwan: report of 28 cases and review of clinical manifestations and treatment. Clin Infect Dis. 1992;15:271–6.CrossRef Chuang YC, Yuan CY, Liu CY, Lan CK, Huang AH. Vibrio vulnificus infection in Taiwan: report of 28 cases and review of clinical manifestations and treatment. Clin Infect Dis. 1992;15:271–6.CrossRef
14.
go back to reference Zhang XH, Austin B. Haemolysins in Vibrio species. J Appl Microbiol. 2005;98:1011–9.CrossRef Zhang XH, Austin B. Haemolysins in Vibrio species. J Appl Microbiol. 2005;98:1011–9.CrossRef
15.
go back to reference Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC. Predictors of mortality in patients with necrotizing fasciitis. Am J Emerg Med. 2008;26:170–5.CrossRef Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC. Predictors of mortality in patients with necrotizing fasciitis. Am J Emerg Med. 2008;26:170–5.CrossRef
19.
go back to reference Wu CJ, Chen PL, Tang HJ, et al. Incidence of Aeromonas bacteremia in southern Taiwan: vibrio and Salmonella bacteremia as comparators. J Microbiol Immunol Infect. 2014;47:145–8.CrossRef Wu CJ, Chen PL, Tang HJ, et al. Incidence of Aeromonas bacteremia in southern Taiwan: vibrio and Salmonella bacteremia as comparators. J Microbiol Immunol Infect. 2014;47:145–8.CrossRef
20.
go back to reference Jeong HG, Satchell KJF. Additive function of Vibrio vulnificus MARTXVv and VvhA cytolysins promotes rapid growth and epithelial tissue necrosis during intestinal infection. PLoS Pathog. 2012;8:e1002581.CrossRef Jeong HG, Satchell KJF. Additive function of Vibrio vulnificus MARTXVv and VvhA cytolysins promotes rapid growth and epithelial tissue necrosis during intestinal infection. PLoS Pathog. 2012;8:e1002581.CrossRef
21.
go back to reference Lo H, Lin J, Chen Y, et al. RTX toxin enhances the survival of Vibrio vulnificus during infection by protecting the organism from phagocytosis. J Infect Dis. 2011;203:1866–74.CrossRef Lo H, Lin J, Chen Y, et al. RTX toxin enhances the survival of Vibrio vulnificus during infection by protecting the organism from phagocytosis. J Infect Dis. 2011;203:1866–74.CrossRef
22.
go back to reference Miyoshi S, Kawata K, Tomochika S, et al. The C-terminal domain promotes the hemorrhagic damage caused by Vibrio vulnificus metalloprotease. Toxicon. 2001;39:1883–6.CrossRef Miyoshi S, Kawata K, Tomochika S, et al. The C-terminal domain promotes the hemorrhagic damage caused by Vibrio vulnificus metalloprotease. Toxicon. 2001;39:1883–6.CrossRef
23.
go back to reference Elgaml A, Miyoshi SI. Regulation systems of protease and hemolysin production in Vibrio vulnificus. Microbiol Immunol. 2017;61:1–11.CrossRef Elgaml A, Miyoshi SI. Regulation systems of protease and hemolysin production in Vibrio vulnificus. Microbiol Immunol. 2017;61:1–11.CrossRef
24.
go back to reference Tsai YH, Huang TY, Kuo LT, Chuang PY, Hsiao CT, Huang KC. Comparison of surgical outcomes and predictors in patients with monomicrobial necrotizing fasciitis and sepsis caused by Vibrio vulnificus, Aeromonas hydrophila, and Aeromonas sobria. Surg Infect (Larchmt). 2022. https://doi.org/10.1089/sur.2021.337.CrossRef Tsai YH, Huang TY, Kuo LT, Chuang PY, Hsiao CT, Huang KC. Comparison of surgical outcomes and predictors in patients with monomicrobial necrotizing fasciitis and sepsis caused by Vibrio vulnificus, Aeromonas hydrophila, and Aeromonas sobria. Surg Infect (Larchmt). 2022. https://​doi.​org/​10.​1089/​sur.​2021.​337.CrossRef
26.
go back to reference Chang CP, Hsiao CT, Fann WC. Risk factors associated with bacteremia correlated with mortality in patients with acute bacterial skin and skin structure infection. Intern Emerg Med. 2019;14(2):259–64.CrossRef Chang CP, Hsiao CT, Fann WC. Risk factors associated with bacteremia correlated with mortality in patients with acute bacterial skin and skin structure infection. Intern Emerg Med. 2019;14(2):259–64.CrossRef
30.
go back to reference Chang CP, Fann WC, Wu SR, et al. Lactate on emergency department arrival as a predictor of in-hospital mortality in necrotizing fasciitis: a retrospective study. J Orthop Surg Res. 2019;14:73.CrossRef Chang CP, Fann WC, Wu SR, et al. Lactate on emergency department arrival as a predictor of in-hospital mortality in necrotizing fasciitis: a retrospective study. J Orthop Surg Res. 2019;14:73.CrossRef
32.
go back to reference Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41.CrossRef Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41.CrossRef
Metadata
Title
In-hospital mortality associated with necrotizing soft tissue infection due to Vibrio vulnificus: a matched-pair cohort study
Authors
Chih-Yao Chang
Kai-Hsiang Wu
Po-Han Wu
Shang-Kai Hung
Cheng-Ting Hsiao
Shu-Ruei Wu
Chia-Peng Chang
Publication date
01-12-2022
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2022
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-022-00433-z

Other articles of this Issue 1/2022

World Journal of Emergency Surgery 1/2022 Go to the issue