Tsai Yao-Hung, Huang Tsung-Jen, Hsu Robert Wen-Wei, Weng Yi-Jan, Hsu Wei-Hsiu, Huang Kuo-Chin, Peng Kuo-Ti
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, at Chia-Yi, Chang Gung University College of Medicine, Taiwan, Republic of China.
J Trauma. 2009 Mar;66(3):899-905. doi: 10.1097/TA.0b013e31816a9ed3.
Vibrio species are a rare cause of necrotizing soft-tissue infections and primary septicemia, which are likely to occur in patients with hepatic disease, diabetes, adrenal insufficiency, and immunocompromised conditions. These organisms thrive in warm seawater and are often present in raw oysters, shellfish, and other seafood. This study examined fulminating clinical characteristics of Vibrio vulnificus and Vibrio cholerae non-O1 soft-tissue infections and identified outcome predictors.
Thirty patients with necrotizing fasciitis and sepsis caused by Vibrio species were retrospectively reviewed. Twenty-eight patients had a history of contact with seawater or raw seafood. Eight patients had hepatic disease such as hepatitis or liver cirrhosis, and seven patients had diabetes mellitus. Nine patients had hepatic dysfunction combined with diabetes mellitus. Microbiology laboratory culture studies confirmed V. vulnificus in 23 patients and V. cholerae non-O1 in seven patients.
Surgical debridement or immediate limb amputation was initially performed in all patients with necrotizing soft-tissue infections. Eleven patients (37%) died within several days of admission and 19 survived. The mortality of V. cholerae non-O1 group (57%) is higher than that of the V. vulnificus group (30%). A significantly higher mortality rate was noted in patients with initial presentations of a systolic blood pressure of < or =90 mm Hg, leukopenia, decreased platelet counts, and a combination of hepatic dysfunction and diabetes mellitus.
Vibrio necrotizing soft-tissue infections should be suspected in patients with appropriate clinical findings and history of contact with seawater or seafood. V. cholerae non-O1 may cause bacteremia more often than V. vulnificus in patients with liver cirrhosis. Early fasciotomy and culture-directed antimicrobial therapy are aggressively recommended in patients with hypotensive shock, leukopenia, high band forms of white blood cells, decreased platelet counts, severe hypoalbuminemia, and underlying chronic illness, such as hepatic dysfunction and diabetes mellitus.
弧菌属是坏死性软组织感染和原发性败血症的罕见病因，这些感染多见于患有肝脏疾病、糖尿病、肾上腺功能不全和免疫功能低下的患者。这些微生物在温暖的海水中大量繁殖，常存在于生牡蛎、贝类和其他海鲜中。本研究调查了创伤弧菌和非O1群霍乱弧菌软组织感染的暴发性临床特征，并确定了预后预测因素。
对30例由弧菌属引起的坏死性筋膜炎和败血症患者进行回顾性研究。28例患者有接触海水或生海鲜的病史。8例患者有肝脏疾病，如肝炎或肝硬化，7例患者患有糖尿病。9例患者肝功能不全合并糖尿病。微生物实验室培养研究证实，23例患者感染创伤弧菌，7例患者感染非O1群霍乱弧菌。
所有坏死性软组织感染患者均首先进行了手术清创或立即截肢。11例患者（37%）在入院数天内死亡，19例存活。非O1群霍乱弧菌组的死亡率（57%）高于创伤弧菌组（30%）。收缩压≤90 mmHg、白细胞减少、血小板计数降低以及肝功能不全和糖尿病并存的患者死亡率显著更高。
有适当临床症状且有接触海水或海鲜史的患者应怀疑患有弧菌性坏死性软组织感染。在肝硬化患者中，非O1群霍乱弧菌可能比创伤弧菌更常引起菌血症。对于出现低血压休克、白细胞减少、高杆状核白细胞、血小板计数降低、严重低白蛋白血症以及存在潜在慢性疾病（如肝功能不全和糖尿病）的患者，强烈建议早期进行筋膜切开术并采用针对性培养的抗菌治疗。
