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Aljindan R, Allahham R, Alghamdi R, Alhabib I, AlNassri S, Alkhalifa W, Diab A, Alomar A, Yamani L, Elhadi N. Isolation and Characterization of Cholera Toxin Gene-Positive Vibrio cholerae Non-O1/Non-O139 Isolated from Urinary Tract Infection: A Case Report. Infect Drug Resist 2024; 17:1147-1152. [PMID: 38529069 PMCID: PMC10962659 DOI: 10.2147/idr.s456654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/16/2024] [Indexed: 03/27/2024] Open
Abstract
Background Urinary tract infection (UTI) caused by V. cholerae is rare and less common. V. cholerae is a Gram-negative bacterium motile using single polar flagellum and, originally, is a waterborne microbe found in aquatic and estuarine environments. Toxigenic V. cholerae is well-known as a causative agent of acute and excessive watery diarrhea after ingesting food and water contaminated with this bacterium. Case Presentation A 27-year-old male patient presented to the emergency department on 17th July 2021 with burning micturition, normal vital signs, and no fever, vomiting, or diarrhea. In 2017, the patient complained of short stature and vitamin D deficiency. He was on human growth hormone from January 2018 till October 2019. The diagnosis was V. cholerae Non-O1/non-O139 urinary tract infection (UTI). Considering a urinary tract infection, empirical treatment with Lornoxicam and Ciprofloxacin was initiated, while the result of urine culture was still pending. The patient was discharged on the same day and without any complications. Conclusion V. cholerae non-O1/non-O139 is primarily a marine inhabitant and is associated with sporadic cases resulting in cholera-like diarrhea after consumption of contaminated seafood and exposure to seawater. Extraintestinal infection associated with this bacterium should no longer be ignored as this change in the behavior of cholera bacteria mechanism of pathogenicity might be related to some associated virulence genes.
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Affiliation(s)
- Reem Aljindan
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Reema Allahham
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Rana Alghamdi
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ibrahim Alhabib
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Samia AlNassri
- Department of Infection Control, King Fahad Hospital of the University, Alkhobar, Kingdom of Saudi Arabia
| | - Wala Alkhalifa
- Department of Microbiology, Comprehensive Screening Center, Eastern Health Cluster, Dammam, Kingdom of Saudi Arabia
| | - Asim Diab
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Amer Alomar
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Lamya Yamani
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Nasreldin Elhadi
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Curran EH, Devine MD, Hartley CD, Huang Y, Conrady CD, Debiec MR, Justin GA, Thomas J, Yeh S. Ophthalmic implications of biological threat agents according to the chemical, biological, radiological, nuclear, and explosives framework. Front Med (Lausanne) 2024; 10:1349571. [PMID: 38293299 PMCID: PMC10824978 DOI: 10.3389/fmed.2023.1349571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
As technology continues to evolve, the possibility for a wide range of dangers to people, organizations, and countries escalate globally. The United States federal government classifies types of threats with the capability of inflicting mass casualties and societal disruption as Chemical, Biological, Radiological, Nuclear, and Energetics/Explosives (CBRNE). Such incidents encompass accidental and intentional events ranging from weapons of mass destruction and bioterrorism to fires or spills involving hazardous or radiologic material. All of these have the capacity to inflict death or severe physical, neurological, and/or sensorial disabilities if injuries are not diagnosed and treated in a timely manner. Ophthalmic injury can provide important insight into understanding and treating patients impacted by CBRNE agents; however, improper ophthalmic management can result in suboptimal patient outcomes. This review specifically addresses the biological agents the Center for Disease Control and Prevention (CDC) deems to have the greatest capacity for bioterrorism. CBRNE biological agents, encompassing pathogens and organic toxins, are further subdivided into categories A, B, and C according to their national security threat level. In our compendium of these biological agents, we address their respective CDC category, systemic and ophthalmic manifestations, route of transmission and personal protective equipment considerations as well as pertinent vaccination and treatment guidelines.
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Affiliation(s)
- Emma H. Curran
- Creighton University School of Medicine, Omaha, NE, United States
| | - Max D. Devine
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Caleb D. Hartley
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Ye Huang
- Department of Ophthalmology, University of Illinois-Chicago, Chicago, IL, United States
| | - Christopher D. Conrady
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Microbiology and Pathology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Matthew R. Debiec
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Grant A. Justin
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Joanne Thomas
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States
- National Strategic Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
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Huang TY, Kuo SF, Tsai YH, Chen JL, Peng KT, Huang YK, Hung CH, Li YY, Li HJ, Hsiao CT, Hsu WH. The Impact of Cefuroxime Susceptibility on Aeromonas Necrotizing Fasciitis Outcomes. Microorganisms 2023; 11:2776. [PMID: 38004787 PMCID: PMC10673460 DOI: 10.3390/microorganisms11112776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Despite aggressive antibiotic therapy and surgical debridement, Aeromonas necrotizing fasciitis (NF) can lead to high amputation and mortality rates. Our study compares the different antibiotic minimum inhibitory concentrations (MICs) via Epsilometer tests (E-tests) between non-survivors and survivors of Aeromonas NF of limbs. A prospective review of 16 patients with Aeromonas NF was conducted for 3.5 years in a tertiary coastal hospital. E-tests were conducted for 15 antimicrobial agents to determine the MIC value for Aeromonas species. These patients were divided into non-survival and survival groups. The clinical outcomes, demographics, comorbidities, presenting signs and symptoms, laboratory findings, and microbiological results between the two periods were compared. A total of four patients died, whereas 12 survived, resulting in a 25% mortality rate. A higher proportion of bloodstream infections (100% vs. 41.7%; p = 0.042), monomicrobial infections (100% vs. 33.3%; p = 0.021), shock (100% vs. 33.3%; p = 0.021), serous bullae (50% vs. 0%; p = 0.009), liver cirrhosis (100% vs. 25%; p = 0.009), chronic kidney disease (100% vs. 33.3%; p = 0.021), lower susceptibility to cefuroxime (25% vs. 83.3%; p = 0.028), and ineffective antibiotic prescriptions (75% vs. 16.7%; p = 0.029) was observed in non-survivors. Aeromonas NF is an extremely rare skin and soft-tissue infection that is associated with high mortality, bacteremia, antibiotic resistance, and polymicrobial infection. Therefore, antibiotic regimen selection is rendered very challenging. To improve clinical outcomes and irrational antimicrobial usage, experienced microbiologists can help physicians identify specific pathogens and test MIC.
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Affiliation(s)
- Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan; (T.-Y.H.); (C.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (Y.-H.T.); (J.-L.C.); (K.-T.P.); (Y.-K.H.); (Y.-Y.L.)
- Microbiology Treatment and Research Center, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan;
| | - Shu-Fang Kuo
- Microbiology Treatment and Research Center, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan;
- Departments of Laboratory Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
- Department of Medical Biotechnology and Laboratory Sciences, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
| | - Yao-Hung Tsai
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (Y.-H.T.); (J.-L.C.); (K.-T.P.); (Y.-K.H.); (Y.-Y.L.)
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Jiun-Liang Chen
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (Y.-H.T.); (J.-L.C.); (K.-T.P.); (Y.-K.H.); (Y.-Y.L.)
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Kuo-Ti Peng
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (Y.-H.T.); (J.-L.C.); (K.-T.P.); (Y.-K.H.); (Y.-Y.L.)
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Yao-Kuang Huang
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (Y.-H.T.); (J.-L.C.); (K.-T.P.); (Y.-K.H.); (Y.-Y.L.)
- Microbiology Treatment and Research Center, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan;
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Chien-Hui Hung
- Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan; (T.-Y.H.); (C.-H.H.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, Taoyuan 33302, Taiwan
| | - Yen-Yao Li
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (Y.-H.T.); (J.-L.C.); (K.-T.P.); (Y.-K.H.); (Y.-Y.L.)
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Hsing-Jung Li
- Department of Pediatrics, St. Martin De Porres Hospital, Chiayi City 60069, Taiwan;
| | - Cheng-Ting Hsiao
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (Y.-H.T.); (J.-L.C.); (K.-T.P.); (Y.-K.H.); (Y.-Y.L.)
- Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
| | - Wei-Hsiu Hsu
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan; (Y.-H.T.); (J.-L.C.); (K.-T.P.); (Y.-K.H.); (Y.-Y.L.)
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi City 61363, Taiwan
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Rehm C, Kolm C, Pleininger S, Heger F, Indra A, Reischer GH, Farnleitner AAH, Kirschner AKT. Vibrio cholerae-An emerging pathogen in Austrian bathing waters? Wien Klin Wochenschr 2023; 135:597-608. [PMID: 37530997 PMCID: PMC10651712 DOI: 10.1007/s00508-023-02241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/11/2023] [Indexed: 08/03/2023]
Abstract
Vibrio cholerae, an important human pathogen, is naturally occurring in specific aquatic ecosystems. With very few exceptions, only the cholera-toxigenic strains belonging to the serogroups O1 and O139 are responsible for severe cholera outbreaks with epidemic or pandemic potential. All other nontoxigenic, non-O1/non-O139 V. cholerae (NTVC) strains may cause various other diseases, such as mild to severe infections of the ears, of the gastrointestinal and urinary tracts as well as wound and bloodstream infections. Older, immunocompromised people and patients with specific preconditions have an elevated risk. In recent years, worldwide reports demonstrated that NTVC infections are on the rise, caused amongst others by elevated water temperatures due to global warming.The aim of this review is to summarize the knowledge gained during the past two decades on V. cholerae infections and its occurrence in bathing waters in Austria, with a special focus on the lake Neusiedler See. We investigated whether NTVC infections have increased and which specific environmental conditions favor the occurrence of NTVC. We present an overview of state of the art methods that are currently available for clinical and environmental diagnostics. A preliminary public health risk assessment concerning NTVC infections related to the Neusiedler See was established. In order to raise awareness of healthcare professionals for NTVC infections, typical symptoms, possible treatment options and the antibiotic resistance status of Austrian NTVC isolates are discussed.
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Affiliation(s)
- Carmen Rehm
- Division Water Quality and Health, Karl-Landsteiner University of Health Sciences, Krems, Austria
- Institute for Hygiene and Applied Immunology - Water Microbiology, Medical University Vienna, Vienna, Austria
- Interuniversity Cooperation Centre Water & Health
| | - Claudia Kolm
- Division Water Quality and Health, Karl-Landsteiner University of Health Sciences, Krems, Austria
- Interuniversity Cooperation Centre Water & Health
- Institute for Chemical, Environmental and Bioscience Engineering, Research Group Microbiology and Molecular Diagnostics 166/5/3, Technische Universität Wien, Vienna, Austria
| | - Sonja Pleininger
- Institute for Medical Microbiology and Hygiene, National Reference Centre for Vibrio cholerae, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Florian Heger
- Institute for Medical Microbiology and Hygiene, National Reference Centre for Vibrio cholerae, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - Alexander Indra
- Institute for Medical Microbiology and Hygiene, National Reference Centre for Vibrio cholerae, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Georg H Reischer
- Interuniversity Cooperation Centre Water & Health
- Institute for Chemical, Environmental and Bioscience Engineering, Research Group Microbiology and Molecular Diagnostics 166/5/3, Technische Universität Wien, Vienna, Austria
| | - Andreas A H Farnleitner
- Division Water Quality and Health, Karl-Landsteiner University of Health Sciences, Krems, Austria
- Interuniversity Cooperation Centre Water & Health
- Institute for Chemical, Environmental and Bioscience Engineering, Research Group Microbiology and Molecular Diagnostics 166/5/3, Technische Universität Wien, Vienna, Austria
| | - Alexander K T Kirschner
- Division Water Quality and Health, Karl-Landsteiner University of Health Sciences, Krems, Austria.
- Institute for Hygiene and Applied Immunology - Water Microbiology, Medical University Vienna, Vienna, Austria.
- Interuniversity Cooperation Centre Water & Health, .
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Rational Use of Antibiotics and Education Improved Aeromonas Necrotizing Fasciitis Outcomes in Taiwan: A 19-Year Experience. Antibiotics (Basel) 2022; 11:antibiotics11121782. [PMID: 36551439 PMCID: PMC9774671 DOI: 10.3390/antibiotics11121782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Aeromonas necrotizing fasciitis (NF) causes high rates of amputation and mortality, even after aggressive surgical debridement and antibacterial therapy. This study investigated the effects of rational use of antibiotics and education by infectious disease (ID) physicians on Aeromonas NF treatment outcomes. METHODS Retrospective review for conducted for four years (period I, without an ID physician, December 2001 to December 2005) and 15 years (period II, with an ID physician, January 2006 to March 2021). In period II, the hospital-wide computerized antimicrobial approval system (HCAAS) was also implemented. A pretest-posttest time series analysis compared the two periods. Differences in clinical outcomes, demographics, comorbidities, signs and symptoms, laboratory findings, Aeromonas antibiotic susceptibility, and antibiotic regimens were compared between the two periods. RESULTS There were 19 patients in period I and 53 patients in period II. Patients had a lower rate of amputation or mortality in period II (35.8%) compared with period I (63.2%). Forty-four patients (61.1%) had polymicrobial infections. In the emergency room, the rate of misdiagnosis decreased from 47.4% in period I to 28.3% in period II, while effective empiric antibiotic usage increased from 21.1% in period I to 66.0% in period II. After the ID physician's adjustment, 69.4% received monotherapy in period II compared to 33.3% in period I. CONCLUSIONS Because Aeromonas NF had a high mortality rate and was often polymicrobial, choosing an antibiotic regimen was difficult. Using the HCAAS by an experienced ID physician can improve rational antibiotic usage and clinical outcomes in Aeromonas NF.
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Vibrio spp.: Life Strategies, Ecology, and Risks in a Changing Environment. DIVERSITY 2022. [DOI: 10.3390/d14020097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vibrios are ubiquitous bacteria in aquatic systems, especially marine ones, and belong to the Gammaproteobacteria class, the most diverse class of Gram-negative bacteria. The main objective of this review is to update the information regarding the ecology of Vibrio species, and contribute to the discussion of their potential risk in a changing environment. As heterotrophic organisms, Vibrio spp. live freely in aquatic environments, from marine depths to the surface of the water column, and frequently may be associated with micro- and macroalgae, invertebrates, and vertebrates such as fish, or live in symbiosis. Some Vibrio spp. are pathogenic to humans and animals, and there is evidence that infections caused by vibrios are increasing in the world. This rise may be related to global changes in human behavior (increases in tourism, maritime traffic, consumption of seafood, aquaculture production, water demand, pollution), and temperature. Most likely in the future, Vibrio spp. in water and in seafood will be monitored in order to safeguard human and animal health. Regulators of the microbiological quality of water (marine and freshwater) and food for human and animal consumption, professionals involved in marine and freshwater production chains, consumers and users of aquatic resources, and health professionals will be challenged to anticipate and mitigate new risks.
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Different types of bullae of limbs with necrotizing fasciitis predict different outcome: a prospective study. Infection 2021; 49:135-144. [PMID: 33389697 PMCID: PMC7851011 DOI: 10.1007/s15010-020-01559-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
Study objective Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. Bullae are special skin manifestations of NF. This study was conducted to analyze the differences between different types of bullae of limbs with NF for providing the information to emergency treatment. Methods From April 2015 to August 2018, patients were initially enrolled based on surgical confirmation of limbs with NF. According to the presence of different bullae types, patients were divided into no bullae group (Group N), serous-filled bullae group (Group S), and hemorrhagic bullae group (Group H). Data such as demographics, clinical outcomes, microbiological results, presenting symptoms/signs, and laboratory findings were compared among these groups. Results In total, 187 patients were collected, with 111 (59.4%) patients in Group N, 35 (18.7%) in Group S, and 41 (21.9%) in Group H. Group H had the highest incidence of amputation, required intensive care unit care, and most patients infected with Vibrio species. In Group N, more patients were infected with Staphylococcus spp. than Group H. In Group S, more patients were infected with β-hemolytic Streptococcus than Group H. Patients with bacteremia, shock, skin necrosis, anemia, and longer prothrombin time constituted higher proportions in Group H and S than in Group N. Conclusions In southern Taiwan, patients with NF accompanied by hemorrhagic bullae appear to have more bacteremia, Vibrio infection, septic shock, and risk for amputation. If the physicians at the emergency department can detect for the early signs of NF as soon as possible, and more patient’s life and limbs may be saved.
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Huang TY, Peng KT, Hsu WH, Hung CH, Chuang FY, Tsai YH. Independent Predictors of Mortality for Aeromonas Necrotizing Fasciitis of Limbs: An 18-year Retrospective Study. Sci Rep 2020; 10:7716. [PMID: 32382057 PMCID: PMC7205975 DOI: 10.1038/s41598-020-64741-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
Necrotizing fasciitis (NF) of the limbs caused by Aeromonas species is an extremely rare and life-threatening skin and soft tissue infection. The purpose of this study was to evaluate the specific characteristics and the independent predictors of mortality in patients with Aeromonas NF. Sixty-eight patients were retrospectively reviewed over an 18-year period. Differences in mortality, demographics data, comorbidities, symptoms and signs, laboratory findings, microbiological analysis, empiric antibiotics treatment and clinical outcomes were compared between the non-survival and the survival groups. Twenty patients died with the mortality rate of 29.4%. The non-survival group revealed significant differences in bacteremia, monomicrobial infection, cephalosporins resistance, initial ineffective empiric antibiotics usage, chronic kidney disease, chronic hepatic dysfunction, tachypnea, shock, hemorrhagic bullae, skin necrosis, leukopenia, band polymorphonuclear neutrophils >10%, anemia, and thrombocytopenia. The multivariate analysis identified four variables predicting mortality: bloodstream infection, shock, skin necrosis, and initial ineffective empirical antimicrobial usage against Aeromonas. NF caused by Aeromonas spp. revealed high mortality rates, even through aggressive surgical debridement and antibacterial therapies. Identifying those independent predictors, such as bacteremia, shock, progressive skin necrosis, monomicrobial infection, and application of the effective antimicrobial agents against Aeromonas under the supervision of infectious doctors, may improve clinical outcomes.
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Affiliation(s)
- Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Kuo-Ti Peng
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Chinese Medicine, School of Medicine, Chang Gung University, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Chinese Medicine, School of Medicine, Chang Gung University, Chiayi, Taiwan
| | - Chien-Hui Hung
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fang-Yi Chuang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hung Tsai
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,Department of Chinese Medicine, School of Medicine, Chang Gung University, Chiayi, Taiwan.
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Huang TY, Peng KT, Hsiao CT, Fann WC, Tsai YH, Li YY, Hung CH, Chuang FY, Hsu WH. Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan. BMC Infect Dis 2020; 20:60. [PMID: 31959118 PMCID: PMC6972015 DOI: 10.1186/s12879-020-4796-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
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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Affiliation(s)
- Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Ti Peng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan.,Department of Medicine, School of Medicine, Chang Gung University, Tao Yuan, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hung Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan
| | - Yen-Yao Li
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan
| | - Chien-Hui Hung
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fang-Yi Chuang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan. .,Department of Medicine, School of Medicine, Chang Gung University, Tao Yuan, Taiwan.
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