Emergency Debridement with Empirical Antibiotics Treatment for Clinically Diagnosed Vibrio Sepsis

Abstract

Background : To evaluate the role of emergency debridement performed in

conjunction with an empirical antibiotic therapy in clinically diagnosed, full-blown

Vibrio vulnificus Sepsis.

Methods : Immediate surgical debridement was performed on 13 out of 15 patients

who were clinically diagnosed as having Vibrio vulnificus sepsis.

Results : Among 15 patients clinically diagnosed Vibrio vulnificus spepsis, Vibrio

vulnificus was isolated in 8 patients. Underlying diseases were liver cirrhosis(2), chronic alcohol ingestion or chronic liver disease(10), diabetes mellitus(3), gastrectomy(1) and in 4 cases no underlying condition was identified. All patients had skin lesions such as erythema, mulla, vesicle and gangrene. All but one initially showed variable degree of hypotension, thrombocytopenia, hepatic dysfunction, renal failure and mental confusion.

Their mean APACHE Ⅲ score was 84. Immediate survival (within 48hrs) in clinically

diagnosed Vibrio sepsis was 80(12/15)% and long term survival rate among them was

66.6%.

Forty eight hour survival rate in bacteriologically confirmed cases of Vibrio vulnificus sepsis was 75%, where their long term survival was 62.5%.

Conclusion : In treating full-blown Vibrio vulnificus sepsis, immediate emergency

surgical debridement performed in conjunction with the empirical antibiotics gives a possibility to improve both immediate and long term prognosis of the disease.