Is Early Surgical Intervention an Important Role in the Treatment of Patients with Vibrio Vulnificus Soft Tissue Infection?

Vibrio vulnificus感染發生在患有慢性疾病病人身上，有可能引起快速致死。早期診斷、使用適當抗生素以及外科治療被認定可降低此疾病的死亡率。此篇報告就是要探討外科治療對此疾病的影響程度。我們回顧從西元2000年5月到2004年12月期間在奇美醫學中心的病歷，共有89人被Vibrio vulnificus感染，其中有69人有軟組織感染現象。此69人死亡率為17.39%，當中有接受外科治療的病人死亡率為10.71%，沒有接受外科治療的病人死亡率為46.15%,有接受外科治療的病人死亡率明顯有意義地低於沒有接受外科治療的病人。在患有肝病變的病人的分析上，有接受外科治療的病人死亡率亦較低(27%)，但因個案數少，沒法顯出明顯差異。總括而言，對Vibrio vulnificus感染的診斷需要高度警戒，早期手術包括清瘡、筋膜切開、甚至截肢是有其必須性，不用遲疑，特別是在患有慢性疾病病人的治療處置上。

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Background: Vibrio Vulnificus (Vibrio V.), a gram-negative bacterium, is capable of causing a rapidly fatal infection in patients with underlying chronic disease. Early suspicion and diagnosis with appropriate antibiotic administration, and early surgical intervention are important and recommended to reduce the mortality rate associated with this disease. Objectives: To report the influence of early surgical intervention. Materials and methods: we analyzed retrospectively the clinical charts in eighty-nine patients with Vibrio V. infection who were treated at Chi. Mei. Medical center between May, 2000 and December, 2004. Sixty-nine patients developed soft tissue infection. Results: Total mortality rate of these patients with Vibrio V. soft tissue infection was 17.39%. The mortality rate was lower in patients with surgical intervention (10.71%, 6/56) compared with those without surgical treatment (46.15%, 6/13, P=0.007). In patients with underlying liver disease, surgical intervention still proves to be able to lower down the mortality rate (27%, 4/15). Conclusion: A high index of suspicion is necessary for the diagnosis of Vibrio V. infection. The willingness to surgical debridement, fasciotomy, or limb amputation without hesitation at a very early time point, not waiting septicemia to occur, can really reduce the mortality rate of the fetal disease, especially for patients with underlying chronic disease.

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