Background: Vibrio and Aeromonas species, which can cause
necrotizing fasciitis and primary septicemia, are members of the Vibrionaceae
family and thrive in aquatic environments. Because the clinical symptoms and
signs of necrotizing fasciitis and sepsis caused by these two bacteria are
similar, the purposes of this study were to describe the clinical
characteristics of Vibrio vulnificus and Aeromonas infections, to
analyze the risk factors for death, and to compare the effects of surgical
treatment on the outcome.
Methods: The cases of thirty-two patients with necrotizing
soft-tissue infections and sepsis caused by Vibrio vulnificus
(seventeen patients) and Aeromonas species (fifteen patients) were
retrospectively reviewed over a four-year period. Surgical débridement
or immediate limb amputation was initially performed in all patients.
Demographic data, underlying diseases, laboratory results, and clinical
outcome were analyzed for each patient in both groups.
Results: Six patients in the Vibrio vulnificus group and
four patients in the Aeromonas group died. The patients who died had
significantly lower serum albumin levels than did the patients who survived (p
< 0.05). The patients with a combination of hepatic dysfunction and
diabetes mellitus had a higher mortality rate than those with either hepatic
disease or diabetes mellitus alone (p < 0.05). The patients with Vibrio
vulnificus infections had a significantly lower systolic blood pressure
at presentation (p = 0.006). The patients with Aeromonas infections who died
had significantly lower white blood-cell counts (p = 0.03) with significantly
fewer numbers of segmented white blood cells than those who died in the
Vibrio vulnificus group (p = 0.01).
Conclusions: The contact history of patients with a rapid onset of
cellulitis can alert clinicians to a differential diagnosis of soft-tissue
infection with Vibrio vulnificus (contact with seawater or raw
seafood) or Aeromonas species (contact with fresh or brackish water, soil, or
wood). Early fasciotomy and culture-directed antimicrobial therapy should be
aggressively performed in those patients with hypotensive shock, leukopenia,
severe hypoalbuminemia, and underlying chronic illness, especially a
combination of hepatic dysfunction and diabetes mellitus.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.