Antibiotic therapy for necrotizing fasciitis caused by Vibrio vulnificus

Objectives: To compare the effectiveness of a third-generation cephalosporin alone, a third-generation cephalosporin plus minocycline, and a fluoroquinolone in patients with necrotizing fasciitis (NF) caused by Vibrio vulnificus. Methods: A retrospective review of case notes was performed for 89 patients who presented with NF caused by V. vulnificus and underwent surgical intervention within 24 h of admission between 2003 and 2010. Data on comorbidities, clinical manifestations, laboratory studies, treatments and outcomes were extracted for analysis. These patients were grouped according to the antimicrobials prescribed: those who received only a third-generation cephalosporin (Group 1; n=18); a third-generation cephalosporin plus minocycline (Group 2; n=49); or a fluoroquinolone with/without minocycline (Group 3; n=22). Results: The mean age of the 89 patients included in the study was 64.0±12.0 years (range 33-89 years); 55% of the patients were male. There were no differences in age, sex or clinical characteristics among the three groups except that patients in Group 3 had a higher frequency of underlying chronic renal insufficiency than those in Groups 1 and 2 (P=0.009). Groups 2 and 3 each had a significantly lower case fatality rate than Group 1 (61% in Group 1 versus 14%in Group 2, P=0.0003; 61% in Group 1 versus 14% in Group 3, P=0.0027), while no difference in case fatality rate was noted between Groups 2 and 3. Conclusions: Our data suggested that, in addition to primary surgery, fluoroquinolones or third-generation cephalosporins plus minocycline are the best option for antibiotic treatment of NF caused by V. vulnificus.