Prognostic factors for primary septicemia and wound infection caused by Vibrio vulnificus

Objectives: The purpose of this study was to explore the predictive factors for mortality in primary septicemia or wound infections caused by Vibrio vulnificus. Methods: A retrospective review of 90 patients 18 years and older who were hospitalized due to V vulnificus infection between January 2000 and December 2006 was performed. Clinical characteristics, laboratory studies, treatments, and outcomes retrieved from medical records were analyzed. Multiple logistic regression and receiver operating characteristic curve analyses were performed. Results: Of 90 patients identified as V vulnificus infections, 39 had primary septicemia and 51 had wound infection. The mean age was 63.0 ± 11.9 years. The mean Acute Physiology and Chronic Health Evaluation (APACHE II) and Mortality in Emergency Department Sepsis (MEDS) scores on admission were 11.1 ± 4.9 and 5.5 ± 3.8, respectively. Fifteen patients died, yielding an in-hospital mortality rate of 17%. Multivariate analysis revealed that higher APACHE II (odds ratio, 1.5; 95% confidence interval [CI], 1.2-1.8; P< .0001) and MEDS (odds ratio, 1.3; 95% CI, 1.1-1.6; P = .0201) scores on admission were significantly associated with mortality. The area under the receiver operating characteristic curves values for APACHE II and MEDS in predicting in-hospital mortality were 0.928 (95% CI, 0.854-0.972) and 0.830 (95% CI, 0.736-0.901), respectively. Conclusions: The APACHE II and MEDS scores on admission are significant prognostic indicators in primary septicemia or wound infections caused by V vulnificus. A further prospective study to strengthen this point is required.