NON-O1 VIBRIO-CHOLERAE BACTEREMIA IN PATIENTS WITH CIRRHOSIS - 5-YR EXPERIENCE FROM A SINGLE MEDICAL-CENTER

Objectives: To assess the clinical features and susceptibility of cirr hotic patients to non-O1 Vibrio cholerae bacteremia and to provide our therapeutic experiences in this rare and highly lethal infection, Met hods: Twenty-eight blood culture isolates of non-O1 V. cholerae were i dentified by our clinical microbiology laboratory between July 1989 an d June 1994, Patients with underlying cirrhosis and the aforementioned bacteremia were retrospectively reviewed, Results: Twenty-one cirrhot ic patients (16 male, five female; mean age, 50.9 yr; range 28-67 yr) were identified and classified as Child B (6 cases) and Child C (15 ca ses), Bacteremic episodes occurred most often from March to September, Seafood ingestion (seven cases) and seawater exposure (two cases) wer e risk factors, but nosocomial infections were also noted in six cases , Presenting symptoms and signs included ascites (95.2%), fever (81%), abdominal pain (52.4%), diarrhea (33.3%), and cellulitis with bullae formation (19%), Concurrent spontaneous bacterial peritonitis was dete rmined in 10 cases, seven with positive ascites cultures, Antibiotic t herapy (either cephalothin with gentamicin or ceftriaxone alone) cured most of the bacteremic episodes, The overall case-fatality rate was 2 3.8%, but 75% of the deaths were observed in patients with skin manife station, Conclusions: Patients with decompensated cirrhosis are suscep tible to non-O1 V. cholerae bacteremia and should not ingest raw seafo od or expose skin wounds to salt water, A high index of suspicion and early administration of antibiotics may lower the mortality rate.