PRIMARY SKIN INFECTIONS SECONDARY TO VIBRIO-VULNIFICUS - THE ROLE OF OPERATIVE INTERVENTION

BACKGROUND: Vibrio vulnificus can cause rapidly spreading skin and sof t tissue infections with significant associated morbidity and mortalit y. Patients with underlying chronic illness, such as cirrhosis, diabet es mellitus, or immunosuppression, have been noted to be at high risk for rapid progression of this infection. The importance of early antib iotic therapy has been reported but the role of operative intervention in these patients is less clear. STUDY DESIGN: We report seven patien ts who were operatively treated from April 28, 1991 to September 22, 1 995 for primary skin and soft tissue infections secondary to Vibrio vu lnificus. We have also reviewed the recent literature. The impact of s everal variables including shock, increased white blood cell count, fe ver, and the timing of operative intervention on the length of hospita l stay and intensive care unit stay was analyzed using the Spearman ra nk correlation. The impact of early compared with late operative inter vention was analyzed using the Mann-Whitney U test. All patients had a history of underlying chronic illness and presented with skin infecti ons in association with recent exposure to saltwater and to shellfish. No patient presented earlier than 24 hours from the time of initial i nfection. All patients underwent operative exploration within 46 hours of admission with thorough operative debridement of all necrotic tiss ue. infection was confined to the skin and subcutaneous tissue. RESULT S: There was no mortality among our patients. The presence of perioper ative shock, fever, or elevated white blood cell count did not correla te with an increased intensive care unit stay or an increased hospital stay. Earlier operative exploration and debridement correlated with a decrease in the intensive care unit stay (p<0.02, correlation coeffic ient=0.991) and in the hospital stay (p<0.02, correlation coefficient= 0.929). Patients who underwent debridement within 72 hours from the ti me of the infection had a significantly shorter intensive care unit st ay (p=0.0323) and total hospital stay (p=0.0339). CONCLUSIONS: We advo cate operative exploration and thorough debridement of all necrotic ti ssue in high-risk patients with primary Vibrio vulnificus skin and sof t tissue infections.