Ling-Shan Syue1, Po-Lin Chen2, Chi-Jung Wu3, Nan-Yao Lee4, Ching-Chi Lee4, Chia-Wen Li4, Ming-Chi Li4, Hung-Jen Tang5, Po-Ren Hsueh6, Wen-Chien Ko7. 1. Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan. 2. Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Cheng Kung University, College of Medicine, Tainan, Taiwan. 3. National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan. 4. Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan. 5. Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. 6. Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hsporen@ntu.edu.tw. 7. Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
Abstract
BACKGROUND/ PURPOSE: Aeromonas and Vibrio are important water-borne pathogens causing substantial morbidity and mortality in cirrhotic patients in Taiwan, but the differences in clinical manifestations of Aeromonas and Vibrio bacteremia have not been reported in detail. METHODS: From January 2003 to September 2013, cirrhotic patients with monomicrobial Aeromonas or Vibrio bacteremia at a medical center in Taiwan were included in this study. RESULTS: The study population consisted of 77 cirrhotic patients with Aeromonas bacteremia and 48 patients with Vibrio bacteremia. Both pathogens clustered during the summer season; Vibrio bacteremia was more correlated with higher temperatures (Vibrio: r(2) = 0.95, p < 0.0001; Aeromonas: r(2) = 0.74, p = 0.006) and was associated with ingestion of undercooked seafood (p = 0.03) or cutaneous exposure (p < 0.001). Vibrio bacteremia mainly occurred in mildly or moderately decompensated cirrhosis (Child-Pugh class A and B: 45.8% vs. 20.8%, p = 0.003), and caused more soft-tissue infections (31.3% vs. 5.2%; p < 0.001) and renal dysfunction (1.6 ± 1.2 mg/dL vs. 1.3 ± 0.8 mg/dL, p = 0.006). Sepsis-related mortality was similar in the cases of Vibrio and Aeromonas bacteremia (14.6% vs. 14.3%, p = 0.96), but those with Vibrio bacteremia underwent a fulminant course, as evidenced by a shorter time from bacteremia onset to death (3.1 days vs. 8.2 days, p = 0.04). CONCLUSION: In cirrhotic patients, bacteremia caused by Aeromonas and Vibrio species clustered in summer months and caused similar mortality, but Vibrio bacteremia led to a more severe and fulminant sepsis.
BACKGROUND/ PURPOSE: Aeromonas and Vibrio are important water-borne pathogens causing substantial morbidity and mortality in cirrhotic patients in Taiwan, but the differences in clinical manifestations of Aeromonas and Vibrio bacteremia have not been reported in detail. METHODS: From January 2003 to September 2013, cirrhotic patients with monomicrobial Aeromonas or Vibrio bacteremia at a medical center in Taiwan were included in this study. RESULTS: The study population consisted of 77 cirrhotic patients with Aeromonas bacteremia and 48 patients with Vibrio bacteremia. Both pathogens clustered during the summer season; Vibrio bacteremia was more correlated with higher temperatures (Vibrio: r(2) = 0.95, p < 0.0001; Aeromonas: r(2) = 0.74, p = 0.006) and was associated with ingestion of undercooked seafood (p = 0.03) or cutaneous exposure (p < 0.001). Vibrio bacteremia mainly occurred in mildly or moderately decompensated cirrhosis (Child-Pugh class A and B: 45.8% vs. 20.8%, p = 0.003), and caused more soft-tissue infections (31.3% vs. 5.2%; p < 0.001) and renal dysfunction (1.6 ± 1.2 mg/dL vs. 1.3 ± 0.8 mg/dL, p = 0.006). Sepsis-related mortality was similar in the cases of Vibrio and Aeromonas bacteremia (14.6% vs. 14.3%, p = 0.96), but those with Vibrio bacteremia underwent a fulminant course, as evidenced by a shorter time from bacteremia onset to death (3.1 days vs. 8.2 days, p = 0.04). CONCLUSION: In cirrhotic patients, bacteremia caused by Aeromonas and Vibrio species clustered in summer months and caused similar mortality, but Vibrio bacteremia led to a more severe and fulminant sepsis.