Necrotizing Fasciitis Caused by Non-O1/O139 Vibrio Cholerae -- A 20-year Retrospective Case Series in NCKUH and A Systematic Review

霍亂弧菌感染之壞死性筋膜炎──成大醫院二十年回溯性病例系列報告及系統性文獻回顧

Che-Jui Chang(張哲睿)；Ching-Chi Lee(李青記)；Nan-Yao Lee(李南瑤)；Chung-Lin Chen(陳琮琳)

non-O1/O139 Vibrio cholerae ； necrotizing fasciitis

臺灣整形外科醫學會雜誌

33卷2期（2024 / 06 / 01）

123 - 133

英文;繁體中文

Background: Necrotizing fasciitis (NF), a fulminant deep soft tissue infection, causes substantial morbidity and mortality rates. However, information detailing NF caused by non- O1/O139 Vibrio cholerae (V. cholerae) is ambiguous. Aim and Objectives: We conducted a retrospective case series and a systematic review to evaluate the prognosis and risk factors of NF caused by non-O1/O139 V. cholerae. Materials and Methods: During the period from January 2003 to December 2022, patients experiencing non-O1/O139 V. cholerae-causing NF were retrospectively captured in a university-affiliated medical center. Literature research was undertaken across MEDLINE, Embase, and Airiti Library (Chinese Electronic Periodical Services, CEPS) to characterize cases with NF caused by non-O1/O139 V. cholerae published up to November 30, 2023. Results: Four patients experiencing NF caused by non-O1/O139 V. cholerae were recognized in the study hospital. Through the systematic review, 27 patients with non-O1/O139 V. cholerae-causing NF in 15 reports were included. Of the total 31 patients, their mean age was 61.7 years (range, 43-80 years), with a median hospitalization length of 22 days (range, two days to four months) and an in-hospital mortality rate of 48.4%. Liver cirrhosis (18 cases) and diabetes mellitus (ten) were the leading two comorbidities, yielding a high mortality rate of 66.6% and 60%, respectively. Notably, seventeen (54.8%) of the cases had documented seafood or seawater exposure, and the majority (24 patients, 77.4%) of the included cases were reported in the Asian-Pacific area. Conclusion: Non-O1/O139 V. cholerae is a rare NF pathogen, but a substantial mortality rate in patients with non-O1/O139 V. cholerae-causing NF was disclosed, particularly among those having comorbid diabetes mellitus and/or liver cirrhosis. For NF patients with a travel history or seafood exposures in the mid-latitude northern hemisphere, prompt diagnosis and treatment for V. cholerae infections might be essential.

背景：壞死性筋膜炎是一種迅速侵襲深部軟組織的嚴重感染，造成相當多的患者染病和死亡。然而，目前有關non-O1/O139霍亂弧菌感染導致壞死性筋膜炎的個案十分罕見。目的及目標：本篇提出回溯性病例系列報告與系統性文獻回顧，分析non-O1/O139霍亂弧菌感染導致壞死性筋膜炎的預後與風險因子。材料及方法：一、回溯性研究：檢閱本院2003年1月至2022年12月期間所有non-O1/O139霍亂弧菌感染的病歷。最後共67例個案符合篩選條件，其中有4例為壞死性筋膜炎感染。二、系統性文獻回顧：在多個醫學電子期刊資料庫中查找所有相關文獻，最後15篇文獻共27例個案被我們引用。結果：在回顧性研究中，共有4例由non-O1/O139霍亂弧菌感染導致壞死性筋膜炎的個案。在系統性文獻回顧中，共有15篇文獻包含27例患者為此診斷。這31名患者的住院死亡率為48.4%。肝硬化（18例）和糖尿病（10例）是兩大主要合併症，死亡率分別為66.6%及60%。值得注意的是，17例（54.8%）患者有記錄到海鮮或海水暴露，而大多數（24例，77.4%）的病例報告來自亞太地區。結論：non-O1/O139霍亂弧菌為壞死性筋膜炎的罕見致病菌，但造成相當高的死亡率，特別是合併有肝硬化及糖尿病的患者。對於在北半球中緯度地區有旅行史或海鮮暴露史的壞死性筋膜炎患者，可能需要考慮霍亂弧菌感染的可能性，並迅速診斷與進行治療。