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Characteristic V. alginolyticus V. parahaemolyticus V. cholerae non-O1/O139 V. vulnificus Other species
Total patients 23 (100) 20 (100) 10 (100) 7 (100) 7 (100)
Demographics
Age, y, median (SD) 50 (+26.7) 53 (+22.8) 69 (+19.7) 66 (+11.5) 40 (+24.8)
Sex
M 19 (83) 15 (75) 7 (70) 7 (100) 6 (86)
F 4 (17) 5 (25) 3 (30) 0 1 (14)
Underlying condition
Heart failure 8 (35) 6 (30) 5 (50) 4 (57) 1 (14)
Neoplasia 1 (4) 5 (25) 4 (40) 0 (0) 1 (14)
Diabetes 2 (9) 3 (15) 1 (10) 1 (14) 1 (14)
Kidney failure 2 (9) 1 (5) 1 (10) 0 3 (43)
Immune disease 2 (9) 2 (10) 1 (10) 0 2 (29)
Hemopathy 1 (4) 1 (5) 1 (10) 1 (14) 1 (14)
Liver disease 1 (4) 1 (5) 2 (20) 1 (14) 0
Alcohol use disorder 2 (9) 1 (5) 2 (20) 2 (29) 0
Preexisting wound 3 (13) 0 0 3 (43) 0
Digestive surgery 2 (9) 2 (10) 1 (10) 0 1 (14)
Time to symptom onset, d, median (SD) 2.4 (+2.0) 1.3 (+0.9) 3 (+4.4) 5.6 (+8.1) 1 (+0.0)
Infection type
Acute 14 (61) 19 (95) 10 (100) 7 (100) 5 (71)
Chronic 9 (39) 1 (5) 0 0 2 (29)
Outcome
Recovered 21 (91) 17 (85) 8 (80) 6 (86) 7 (100)
Died 2 (9) 3 (15) 2 (20) 1 (14) 0

Table 1. Clinical characteristics of patients with Vibrio infection, by species, Bay of Biscay, France, 2001–2019*

*Values are no. (%) except as indicated.

 

Antibiotic V. alginolyticus   V. parahaemolyticus   V. cholerae non-O1/O139   V. vulnificus
S I R S I R S I R S I R
Amoxicillin 1 0 15   1 6 7   2 2 3   5 0 0
Ticarcillin 5 0 10   2 2 9   5 0 1   5 0 0
First-generation cephalosporin 10 4 0   13 1 0   4 1 0   4 1 0

Table 2. Available drug-susceptibility test results for the main antibiotics used to treat Vibrio infections, by species, Bay of Biscay, France, 2001–2019*

*Data are no. of cases. I, intermediate; R, resistant; S, susceptible.

 

Characteristic No sepsis, n = 42   Septic shock, n = 13 p value
No. % (95% CI) No. % (95% CI)
Patient sex
M 35 83 (72–95)   10 77 (54–100) 0.685
F 7 17 (5–28)   3 23 (0.2–46)  
Underlying conditions
Heart failure 18 43 (28–58)   6 46 (19–73) Referent
Neoplasia 6 14 (4–25)   4 31 (6–56) 0.223
Diabetes 7 17 (5–28)   1 8 (0–22) 0.664
Kidney failure 5 12 (2–22)   2 15 (0–35) 0.664
Immune disease 5 12 (2–22)   2 15 (0–35) 0.664
Hemopathy 3 7 (0–15)   2 15 (0–35) 0.582
Liver disease 2 5 (0–11)   3 23 (0–46) 0.318
Alcohol use disorder 3 7 (0–15)   4 31 (6–56) 0.102
Preexisting wound 6 14 (4–25)   0 0 (0–0) 0.317
Digestive surgery 4 10 (1–18)   2 15 (0–35) 0.618
Species
V. alginolyticus 10 24 (11–37)   4 31 (6–56)  
V. parahaemolyticus 14 33 (19–48)   5 38 (12–65)  
V. cholerae non-O1/O139 8 19 (7–31)   2 15 (0–35)  
V. vulnificus 6 14 (4–25)   1 8 (0–22)  
Other Vibrio species 4 10 (1–18)   1 8 (0–22)
Outcome
Recovered 40 95 (89–100)   7 54 (27–81) 0.001
Died 2 5 (0–11)   6 46 (19–73)  

Table 3. Clinical characteristics and outcome of patients with and without septic shock after acute Vibrio infection, Bay of Biscay, France, 2001–2019*

*Median patient age ( + SD) was 60 ( + 21.4) for no sepsis and 61 ( + 15.3) for septic shock.

CME / ABIM MOC

Clinical and Epidemiologic Characteristics and Therapeutic Management of Patients With Vibrio Infections, Bay of Biscay, France, 2001–2019

  • Authors: Florence Hoefler, MD; Xavier Pouget-Abadie, MD; Mariam Roncato-Saberan, MD; Romain Lemarié, MD; Eve-Marie Takoudju, MD; François Raffi, MD; Stéphane Corvec, MD; Morgane Le Bras, MS; Charles Cazanave, MD; Philippe Lehours, MD; Thomas Guimard, MD; Caroline Allix-Béguec, PhD
  • CME / ABIM MOC Released: 11/18/2022
  • Valid for credit through: 11/18/2023, 11:59 PM EST
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for primary care physicians, infectious disease specialists, and other clinicians who treat and manage patients who may become infected with Vibrio spp.

The goal of this activity is to assess the epidemiology, microbiology, and prognosis of infection with Vibrio spp.

Upon completion of this activity, participants will:

  • Assess the epidemiology of infection with Vibrio spp. in the current study
  • Evaluate common anatomic sites of infection with Vibrio spp.
  • Distinguish the most common Vibrio spp. isolated in the current study
  • Analyze the treatment and outcomes of Vibrio infections


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Florence Hoefler, MD

    Centre Hospitalier La Rochelle
    La Rochelle
    France
    Centre Hospitalier Troyes
    Troyes
    France

  • Xavier Pouget-Abadie, MD

    Centre Hospitalier La Rochelle
    La Rochelle
    France
     

  • Mariam Roncato-Saberan, MD

    Centre Hospitalier La Rochelle
    La Rochelle
    France
     

  • Romain Lemarié, MD

    Centre Hospitalier La Rochelle
    La Rochelle
    France
     

  • Eve-Marie Takoudju, MD

    Centre Hospitalier Départemental Vendée
    La Roche sur Yon
    France
     

  • François Raffi, MD

    Centre Hospitalier Universitaire de Nantes
    Nantes
    France
     

  • Stéphane Corvec, MD

    Centre Hospitalier Universitaire de Nantes
    Nantes
    France
     

  • Morgane Le Bras, MS

    Centre Hospitalier Universitaire de Nantes
    Nantes
    France
    Centre Hospitalier d'Auxerre
    Auxerre
    France

  • Charles Cazanave, MD

    Centre Hospitalier Universitaire de Bordeaux
    Bordeaux
    France
     

  • Philippe Lehours, MD

    Centre Hospitalier Universitaire de Bordeaux
    Bordeaux
    France

  • Thomas Guimard, MD

    Centre Hospitalier Départemental Vendée
    La Roche sur Yon
    France
     

  • Caroline Allix-Béguec, PhD

    Centre Hospitalier La Rochelle
    La Rochelle
    France

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
     

    Disclosures

    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.
     

Editor

  • Jude Rutledge, BA

    Copyeditor
    Emerging Infectious Diseases

Compliance Reviewer

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.


Accreditation Statements

Medscape

Interprofessional Continuing Education

In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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CME / ABIM MOC

Clinical and Epidemiologic Characteristics and Therapeutic Management of Patients With Vibrio Infections, Bay of Biscay, France, 2001–2019

Authors: Florence Hoefler, MD; Xavier Pouget-Abadie, MD; Mariam Roncato-Saberan, MD; Romain Lemarié, MD; Eve-Marie Takoudju, MD; François Raffi, MD; Stéphane Corvec, MD; Morgane Le Bras, MS; Charles Cazanave, MD; Philippe Lehours, MD; Thomas Guimard, MD; Caroline Allix-Béguec, PhDFaculty and Disclosures

CME / ABIM MOC Released: 11/18/2022

Valid for credit through: 11/18/2023, 11:59 PM EST

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Note: It is Medscape's policy to avoid the use of Brand names in accredited activities. However, in an effort to be as clear as possible, trade names are used in this activity to distinguish between different susceptibility tests. It is not meant to promote any particular product.

Abstract and Introduction

Noncholera vibriosis is a rare, opportunistic bacterial infection caused by Vibrio spp. other than V. cholerae O1/O139 and diagnosed mainly during the hot summer months in patients after seaside activities. Detailed knowledge of circulating pathogenic strains and heterogeneities in infection outcomes and disease dynamics may help in patient management. We conducted a multicenter case-series study documenting Vibrio infections in 67 patients from 8 hospitals in the Bay of Biscay, France, over a 19-year period. Infections were mainly caused by V. alginolyticus (34%), V. parahaemolyticus (30%), non-O1/O139 V. cholerae (15%), and V. vulnificus (10%). Drug-susceptibility testing revealed intermediate and resistant strains to penicillins and first-generation cephalosporins. The acute infections (e.g., those involving digestive disorder, cellulitis, osteitis, pneumonia, and endocarditis) led to a life-threatening event (septic shock), amputation, or death in 36% of patients. Physicians may need to add vibriosis to their list of infections to assess in patients with associated risk factors.

Introduction

Some opportunistic pathogens associated with marine environments are already known but until now have caused rare infectious diseases. Among those pathogens are Vibrio spp. other than the well-known V. cholerae belonging to serogroups O1 and O139, which causes cholera. Vibrio spp. are gram negative, curved, rod-shaped bacteria that are natural inhabitants of the aquatic environment [1]. Vibrio infections can be very severe or even fatal; they cause gastroenteritis, severe bacterial cellulitis, or necrotizing fasciitis and can lead to septic shock. Infections are more common in patients with multiple underlying conditions, including liver disease, heart failure, diabetes, liver cirrhosis, alcohol abuse, and immunocompromising conditions [2–5]. Vibrio spp. can also cause mild diseases, such as chronic ear infections, which are more likely to affect younger patients [6]. Humans acquire Vibrio infections after eating contaminated raw seafood, especially oysters, or after exposing an injury to the marine environment [7]. Infections occur mainly during the hot summer months, which is probably attributable to higher water temperatures [8,9] and to increased seawater-related activities.

Because vibriosis is a relatively rare disease and is not reported in most national surveillance systems, the global incidence rate of Vibrio spp. infections other than V. cholerae O1/O139 is underestimated. In the United States, where those infections are notifiable, a marked seasonal distribution and an increasing incidence rate have been observed [10–12]. Because of their rarity, Vibrio infections are very poorly known and therefore probably underdiagnosed. Delays in therapeutic management and, in particular, in the prescription of a targeted antibiotic regimen have been documented [13]. Our study aimed to make an inventory of Vibrio infections diagnosed in hospitals in the Bay of Biscay on the west coast of France and to describe the clinical and epidemiologic characteristics of the patients and their therapeutic management.