Wednesday, February 1, 2023
| 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.
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
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We conducted a multicenter case-series study based on data collected from 8 tertiary and secondary care hospitals in the Bay of Biscay, France. We included all cases of vibriosis other than those caused by V. cholerae O1/O139 diagnosed during January 2001–December 2019.
We defined a Vibrio infection as a positive biologic sample (e.g., blood, skin sample, surgical biopsy, stool sample, bronchoalveolar lavage, and ear sample) to a Vibrio species other than V. cholerae O1/O139. Conventional microbiologic methods were used to isolate bacteria from the different types of samples. BACTEC automated blood culture system (Becton, Dickinson and Company, https://www.bd.com) was used before conventional culture for the rapid detection of microorganisms in blood samples. Since 2018, automated diagnostic testing of stool samples for direct qualitative detection and differentiation of enteric bacterial pathogens has been performed with the BD MAX Enteric Bacterial Panel performed on the BD MAX system (Becton, Dickinson and Company). Before 2014, API 20 E biochemical tests (bioMérieux, https://www.biomerieux.com) were used for species identification. Since 2014, those tests have been replaced by the use of the Bruker Biotyper matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (https://www.bruker.com). Antibiotic susceptibility was tested on the main class of antibiotics, including penicillins, cephalosporins, carbapenems, and fluoroquinolones. Antimicrobial susceptibility testing was performed using Mueller–Hinten agar disk diffusion tests (AST Disks; Bio-Rad, https://www.bio-rad.com) in accordance with the recommendations of the Committee on Antimicrobial Susceptibility of the French Society for Microbiology. Most isolates were sent to the national reference center for confirmation of species identification and susceptibility results.
This study received a favorable opinion from the Committee of Expertise for Health Research, Studies, and Evaluations (registration no. TPS 1170745). It was authorized by the Commission Nationale de l’Informatique et des Libertés (decision no. DR-2020–125). A letter explaining the study and the patients’ rights regarding the use of their data was sent to the last known address of the patients. This study was registered on clinicaltrials.gov (identifier NCT04451707).
We retrieved sociodemographic data, sea-related activity, and clinical and therapeutic data from patient medical records. We used means (+SD) to describe continuous variables, and percentages and 95% CIs to describe categoric variables. We explored associated factors with sepsis. We used Mann–Whitney tests to compare continuous data of independent samples where appropriate. We used the Fisher test of homogeneity for categoric variables. We used an α level of 0.05 for statistical tests, for which we also calculated SDs and 95% CIs.
