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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
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.


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    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: Results

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Results

Population and Temporality of Infections

Data from 67 patients diagnosed with Vibrio infection were available for the period 2001–2019 (Table 1). Most patients were men (81%), and the average age was 54 years (SD +24 years). In the subgroup of patients with acute infections (including cutaneous infections and gastroenteritis), the mean age was 60 (SD +20) years, and 71% of the patients had >1 underlying condition. Patients with chronic ear infections were younger (mean age 27 years [SD +24 years]), and all but 1 had no underlying conditions.

The description of environmental factors was available for 57% of patients. Among those patients, 55.3% of infections were contracted at the beach, 39.5% by handling or eating seafood, and 5.3% while abroad. Most infections (82%) occurred during June–September. The number of reported cases reached 2 peaks, in 2003 and 2018.

Clinical Features

The average duration between known exposure and onset of symptoms was 2.4 days (SD +3.8 days), and it varied from <1 day for patients with gastroenteritis, cellulitis, or pneumonia, to 20 days for patients with osteitis. Digestive disorders were reported in 23 (34.4%) of the patients, including 6% with severe intraabdominal infection (Table 2). Cellulitis was reported in 23 (34.4%) of the patients, and 3 had soft tissue infection complicated by osteitis. Near drowning–associated pneumonia was reported in 8 (12%) of the patients. A case of endocarditis was described in a patient whose pacemaker had been exposed to seawater through a preexisting chronic wound while swimming in the Atlantic Ocean. Chronic ear infection (chronic otitis or cholesteatoma) affected 12 (18%) of the patients.

Diagnostic Testing, Vibrio Species, and Drug-Susceptibility Testing

Vibrio infections were diagnosed from blood samples (26.9%), feces (20.9%), biopsies (20.9%), ear swab samples (17.9%), bronchoalveolar lavage samples (7.5%), and skin samples (6%). The most frequently identified species were V. alginolyticus (34%) and V. parahaemolyticus (30%). V. cholerae non-O1/O139 was found in 15% of patients, and V. vulnificus was found in 10%. The remaining patients were infected with other Vibrio species. Other bacteria were co-isolated in samples from 5 patients (methicillin-sensitive Staphylococcus aureus in 2 skin samples; Streptococcus mitis in a bronchoalveolar lavage; Proteus vulgaris and Haemophilus influenza in another bronchoalveolar lavage; and Klebsiella pneumoniae, Enterococcus faecalis, and Enterobacter cloacae in a bone biopsy).

Susceptibility testing revealed strains with resistance or intermediate resistance to amoxicillin in most V. alginolyticus, V. parahaemolyticus, and V. cholerae non-O1/O139 strains (Table 2). Strains with resistance or intermediate resistance to ticarcillin were also found in most V. alginolyticus and V. parahaemolyticus strains and to a lesser extent in V. cholerae non–O1/O139 strains. V. vulnificus strains were sensitive to all of these penicillins.

Diseases Caused by Vibrio infection

V. alginolyticus was responsible for various pathologies, but more particularly for otitis (39%) (Figure).

Enlarge

Figure. Diseases caused by Vibrio infection in 67 patients, by species, Bay of Biscay, France, 2001–2019. A) V. alginolyticus. B) V. parahaemolyticus. C) V. cholerae non-O1/O139. D) V. vulnificus. Numbers in chart sections indicate number of patients. Intraabdominal infection corresponds to pancreatitis, liver abscess, phlegmoneous ileitis, cholecystis, and peritonitis.

V. parahaemolyticus was identified in patients with cellulitis (40%) and gastroenteritis (40%). V. cholerae non-O1/O139 was almost exclusively responsible for digestive disorders (90%). V. vulnificus was exclusively found in cellulitis and soft tissue infections complicated by osteitis.

Treatment

Most (84%) patients required hospitalization. The average time from symptom onset to treatment was 2.7 days (SD +4.9) days. Most of the patients received antibiotics (90%), of whom >50% received a multidrug regimen. The main prescribed antibiotics were penicillins (91%), quinolones (36%), cephalosporins (30%), metronidazole (15%), tetracycline (10%), and aminoglycosides (9%).

Twenty-two patients (33%) underwent surgery. Eleven patients with necrotizing cellulitis and 3 patients with osteitis required surgical debridement. For 6 of those 11 patients, amputation was necessary. Five patients with chronic ear infection required either surgical excision (n = 3), meatotomy (n = 1), or tympanoplasty (n = 1). Two patients had a cholecystectomy, and 1 patient with phlegmonous ileitis had partial colectomy.

Factors Associated with Severe Forms

All patients with chronic infection were cured. Among patients with acute infection, 13 (24%) went into septic shock (Table 3), 6 (11%) had amputations, and 8 (14%) died. Half of the amputations were associated with V. vulnificus infections. Older age and malignant hemopathy (e.g., acute leukemia and lymphoma under chemotherapy) were associated with death. Three patients suffered pneumonia after near drowning, and death may have been attributable to cardiorespiratory arrest and intensive care complications. A probable link between Vibrio infection and death could be established for 5 patients. The case-fatality rate was the highest for V. vulnificus infections (1 attributable death out of 7 infections), followed by V. parahaemolyticus (2 attributable deaths out of 19 infections) and V. cholerae non-O1/O139 (1 attributable death out of 10 infections). The case-fatality rate was the lowest for V. alginolyticus infections (1 attributable death out of 14 infections).