Outcomes of Third-Generation Cephalosporin Plus Ciprofloxacin or Doxycycline Therapy in Patients with Vibrio vulnificus Septicemia: A Propensity Score-Matched Analysis

• Published in: PLoS neglected tropical diseases Vol. 13; no. 6; p. e0007478
• Main Authors: Kim, Seong Eun, Shin, Sung Un, Oh, Tae Hoon, Kim, Uh Jin, Darboe, Kalifa Sanneh, Kang, Seung-Ji, Jang, Hee-Chang, Jung, Sook-In, Shin, Hee-Young, Park, Kyung-Hwa
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.06.2019; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Amides; Analysis; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bactericidal activity; Beta lactamases; Biology and Life Sciences; Care and treatment; Case-Control Studies; Cephalosporins; Cephalosporins - therapeutic use; Ciprofloxacin; Ciprofloxacin - therapeutic use; Clinical trials; Cross infection; Cytokines; Doxycycline; Doxycycline - therapeutic use; Drug resistance; Drug Therapy, Combination - methods; E coli; Enzymes; Fasciotomy; Female; Health care facilities; Humans; Infection; Infections; Infectious diseases; Lactams; Male; Medical centers; Medical prognosis; Medical research; Medical schools; Medicine and Health Sciences; Middle Aged; Mortality; Necrotizing fasciitis; Orthopedic surgery; Patients; Propensity scores; Rank tests; Republic of Korea; Retrospective Studies; Risk factors; Seafood; Sepsis; Sepsis - drug therapy; Sepsis - microbiology; Septicemia; Skin; Survival; Teaching hospitals; Tetracyclines; Therapy; Tigecycline; Treatment Outcome; Tropical diseases; Vibrio infections; Vibrio Infections - drug therapy; Vibrio Infections - microbiology; Vibrio vulnificus; Vibrio vulnificus - drug effects; Vibrio vulnificus - isolation & purification; Waterborne diseases; Young Adult; β-Lactam antibiotics; Republic of Korea; United States > US; South Korea
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0007478

Combination therapy with a third-generation cephalosporin (TGC) and a tetracycline analogue is recommended for Vibrio vulnificus infection. The combination of a TGC and ciprofloxacin has synergistic in vitro bactericidal activity against V. vulnificus. No clinical study has compared the standard regimen with TGC plus ciprofloxacin therapy for V. vulnificus infection. Patients with a confirmed V. vulnificus infection at two medical centers in Korea from 1991 to 2016 were enrolled in this study. The patients were grouped according to the type of antibiotic administered. A retrospective propensity-score-matched case-control study of patients treated with TGC plus doxycycline or TGC plus ciprofloxacin was performed. The clinical characteristics and outcomes of the patients were analyzed. A total of 218 patients were confirmed to have V. vulnificus septicemia during the study, and the 30-day survival rate was 39% (85/218). The patients were classified into the following six treatment groups: TGC monotherapy (n = 82), TGC plus doxycycline therapy (n = 42), TGC plus ciprofloxacin therapy (n = 39), ciprofloxacin monotherapy (n = 14), other β-lactam monotherapy (n = 10), and other (n = 31). The survival rates of these groups were as follows: TGC monotherapy (35%), TGC plus doxycycline (38%), TGC plus ciprofloxacin (54%), ciprofloxacin monotherapy (29%), other β-lactam (20%), and other (39%). The 30-day survival rate showed no significant difference between the TGC plus doxycycline and TGC plus ciprofloxacin groups (log-rank test, P = 0.18). Among the 81 patients treated with TGC plus doxycycline or TGC plus ciprofloxacin, 12 per treatment group were selected by propensity-score matching. There was no significant difference in the baseline characteristics or the frequency of fasciotomy between the two groups. The 30-day survival rate showed no significant difference between the TGC plus doxycycline (50%) and TGC plus ciprofloxacin (67%) groups (log-rank test, P = 0.46). Our data suggest that the outcome of TGC plus ciprofloxacin therapy was comparable to that of TGC plus doxycycline therapy in patients with V. vulnificus septicemia.