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. 2015 Jun 11:15:226.
doi: 10.1186/s12879-015-0959-z.

Antibiotic use for Vibrio infections: important insights from surveillance data

Kam Cheong Wong  1   2 , Anthony M Brown  3 , Georgina M Luscombe  4 , Shin Jie Wong  5 , Kumara Mendis  6
Affiliations

Antibiotic use for Vibrio infections: important insights from surveillance data

Kam Cheong Wong et al. BMC Infect Dis. .

Abstract

Background: There is a paucity of data on the in vivo efficacy of antibiotics for lethal Vibrio species. Analyses of long-term surveillance datasets may provide insights into use of antibiotics to decrease mortality.

Methods: The United States Centers for Disease Control and Prevention (CDC) Cholera and Other Vibrio Illness Surveillance (COVIS) dataset from 1990 to 2010, with 8056 records, was analysed to ascertain trends in antibiotics use and mortality.

Results: Two-thirds of patients (5243) were prescribed antibiotics - quinolones (56.1 %), cephalosporins (24.1 %), tetracyclines (23.5 %), and penicillins (15.4 %). Considering all Vibrio species, the only class of antibiotic associated with reduced odds of mortality was quinolone (odds ratio 0.56, 95 % CI 0.46-0.67). Patients with V. vulnificus treated according to CDC recommendations had lower mortality (quinolone alone: 16.7 %, 95 % CI 10.2-26.1; tetracycline plus cephalosporin: 21.7 %, 16.8-27.5; no antibiotic: 51.1 %, 45.6-56.7; each p < 0.001). Cephalosporin alone was associated with higher mortality (36.8 %, 28.2-46.3). For V. cholerae non-O1, non-O139, mortality rates were lower for quinolone (0 %, 0-2.0) or tetracycline (4.3 %, 1.2-14.5) compared to no antibiotic (9.3 %, 6.4-13.3). For all Vibrio species, mortality rates increased with number of antibiotics in the treatment regimen (p < 0.001). Treatment regimens that included quinolone were associated with lower mortality rates regardless of the number of antibiotics used. The main clinical syndromes of patients with V. vulnificus infection were septicaemia (53.1 %) and wound infections (30.6 %). Mortality among V. vulnificus patients with septicaemia was significantly higher than for other clinical syndromes (p < 0.001). In a multivariate regression model, mortality in cases with V. vulnificus was associated with presence of pre-existing conditions (ORs ranged from 4.52 to 10.30), septicaemia (OR 2.64, 95 % CI 1.92-3.63) and no antibiotic treatment (OR 7.89, 95 % CI 3.94-15.80).

Conclusion: In view of the lack of randomized control trials, surveillance data may inform treatment decisions for potentially lethal Vibriosis. Considering all Vibrio species, use of quinolones is associated with lower mortality and penicillin alone is not particularly effective. For the most lethal species, V. vulnificus, treatment that includes either quinolone or tetracycline is associated with lower mortality than cephalosporin alone. We recommend treating patients who present with a clinical syndrome suggestive of V. vulnificus infection with a treatment regimen that includes a quinolone.

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Figures

Fig. 1
Fig. 1
Patients with Vibrio infections over time, 1990 – 2010, in United States
Fig. 2
Fig. 2
Patterns of antibiotic use in the United States for patients with Vibrio illness: 1990 to 2010 (N = 5243)
Fig. 3
Fig. 3
a Mortality by use of quinolone in treatment regimen. b Mortality by use of cephalosporin in treatment regimen. c Mortality by use of tetracycline in treatment regimen. d Mortality by use of penicillin in treatment regimen. ** indicates a statistically significant difference at p < 0.001, * indicates a statistically significant difference at p < 0.05. n = 3132 used one antibiotic; 1305 used two antibiotics; 652 used three antibiotics; 154 used four antibiotics
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References

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