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[A protocol for diagnosis and treatment of Vibrio vulnificus sepsis].

OBJECTIVE
Vibrio vulnificus sepsis is one of the most fatal disease with a high mortality which exceeds 50%. But at present there is no evidence-based guidelines for diagnosis and therapy of Vibrio vulnificus sepsis because of its dispersion in occurrence and low incidence.


METHODS
Based on our ten-year research and review of literature, we try to draft a protocol to improve the diagnostic criteria and treatment of Vibrio vulnificus sepsis. Animal experiments and clinical research were undertaken and the related literature from CINK and PUBMED were reviewed.


RESULTS
(1)A criterion for early clinical diagnosis of Vibrio vulnificus sepsis was proposed, including an abrupt onset with fever during the months from April to November, characteristic cutaneous lesions (most commonly haemorrhagic bullae on the extremities) or even extensive necrosis of skin and muscular tissue, progressive hypotension or shock accompanied by multiple organ dysfunction syndrome (MODS), preexisting liver disease or chronic abuse use of alcohol, and consumption of raw seafood or contact with seawater within 1-2 weeks. (2)The best antibiotic therapy is early administration of a combination of the third-generation cephalosporins and the quinolones in full dosage. (3)Aggressive wound debridement, appropriate dermoplasty and supportive care contribute to a better outcome.


CONCLUSION
This protocol will help improve the outcome of patients with Vibrio vulnificus sepsis. But it is a crude guideline and needs to be updated when some important new knowledge becomes available.