非霍乱弧菌感染的预后根据宿主的基础共病和感染临床表现而有所不同。
副溶血性弧菌相关胃肠炎
对于正常宿主而言,这通常是一种持续时间不超过 5 天的自限性腹泻疾病。[17]Neill MA, Carpenter CCJ. Chapter 212, Other pathogenic vibrios. In: Mandell GL, Douglas RG, Bennett JE, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Elsevier, Churchill Livingstone; 2005:2544-2548.
副溶血性弧菌软组织感染
通常是自限性皮肤感染,偶尔需要短疗程口服抗生素治疗。[17]Neill MA, Carpenter CCJ. Chapter 212, Other pathogenic vibrios. In: Mandell GL, Douglas RG, Bennett JE, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 6th ed. Philadelphia, PA: Elsevier, Churchill Livingstone; 2005:2544-2548.[30]Tantillo GM, Fontanarosa M, Di Pinto A, et al. Updated perspectives on emerging vibrios associated with human infections. Lett Appl Microbiol. 2004;39:117-126.http://www.ncbi.nlm.nih.gov/pubmed/15242449?tool=bestpractice.com
创伤弧菌感染
原发性败血症的病死率 (28%) 高于伤口感染的病死率 (8%)。入院急性生理性和慢性健康评分 II (APACHE II) > 15 与死亡率 > 50% 相关。[52]Chou TN, Lee YT, Lai YY, et al. Prognostic factors for primary septicemia and wound infection caused by Vibrio vulnificus. Am J Emerg Med. 2010;28:424-431.http://www.ncbi.nlm.nih.gov/pubmed/20466220?tool=bestpractice.com快速急诊医学评分 (REMS) ≥ 8 与死亡风险增加显著相关。[53]Kuo SH, Tsai CF, Li CR, et al. Rapid Emergency Medicine Score as a main predictor of mortality in Vibrio vulnificus-related patients. Am J Emerg Med. 2013;31:1037-1041.http://www.ncbi.nlm.nih.gov/pubmed/23702054?tool=bestpractice.com受伤或症状出现后超过 3 天未前往急诊科就诊,将导致死亡率上升(3 天内就诊的死亡率为 13%,超过 3 天的死亡率为 55.6%)。[54]Lee YC, Hor LI, Chiu HY, et al. Prognostic factor of mortality and its clinical implications in patients with necrotizing fasciitis caused by Vibrio vulnificus. Eur J Clin Microbiol Infect Dis. 2014;33:1011-1018.http://www.ncbi.nlm.nih.gov/pubmed/24419406?tool=bestpractice.com
坏死性软组织感染伴脓毒性休克的死亡率约为 23%,而接受早期筋膜切开术并且不伴有休克的患者死亡率为 4.9%。[47]Kuo YL, Shieh SJ, Chiu HY, et al. Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention. Eur J Clin Microbiol Infect Dis. 2007;26:785-792.http://www.ncbi.nlm.nih.gov/pubmed/17674061?tool=bestpractice.com
由于需要长期入住 ICU、接受多次失活组织清创手术并且可能截肢,入院治疗可能相当复杂。
从统计来看,白蛋白低于 20 g/L (2 g/dL) 的低白蛋白血症与死亡或大截肢的结果相关。[48]Huang KC, Hsieh PH, Huang KC, et al. Vibrio necrotizing soft-tissue infection of the upper extremity: factors predictive of amputation and death. J Infect. 2008;57:290-297.http://www.ncbi.nlm.nih.gov/pubmed/18755513?tool=bestpractice.com重症监护病房收治的坏死性蜂窝织炎或筋膜炎患者, 2 个或更多肢体的皮肤或软组织受累的患者,或者 APACHE II 评分较高的患者具有显著的死亡风险。[49]Chen S, Chan K, Chao W, et al. Clinical outcomes and prognostic factors for patients with Vibrio vulnificus infections requiring intensive care: a 10 year retrospective study. Crit Care Med. 2010;38:1984-1990.http://www.ncbi.nlm.nih.gov/pubmed/20657269?tool=bestpractice.com