Clinical characteristics, treatment outcomes, and predictors of early mortality in Vibrio vulnificus infection in Eastern Thailand: A 6.5-year multicenter cohort study

Vibrio vulnificus is a rapidly progressive, life-threatening pathogen endemic to coastal environments, yet clinical data from Southeast Asia remain limited despite substantial environmental contamination. We conducted a 6.5-year multicenter retrospective cohort study at two tertiary-care hospitals in Eastern Thailand to describe clinical characteristics, antimicrobial susceptibility, treatment practices, and factors associated with early mortality among adults with culture-confirmed V. vulnificus infection. Forty-nine patients were identified, most of whom presented with severe illness; 83.7% had bacteremia, 61.2% required mechanical ventilation, and 75.5% required vasopressor support. Skin and soft tissue infection was the most common syndrome, with necrotizing soft-tissue infection accounting for approximately two-thirds of cases. Antimicrobial susceptibility was uniformly high for fluoroquinolones, carbapenems, and third-generation cephalosporins, although susceptibility to doxycycline was unavailable. Despite high rates of empirical antimicrobial therapy (91.8%), mortality remained substantially high: 42.9% died within 48 hours, and 7-day mortality reached 49.0%. In multivariable analysis, elevated serum lactate and lack of surgical treatment were associated with early mortality, while chronic alcohol use and vasopressor requirement showed nonsignificant trends toward increased mortality. These findings highlight the fulminant nature of V. vulnificus infection and the narrow therapeutic window for effective intervention. In settings where necrotizing soft-tissue infection is common and patients present with advanced disease, early recognition, aggressive resuscitation, timely surgical management, and prompt initiation of antimicrobial therapy remain essential. This study provides region-specific epidemiologic and clinical insights that may inform clinical management and public health strategies in coastal communities at risk.