Study objectives: To our knowledge, the predictors of
respiratory failure (RF) and long-term mechanical ventilation have not
previously been examined in patients with wound botulism associated
with black tar heroin use.
Design: Retrospective case
Setting: A large university hospital.
Patients: Twenty consecutive patients from 1991 to 1998
with a diagnosis of wound botulism associated with drug use as
identified through chart records from a single institution.
Results: The predominant mode of drug use was subcutaneous
(75%). Fifteen of 20 patients (75%) developed RF. The clinical
presentation was similar in groups with RF and without RF. Of those
patients who received antitoxin within 12 h of presentation, 57%
required mechanical ventilation compared to 85% of patients receiving
the antitoxin after 12 h. The median durations of mechanical
ventilation were 11 days for those who received antitoxin within
12 h, and 54 days for those who did not receive antitoxin
within 12 h. The duration of mechanical ventilation for patients
receiving antibiotics within 12 h was 35 days vs 54 days for
patients receiving antibiotics after 12 h. Early tracheostomy
(< 10 days after initial intubation) was associated with a shorter
duration of mechanical ventilation (median, 45 days vs 60 days,
Conclusion: Early antitoxin
administration may decrease the need for and duration of mechanical
ventilation among patients with wound botulism. Early tracheostomy may
be beneficial for patients with RF.