Management of Vibrio vulnificus Wound Infections After a Disaster

What is Vibrio vulnificus?

Vibrio vulnificus is a bacterium that is a rare cause of illness in the United States. Infection with V. vulnificus is a serious health threat that predominantly affects people with a compromised immune system or an underlying illness, especially liver disease. The bacteria is a natural inhabitant of coastal waters. People who develop wound infections generally do so following contamination of a pre-existing wound or through an injury acquired while exposed to brackish or salt water. V. vulnificus infection is very rare among children.

Management of Vibrio vulnificus wound infections

V. vulnificus infection should be considered for infected wounds that were exposed to coastal waters. Treatment should be initiated immediately because antibiotics improve survival. Aggressive attention should be given to the wound site; amputation of the infected limb is sometimes necessary.

• Culture of wound or hemorrhagic bullae is recommended, and all V. vulnificus isolates should be forwarded to a public health laboratory
• Blood cultures are recommended if the patient is febrile, has hemorrhagic bullae, or has any sign of sepsis
• Necrotic tissue should be debrided; severe cases may require fasciotomy or limb amputation
• Antibiotic therapy: Doxycycline (100mg PO/IV twice a day for 7–14 days) and a third-generation cephalosporin (e.g., ceftazidime 1–2g IV/IM every eight hours) is generally recommended
• A single agent regimen with a fluoroquinolone such as levofloxacin, ciprofloxacin, or gatifloxacin, has been reported to be at least as effective in an animal model as a regimens with doxycycline and a cephalosporin
• Children, in whom doxycycline and fluoroquinolones are sometimes contradicted, can be treated with trimethoprim-sulfamethoxazole plus an aminoglycoside

See further information about Vibrio vulnificus.