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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 persons with an underlying illness or a compromised immune system, and especially affects persons with liver disease. The organism is a natural inhabitant of warm coastal waters. Persons who develop wound infections generally do so following contamination of a pre-existing wound or through an injury acquired while exposed to warm coastal waters where the V. vulnificus organism is growing. In children, V. vulnificus infection is very rare, and most affected children have an underlying condition, such as thalassemia or nephrotic syndrome; one case of a healthy child who acquired the infection after exposure to a contaminated water basin has been documented.

Management of Vibrio vulnificus wound infections

If V. vulnificus is suspected, 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. Clinical trials for the management of V. vulnificus infection have not been conducted. The antibiotic recommendations below come from documents published by infectious disease experts; they are based on case reports and animal models.

  • 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 signs of sepsis
  • 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 combination drug regimens with doxycycline and a cephalosporin
  • Children, in whom doxycycline and fluoroquinolones are contraindicated, can be treated with trimethoprim-sulfamethoxazole plus an aminoglycoside
  • Necrotic tissue should be debrided; severe cases may require fasciotomy or limb amputation

See further information about Vibrio vulnificus.