Vibrio Vulnificus

[ngmc11]

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If patient came in with a wound from the ocean, what do you use to treat in a relatively healthy pt after it gets sutured?
Doxy plus 3rd generation ceph (like cefdinir)?
Levaquin?

 

[KARM12]

If patient came in with a wound from the ocean, what do you use to treat in a relatively healthy pt after it gets sutured?
Doxy plus 3rd generation ceph (like cefdinir)?
Levaquin?

Do you know it is vibrio already?

Those regimens are recommended from the CDC - but they usually use IV therapy, so IV doxy plus IV ceftaz (not po cefdinir). This pathogen causes a lot of nec fasc, so likely would not screw around with po therapy initially if I thought it was vibrio.

FQ are also an option.

 

[Its Z]

Definitely throw in Dapto, Zyvox, Mycamine, Tygacil, Merrem, and Amikacin.

And don't forget to apply some triple antibiotic on the wound... and do a spit clean.

 

[xiphoid2010]

Definitely throw in Dapto, Zyvox, Mycamine, Tygacil, Merrem, and Amikacin.

And don't forget to apply some triple antibiotic on the wound... and do a spit clean.

Got one of those docs I see. I feel ya.

 

[Its Z]

Got one of those docs I see. I feel ya.

No dood. We don't. My abx cost is $6 per APD.
We hardly use big guns. Our Ps A susceptibilty is 97%+ for Zosyn. We have almost no ESBL.
Our strep dies when we spit on it.

I created a decade long trend of our antibiogram...the only major changes were with MRSA...which actually got better the past 6 years and increase in VRE.

e coli got stronger against FQ... but that's about it.

We have an awesome community ABS program. we should probably publish

 

[xiphoid2010]

No dood. We don't. My abx cost is $6 per APD.
We hardly use big guns. Our Ps A susceptibilty is 97%+ for Zosyn. We have almost no ESBL.
Our strep dies when we spit on it.

I created a decade long trend of our antibiogram...the only major changes were with MRSA...which actually got better the past 6 years and increase in VRE.

e coli got stronger against FQ... but that's about it.

We have an awesome community ABS program. we should probably publish

Now that I got my plate full with non-clinical work, the abuses are on the rise again. It seems in an undeserved neighborhood, you are stuck with subpar practice all around and very little support or resources to make changes. 🙁

 

[ngmc11]

Plastic surgeon wanted to cover for any potential skin infection after his work on the wound and the potential for sea water pathogens like vibrio... ER docs said she just gives levaquin for 7 days. She said it was textbook to not treat...

 

[pinipig523]

Other than vibrio - you need to treat for Aeromonas.

You go with a flouroquinolone like levaquin.