Introduction

It is generally understood that infections can further complicate and prolong wound healing. Surgical and burn wounds are at a greater risk of infection, with reports estimating that 0.5-3% of surgical patients will experience infection.¹ To further complicate care today, nosocomial infections from more aggressive, multi-drug resistant pathogens like Pseudomonas aeruginosa are on the rise, with reports estimating that the strain accounts for 4.5-6.3% of surgical site infections (SSI) as well as increased mortality among burn and surgical patients.²

With issues like antimicrobial resistance, increases in nosocomial infections, and even, at times, subsequent litigation, wound care professionals have a greater burden regarding infection prevention and management. Staying abreast of data and evidence-based practice for wound infection is more important than ever. Impacts of the COVID-19 pandemic on facility staffing and training have increased rates and complications regarding wound infections, but could other crises be impacting infection prevalence?

On September 1, the Centers for Disease Control and Prevention (CDC) issued a health advisory regarding the pathogen Vibrio vulnificus.³ The health advisory stated that due to higher temperatures of coastal waters, V. vulnificus prevalence has increased on the east coast.³

What Is Vibrio vulnificus?

V. vulnificus is a rare but aggressive species of Vibrio bacteria commonly found in warm coastal waters, usually on the Gulf Coast.^3,4 This species is sensitive to the water's temperature. For this reason, many climate experts refer to the species as the “microbial barometer of climate change.”⁴ The CDC reports that 150-200 V. vulnificus cases usually occur yearly, with a 1 in 5 mortality rate. After the pathogen was first recognized in 1976, it was more commonly caused by consuming contaminated shellfish rather than open wound exposure in low-salinity coastal waters. However, with rising temperatures, V. vulnificus is more prevalent and more likely to infect exposed open wounds of individuals in coastal waters. Cases have been reported in New York, Connecticut, and North Carolina, with some proving fatal. V. vulnificus can also lead to several complications, such as necrotizing fasciitis.^3,4

Infection may occur if open wounds (surgical sites, cuts, burns, etc) are exposed to water where the bacteria is present, often including flood water. Individuals with advanced age, diabetes, autoimmune disorders, kidney, and liver diseases are at the greatest risk of infection and subsequent complications.³ Even if the infection is from contaminated shellfish consumption, lesions (bullae) may form on the lower legs in addition to sepsis, diarrhea, and nausea.^3,5

Vibrio Vulnificus: How to Treat

V. vulnificus has a rapid gestation period (12-24 hours), making it imperative that clinicians act quickly. The CDC advises that providers ask patients suspected of infection if they have exposed a wound to East or Gulf Coast waters or have consumed shellfish. Due to the infection's rapid onset, the CDC also urges that clinicians should not wait for confirmation from an infectious disease specialist or lab results to begin treatment.³ Use of antibiotics as well as assessment of the wound site are essential. In particular, wound care professionals should debride any necrotic tissue. If the infection is severe enough, more aggressive debridement, or amputation may become necessary. If V. vulnificus is confirmed, providers should report the case to the appropriate health department.³

Conclusion

Although V. vulnificus has a high mortality rate, it is important to note that this infection is still relatively rare despite rising cases, especially when compared to other vibrio species.^4,6 However, an understanding of V. vulnificus can prove valuable for wound care professionals located near the coasts where prevalence is rising.

References

1. Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. JAMA. 2023;329(3):244–252. doi:10.1001/jama.2022.24075
2. Reynolds D, Kollef M. The epidemiology and pathogenesis and treatment of pseudomonas aeruginosa infections: An Update. Drugs. 2021;81(18):2117-2131. doi:10.1007/s40265-021-01635-6
3. CDC Health Alert Network. Severe Vibrio vulnificus infections in the United States associated with warming coastal waters. Centers for Disease Control and Prevention. Published September 1, 2023. Accessed September 13, 2023. https://emergency.cdc.gov/han/2023/han00497.asp
4. Heng SP, Letchumanan V, Deng CY, et al. Vibrio vulnificus: an environmental and clinical burden. Front Microbiol. 2017;8:997.doi: 10.3389/fmicb.2017.00997
5. Di W, Cui J, Yu H, et al. Vibrio vulnificus necrotizing fasciitis with sepsis presenting with pain in the lower legs in winter: a case report. BMC Infect Dis. 2022;22:670. https://doi.org/10.1186/s12879-022-07655-1
6. Vibrio vulnificus. Florida Health. Updated September 8, 2023. Accessed September 14, 2023. https://www.floridahealth.gov/diseases-and-conditions/vibrio-infections/vibrio-vulnificus/index.html#:~:text=Vibrio%20vulnificus%20is%20a%20bacterium,bacteria%20in%20warm%2C%20brackish%20seawater.

Image credit: shared via CC BY 4.0 from Vibrio vulnificus necrotizing fasciitis with sepsis presenting with pain in the lower legs in winter: a case report.