Characterization of Prophylactic Antimicrobial Therapy Practices for Patients With Marine-Associated Injuries in the Emergency Department.
Centers for Disease Control and Prevention (CDC) recommendations for the treatment of marine-associated wound infections include empiric coverage for Vibrio species with a combination of a third-generation cephalosporin and doxycycline. These recommendations are based on limited data and it remains unclear if this regimen is also indicated for prophylaxis.The purpose of this analysis was to assess the antibiotic regimens used in the emergency department (ED) for prophylaxis of marine-associated injuries relative to the CDC recommendations and evaluate any clinical impact.A retrospective review evaluated adult patients discharged from the ED over a 4-year period with an antibiotic prescription following an injury with marine exposure.114 patients were included in the analysis. The majority of patients were < 40 years of age with no previous medical history and presented after sustaining a laceration secondary to oyster shells. 97.4% received prophylactic antibiotic therapy that did not match the CDC recommendations, with the majority receiving doxycycline monotherapy (82%). A 1.8% 30-day ED revisit rate was noted with 2 patients returning for therapy failure. No patients were admitted to the hospital within 30 days and no documented adverse effects related to antibiotic therapy were noted.Current prophylactic antibiotic prescribing practices diverge from the current CDC recommendations for the treatment of marine-associated infections, however, an effect secondary to these variations was not observed. Further investigations of prophylaxis against Vibrio infections in low-risk patients is warranted to limit collateral damage and improve antimicrobial stewardship in the ED.
Authors: Britany N Byrkit, Elizabeth C LaScala, Lacey MenkinSmith, Gregory A Hall, Kyle A Weant