Soft tissue infection following
water exposure
Epidemiology
- The risk of soft tissue infection due to traumatic injury during water
exposure depends on the source of water.
-Individual at risk include: swimmers, fishermans
and boaters.
*brackish: slightly salty water, as is the mixture of river water and seawater in estuaries.
Diaz JH, Lopez FA. Skin, soft tissue and systemic bacterial infections following aquatic injuries and exposures. Am J Med Sci. 2015
Mar;349(3):269-75.
Bear in mind!
Non-infected wound
Superficial
Wound + Water
exposure
Infected wound
Deep
Microbiology
-
Most of them are Gram negative rods (Vibrio vulnificus,
Pseudomonas and Aeromonas), but it can also be caused Acid-Fast
mycobacteria or Gram positive organisms.
-
Polymicrobial infections are also possible.
-
CDC: the most dangerous are Vibrio vulnificus and Aeromonas
hydrophila.
Diaz JH, Lopez FA. Skin, soft tissue and systemic bacterial infections following aquatic injuries and exposures. Am J Med Sci. 2015
Mar;349(3):269-75.
Clinical evaluation
History and Physical Evaluation:
-Thorough exposure history should be obtained.
-Infected wounds can be classified in:
1- Superficial: cellulitis or abscess.
2- Deep: abscess, necrotizing fasciitis, septic arthritis, osteo
Bourque DL, Vinetz JM. Illnesses Associated with Freshwater Recreation During International Travel. Curr Infect Dis Rep.
2018 May 22;20(7):19.
Clinical evaluation
Labs:
- CBC, ESR, CRP + cultures (both aerobic and anaerobic)
-Immunouppressed patients M. marinum
Imaging:
- Only if it is a deep wound infection
Bourque DL, Vinetz JM. Illnesses Associated with Freshwater Recreation During International Travel. Curr Infect Dis Rep.
2018 May 22;20(7):19.
Management
Management is based on:
1-Wound management.
2-Antibiotic therapy.
3-Tetanus prophylaxis.
Diaz JH. Skin and soft tissue infections following marine injuries and exposures in travelers. J Travel Med. 2014 MayJun;21(3):207-13.
Management
1-Wound management
-
NS irrigation.
-
Devitalized tissue should be debrided.
-
Specimens should be analyzed.
-
Acute infected wounds should be left open with approximation of
wound edges to facilitate closure by secondary intention.
Diaz JH. Skin and soft tissue infections following marine injuries and exposures in travelers. J Travel Med. 2014 MayJun;21(3):207-13.
Management
2-Antibiotic therapy
-
Route of administration: IV or PO.
-
Empiric Antibiotics regimen:
Cephalexin 500mg PO q6h
Cefazolin 1g IV q8h
Clindamycin 300mg q6h
-
+
Levofloxacin 750mg
once daily
±
Doxycycline 100mg q12h
Metronidazol 500mg q6h
Empiric antibiotic should be tailored to microbiology data when
available.
-
Duration of therapy: 10-14 days.
Diaz JH. Skin and soft tissue infections following marine injuries and exposures in travelers. J Travel Med. 2014 MayJun;21(3):207-13.
Are there any questions?
Eduardo F. Avalos Sugastti
International Medical Gradate – National University of Asuncion
Observer in University of Miami – Miller School of Medicine
eduasugastti@gmail.com