Utilization of Hyperbaric Oxygen Therapy with Vibrio Vulnificus Soft Tissue Infection Preventing Amputation.

Introduction:  Vibrio Vulnificus is an opportunistic gram-negative bacterial pathogen that is found in  warm low-salinity waters. V. vulnificus wounds are increasing in prevalence due to the rise in temperatures of the sea water. (3)   According to the CDC, about 150-200 v.vulnificus infections are reported each year. (3)  It primarily infects humans through the consumption of raw or undercooked seafood, especially oysters, or through open wounds exposed to contaminated water.  About one in five people with this infection will die with fatalities occurring as soon as 48 hours after exposure. (1)  Methods:Case Description: An 85-year-old male presented to the ED at Banner University Medical Center (BUMCP) in Phoenix, AZ, on December 3, 2023, with left leg cellulitis. The infection began while the patient was fly fishing near Cancun, Mexico. Initially suspected to be caused by a spider or insect bite, cultures later confirmed a Vibrio vulnificus infection. Before returning to Arizona, the patient underwent his first surgical debridement in Mexico. Upon assessment at BUMCP, significant swelling and erythema from the foot to the proximal thigh, along with large hemorrhagic bullae, were observed. CT scans raised concerns about a necrotizing soft tissue infection.   During hospitalization, the patient received multiple antibiotics and two additional surgical debridement. Post-debridement wounds on the left lower leg measured 20x13x1 cm and 18x4x1 cm. Due to the infection's severity, he faced a high risk of amputation and death.  The wound and hyperbaric medicine team was consulted immediately, and hyperbaric oxygen therapy (HBOT) was initiated on December 5, 2023. The patient underwent a total of 60 HBOT sessions at 2.4 ATA, with four treatments while inpatient and the remainder post-discharge.   Weekly wound assessments and debridements were performed, and nine applications of a skin substitute were utilized every 1-2 weeks. By May 17, 2024, the patient was completely healed.  Results:Discussion:  The patient required multiple surgical debridements and IV antibiotics to quickly control a severe infection. This left him with large full-thickness wounds on his left lower leg, exposing muscle and tendon, and putting him at high risk for amputation and death. Hyperbaric oxygen therapy (HBOT) was used to manage the infection, reduce inflammation, and promote angiogenesis to stimulate wound healing. Early initiation of HBOT, along with a comprehensive multidisciplinary care approach, prevented amputation and death. The patient fully healed without the need for skin grafting.  References:https://english.elpais.com/science-tech/2023-09-06/us-warns-of-deadly-bacteria-in-warming-waters-near-gulf-of-mexico-and-east-coast.html https://emergency.cdc.gov/han/2023/han00497.asp https://p23labs.com/blog/f/early-vibrio-infection-testing-in-both-individuals-and-groups?blogcategory=Testing