How is cellulitis resulting from lacerations and puncture wounds sustained in an aquatic environment treated?

Updated: Jun 14, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Lacerations and puncture wounds sustained in an aquatic environment may be contaminated with bacteria such as Aeromonas hydrophila, Pseudomonas and Plesiomonas species, Vibrio species, Erysipelothrix rhusiopathiae, and others. Treatment in such cases includes the following:

  • Antibiotic treatment should address common gram-positive and gram-negative aquatic organisms

  • Appropriate antibiotic regimens for saltwater or brackish water include doxycycline and ceftazidime, or a fluoroquinolone

  • Appropriate regimens for injuries sustained in freshwater include a third- or fourth-generation cephalosporin (eg, ceftazidime or cefepime) or a fluoroquinolone (eg, ciprofloxacin or levofloxacin)

  • Apparent infection that is not responsive to initial courses of antibiotics as above should raise suspicion for Mycobacterium marinum infection; in such situations, wound biopsy for mycobacterial stains and culture should be considered


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