Empiric antibiotic therapy for seawater injuries: a four-seasonal analysis.
BACKGROUND
Previous seawater studies found Vibrio species associated with morbidity, suggesting that seawater-contaminated wounds should be treated early. The purpose of this study was to identify common seawater pathogens and antibiotic sensitivities to provide empiric antibiotic therapy until patient-specific culture results are available.


METHODS
Seasonal samples were collected from 25 Galveston beach locations and cultured. Colonies were identified and sensitivities were performed using MicroScan Positive and Negative Breakpoint Combo Panels.


RESULTS
In the fall (28.3 degrees C), of 15 species isolated, the three most common isolates were Escherichia coli, Enterococcus faecium, and Klebsiella pneumoniae. Gram-negative isolates were sensitive to levofloxacin, lomefloxacin, and cefepime. Gram-positive isolates were sensitive to penicillin and ampicillin. In the winter (11.1 degrees C), of 14 species isolated, the three most common isolates were Enterobacter agglomerans, E. faecium, and E. coli. Gram-negative isolates were sensitive to levofloxacin, lomefloxacin, and cefepime. Most Gram-positive isolates were sensitive to vancomycin, levofloxacin, penicillin, and ampicillin. In the spring (26.6 degrees C), of 14 species isolated, the three most common isolates were E. coli, Bacillus species, and E. faecium. Gram-negative isolates were sensitive to levofloxacin, lomefloxacin, and cefepime. Most Gram-positive isolates were sensitive to penicillin, ampicillin, vancomycin, and levofloxacin. In the summer (29.7 degrees C), of 17 bacterial species isolated, the three most common isolates were Bacillus species, Enterobacter cloacae, and K. pneumoniae. Gram-negative isolates were sensitive to cefepime, lomefloxacin, and levofloxacin. Gram-positive isolates were sensitive to penicillin, ampicillin, vancomycin, levofloxacin, and chloramphenicol.


CONCLUSIONS
Cultured pathogens were sensitive to penicillin, ampicillin, or levofloxacin. The authors recommend a combination of penicillin or ampicillin with levofloxacin for empiric antibiotic coverage for seawater-contaminated injuries.
Kargel
Jennifer S
JS
Galveston, Texas From the Department of Surgery, University of Texas Medical Branch.
Dimas
Vanessa M
VM
Kao
Dennis S
DS
Heggers
John P
JP
Chang
Peter
P
Phillips
Linda G
LG
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008826:Microbial Sensitivity Tests; D012621:Seasons; D012623:Seawater; D014950:Wounds, Penetrating / Q000382:microbiology*
D000900:Anti-Bacterial Agents