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September 5, 2025Open Access

The clinical characteristics and diagnostic and treatment protocol for 14 acute Vibrio vulnificus infections caused by aquatic products

DMDonghua MaZhongshan People's Hospital JWJinjun WangZhongshan People's Hospital BFBaoying FanZhongshan People's Hospital

Key Points

All patients had a history of aquatic product-related trauma, with rapid progression of symptoms.
Microbial culture confirmed cases faster than mNGS, averaging 1.68 days versus 4.82 days.
Complications occurred in 78.6% of patients, including sepsis in 42.9% and limb amputation in 42.9%.
Proposed diagnostic and treatment protocol aims to enhance clinical decision-making and reduce severe outcomes.

Abstract

Vibrio vulnificus infections caused by aquatic product-related injuries pose severe clinical challenges due to their rapid progression and high morbidity and mortality. Early diagnosis and timely intervention are critical to improving patient outcomes, yet standardized diagnostic and treatment protocols remain limited. We conducted a retrospective descriptive case series of 14 patients with confirmed V vulnificus infection admitted between 2020 and 2023. Clinical data, including demographic characteristics, injury history, symptoms, laboratory results, diagnostic methods, treatment strategies, and outcomes, were collected and analyzed. Microbial culture and metagenomic next-generation sequencing (mNGS) were compared in terms of diagnostic timing. All 14 patients had a clear history of aquatic product-related trauma, with 85.7% (12/14) presenting within 24 hours of injury. The average time from injury to symptom onset was 13.11 ± 6.61 hours. All patients exhibited limb erythema, swelling, warmth, and pain; 11 patients (78.6%) developed complications such as sepsis (42.9%), compartment syndrome (35.7%), or multiple organ dysfunction syndrome (28.6%). Ten cases were confirmed by microbial culture (average time: 1.68 ± 0.63 days), and 4 by mNGS (average time: 1.00 day). The average time to diagnosis was shorter in patients diagnosed by culture than those requiring mNGS (1.86 ± 0.68 vs 4.82 ± 0.90 days). All patients received empirical combination antibiotic therapy upon admission; the average duration of intravenous antibiotic treatment was approximately 10 days. Six patients (42.9%) underwent amputation, and 2 (14.3%) died. Among the survivors, 50% achieved Brunnstrom stage V to VI hand function recovery at final follow-up. Early identification and aggressive treatment are essential in managing V vulnificus infections related to aquatic product injuries. mNGS plays an important supplementary role in diagnosis, especially in culture-negative cases. The proposed diagnostic and treatment protocol, based on real-world experience, may help improve clinical decision-making and reduce poor outcomes such as amputation and death.

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