Vibrio Infections: What Clinicians Should Consider and the Public Should Know

Vibrio vulnificus infections can be serious and life-threatening infections. They can lead to necrotizing fasciitis, a severe form of the infection in which the flesh around an open wound dies. In the general public and media it has also been referred to as the “flesh-eating bacteria.”¹

William Schaffner, MD, professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, points out the infections have typically been found down in the US south but are working their way northward.

“Vibrio vulnificus is an organism that likes to live in salty, warm water, and for a long time, it's been largely confined to the Gulf Coast,” Schaffner said. “Now there are, however, what with global warming, it's now moving up in its ecologic niche up the east coast. So there actually have been infections associated with this organism occurring on the coastal waters of the Mid-Atlantic states.”

The bacteria's habitat has reportedly shifted northward by about 30 miles annually, and infections have increased eightfold between 1988 and 2018.²

Schaffner says there are 2 primary ways to contract vibrio vulnificus infections.

“If you go into the water and you have any kind of injury, cut, or scrape, this organism can colonize that opening in the skin, get under it, and cause a flesh-eating bacteria, such that it will spread horizontally, causing severe, necrotizing fasciitis. That's one way,” Schaffner said. “The other way it causes illness is since it's in that salty water oysters, which sieve water in order to get their nutrients, can be infected with vibrio. These Vibrio vulnificus organism, if raw oysters that are infected with Vibrio are eaten by someone with pre existing liver disease. Vibrio can get out of the intestine, get into your bloodstream and cause a very serious, septic illness."

In terms of treatment, the Centers for Disease Control and Prevention (CDC), offers some clinical management guidance including the following:

• “Initiate treatment promptly. Early antibiotic therapy and early surgical intervention improve survival. Do not wait for consultation with an infectious disease specialist or laboratory confirmation of V vulnificus infection to initiate treatment.
• Antibiotic therapy
• Doxycycline (100mg orally or intravenously twice a day for 7–14 days) and a third-generation cephalosporin (eg, ceftazidime 1–2g intravenously or intramuscularly every 8 hours) are recommended.
• Alternate regimens include a third-generation cephalosporin with a fluoroquinolone (eg, 500mg ciprofloxacin orally twice a day) or a fluoroquinolone given alone.
• Children may also be treated with a combination regimen of a third-generation cephalosporin plus doxycycline or ciprofloxacin, or with an alternative regimen of trimethoprim-sulfamethoxazole plus an aminoglycoside. In selecting a regimen, clinicians should be aware of guidance from the American Academy of Pediatrics:
• Fluoroquinolones should not be used routinely as first-line agents in children younger than 18 years except when specific indications exist or in specific conditions for which there are no alternative agents (including oral agents) and the drug is known to be effective for the specific situation.
• Use of tetracyclines as a class of drugs in pediatric patients historically has been limited because of reports that this class could cause permanent dental discoloration in children younger than 8 years. More recent data suggest that doxycycline can be administered for short durations (ie, 21 days or less) without regard to the patient’s age.”²

Adding another layer of complexity is the potential for multidrug resistance. With growing infection rates, this can be a future concern.

“If you have this in mind, contact your microbiology laboratory or quickly get online to get the latest recommendations regarding antibiotic therapy. That's a quick and easy thing to do, and I think is important in these circumstances,” Schaffner said.

Other treatment includes debridement to infected areas and in severe cases, amputation may be recommended during surgery.

In order to prevent this infection, Schaffner provides some guidance to the public.

“People who have liver disease or are immunocompromised in any way should avoid eating raw oysters,” Schaffner said. “As to the rest of us, when we go into warm waters, make sure that we don't get cut or get fish-hook injuries or anything like that while we're in the water. If we do, have those attended to quickly when we get out. And obviously, if you have those sorts of injuries, you may want to stay on the beach and not go into the water.”

References

1. About Vibrio Infection. Centers for Disease Control and Prevention. May 14, 2024. Accessed September 29, 2025.
https://www.cdc.gov/vibrio/about/index.html#cdc_disease_basics_treatment-treatment

2. Severe Vibrio vulnificus Infections in the United States Associated with Warming Coastal Waters. Centers for Disease Control and Prevention. September 1, 2023. Accessed September 29, 2025.https://www.cdc.gov/han/2023/han00497.html