When hospitalist Scott Swygert, MD, of LRMC (co-author of the letter) started to do preliminary debridement of the wound, the patient had no sensation, a classic symptom of necrotizing fasciitis.He
and Mr. Barber then discussed antibiotic coverage.Both knew immediately that they wanted coverage for Vibrio species-marine organisms known to reside in salt or brackish water.The clinicians chose doxycycline, cefazolin and tobramycin administered intravenously for one week during the patient's hospitalization, followed by an additional two weeks of oral doxycycline and cephalexin upon discharge.Cultures were taken and an urgent consult for an orthopedic surgeon was requested.
With summer fast approaching, and waters growing warm-possibly enhancing the growth of the organism-he and Dr. Swygert
submitted the information to The New England Journal of Medicine
in a 300-word letter.The Journal called the organism capable of causing "a rapid, fulminant infection with a high rate of death."
With the approval of The Journal, the clinicians also contacted the Florida media in mid-March, choosing their words carefully.