Bacterial infections develop in about 1 in 20 US adults hospitalized for gunshot wounds, with the greatest risk among those undergoing surgery for injuries to the head, neck, spine, or lower abdomen, per a study published last week in JAMA Network Open.

For the study, a team led by researchers from the University of Maryland School of Medicine (UMSOM) parsed data from the Premier Healthcare Database on US adults hospitalized for firearm injuries from January 2019 to May 2021

Antibiotic exposure low in uninfected patients

In total, 24,024 adults who incurred gunshot wounds were admitted to 323 hospitals. The average age at injury was 32.9 years, and 85.3% were men. The median New Injury Severity Score was 2 (minor injuries), and antibiotic therapy was given for a median of one day. Of all participants, 24.1% were hospitalized, and 8.4% died.

Louisiana beachgoers are being warned to stay out of the water if they have any kind of wound, including cuts or scraps, because of an outbreak of a flesh-eating bacterium.

Five people in Louisiana have died and four are hospitalized owing to Vibrio vulnificus infections so far this year, according to the state’s health department. During this same period over the past decade, the department says the state reported an average of seven cases and one death. 

V vulnificus is found in warm coastal waters, and all nine cases from Louisiana’scurrent outbreak are associated with seawater; each patient had underlying health conditions. People can also get it by consuming raw or undercooked shellfish, particularly oysters. 

The US Centers for Disease Control and Prevention says about 150 to 200 cases of V vulnificus are reported annually, and that about one in five people who are infected will die, sometimes within a couple of days of becoming ill. 

The bacterium causes gastrointestinal symptoms along with septic shock and necrotizing fasciitis, which is a fast-moving infection that destroys tissue and blood vessels beneath the skin. Severe infections might require a limb amputation. 

Climate change is increasing the threat 

Though Gulf Coast states see the most infections, a warming climate is expanding where V vulnificus is found, according to a 2023 analysis in Scientific Reports.

On average, the study authors found, the distribution of infectionshas shifted nearly 30 miles northwards per year. “In the late 1980’s infections were rare above Georgia (32°N) but by 2018 were regularly reported as far north as Philadelphia (40°N),” they wrote.

The study also found that the number of V vulnificus cases in the United States increased eightfold from 1988 through 2018.

Additionally, hurricanes, which are likely becoming more intense because of climate change, can lead to outbreaks of V vulnificus, as was seen with Hurricane Ian in 2022 and Helene in 2024. 

A new analysis suggests that use of the antibiotic doxycycline to prevent sexually transmitted infections (STIs) by men who have sex with men (MSM) in Europe could result in an additional 4.5 million doses of the antibiotic taken in a year.

The study, led by researchers with the European Centre for Disease Prevention and Control and published last week in Eurosurveillance, aimed to estimate how much the use of doxycycline post-exposure prophylaxis (doxyPEP) could increase overall antibiotic consumption among MSM in 30 European Union (EU) countries who are already taking HIV pre-exposure prophylaxis (PrEP)—a population that constitutes a large portion of early doxyPEP users. 

DoxyPEP has been shown, both in clinical trials and real-world studies, to significantly reduce the incidence of chlamydia and syphilis in MSM and transgender women with a history of STIs, and several European countries recommend it for those high-risk groups. It’s less effective against gonorrhea.

“As doxy-PEP use among MSM expands through both formal prescriptions and informal channels, concern about unintended consequences, such as antimicrobial resistance (AMR), are increasing,” the study authors wrote. “The risk of increased doxycycline use is particularly salient given the EU’s 2030 target to reduce antibiotic consumption by 20% relative to 2019 levels in order to address the growing public health threat of AMR.”

Large increase concentrated in a small group

The net increase of 4.5 million doxycycline doses represents roughly 2% of total doxycycline consumption in the EU in 2023. The researchers calculated the amount using a model that estimated, based on expert solicitation, that at least one-third of MSM on PrEP initiate doxyPEP use and 326,000 doses of doxycycline are avoided through reduced treatment of chlamydia infections.

The authors say that while the figure represents a relatively small share of overall antibiotic use, the increase would be concentrated within a small group.

“Because infections are often passed within this group, pathogenic bacteria are exposed to doxycycline repeatedly, which could increase antibiotic resistance,” they wrote, adding that it will be important to monitor uptake, STI trends, and AMR indicators as more EU countries adopt doxyPEP.

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