Case Report: Oyster Shell Lacerations: Antibiotics and Pediatric Population Considerations

Emily Jordan Bush, BS
Shea Cheney, MD
Kaitlyn Yatson, PA-C

Key Words

Vibrio Vulnificus, Oyster Laceration, Pediatrics, Marine Injuries

Consent

Consent was obtained from both the patient's parents.

Abstract

This case report summarizes the assessment and treatment plan of a pediatric patient who sustained a laceration from an oyster shell. The patient presented to a local pediatric emergency department with an uncomplicated laceration to the forearm after falling into an oyster bed in the Southeastern Coastal area. The wound was cleaned and repaired in the ED and the patient was placed on a multi-antibiotic regimen. The patient tolerated the procedure well and the wound healed without complications or infection. This case outlines special considerations for antibiotic selection in pediatric patients with wounds sustained from marine injuries.

Introduction

Marine injuries require careful consideration for wound care and antibiotic selection. Lacerations sustained in a marine environment or from aquatic creatures must be treated as high-risk for complications due to the physical characteristics of such wounds and contamination with bacteria specific to marine environments.

The wounds sustained from oyster shells are unique injuries. Oyster shells tend to be both sharp and fragile, easily leaving shell fragments in the wound. The sharpness of the shell often leads to deep lacerations, and the wound is immediately inoculated with marine bacteria such as Vibrio Vulnificus.¹ Such bacteria may cause rapid and serious infection, such as wound abscesses and, in more severe cases, necrotizing fasciitis.¹

Antibiotic coverage should be directed at treating V. Vulnificus. In this case, the oyster was located in the southeastern coastal area, which harbors bacteria that live in brackish water.

Furthermore, as with any laceration, especially those with a high likelihood of contamination, an up-to-date tetanus vaccine is exceedingly important.

Selection of wound closure techniques should be based on the characteristics of the wound, with a low threshold to leave the wound to heal by secondary intention when the risk of infection is high. If the wound involves deep tissues, is gaping, or would have poor cosmetic outcomes due to the body area involved, wound closure should be considered.² Otherwise, there is no wide consensus on primary closure versus delayed primary wound closure.

It is important to note that directed antibiotic coverage may present challenges in the pediatric population. Several first-line antibiotics present adverse side effect profiles in children, and the risks versus benefits of administering such medications should be weighed prior to selection. Risks of complications may increase in the pediatric population due to potential delayed reporting or unreliable history if given by the child, as well as limitations in antibiotic selection due to increased side effect risk profile in children.

Case

A previously healthy 22-month-old male presented to the pediatric emergency department with a laceration to the right forearm after falling into an oyster bed. The patient is up to date on vaccinations, including Tetanus. Vital signs, including heart rate, respiratory rate, temperature, and oxygen, were age-appropriate. Physical examination revealed an active, well-appearing child in no acute distress with a 3 cm laceration to the posterior right forearm with no foreign body or deep structure involvement. Tendon exam of the right arm showed no functional deficit with full range of motion. No X-ray was performed given no concern for fracture or retained foreign body. For wound repair, extensive irrigation with saline was performed, and chlorhexidine skin preparation was used; LET topical gel was used for local anesthesia. The wound was thoroughly explored in a bloodless field, and no retained foreign bodies were visualized. The laceration was closed with 3 simple interrupted sutures of 4-0 nylon, with loose approximation, and dressed with Bacitracin antibiotic ointment. The patient received intramuscular Ceftriaxone at 50 mg/kg (565 mg) and one dose of intramuscular trimethoprim-sulfamethoxazole. The patient was discharged with instructions to return in 24 and 48-hours for two more doses of 50 mg/kg and to re-examine the wound. The patient was prescribed oral TMP-SMX twice daily at home for a 7-day regimen. A follow-up was arranged for 7 days to remove the sutures. The patient had a favorable outcome, with the wound healing well without infection or complications.

Discussion

This case illustrates special circumstances that must be considered to prevent infection and wound complications in marine injuries. The pediatric population often presents unique challenges, such as potential for unreliable history, delayed reporting, and limitations in antibiotic regimen selection and compliance. These factors should be considered when treating lacerations sustained in a marine environment in the pediatric population. This case summarizes a treatment plan that includes age-specific considerations for increased infection risk. According to the CDC, children can be treated with a third-generation cephalosporin plus doxycycline or a fluoroquinolone, or an alternative combination of trimethoprim-sulfamethoxazole and an aminoglycoside.³ In this case, doxycycline and a fluoroquinolone were ruled out due to their side-effect profiles and the patient’s age. Thus, combination therapy with trimethoprim-sulfamethoxazole and ceftriaxone was chosen. Wound care strategies in marine-associated lacerations should include thorough irrigation and exhaustive wound exploration with careful removal of contaminants and foreign bodies. Imaging may aid in these cases, as tiny shell fragments may be retained quite easily. Primary closure should be avoided when able, but if necessary, the wound should be repaired in loose rather than close approximation with an interrupted suture technique to prevent infection. Appropriate antibiotic selection is essential for favorable outcomes, given the tendency of saltwater bacteria to cause rapid, serious infections, and careful consideration of the risks versus benefits of administering certain preferred antibiotics in the pediatric population. The importance of antibiotic compliance and diligent follow-ups for wound checks should be communicated to patients and families/caregivers. Marine-associated lacerations in pediatric patients require careful evaluation due to the risk of infection with saltwater pathogens. Early and thorough irrigation, appropriate antibiotic coverage, and close follow-up are critical to preventing complications.

Conclusion

Marine-associated lacerations in pediatric patients require careful evaluation due to the risk of infection with saltwater pathogens. Early and thorough irrigation, appropriate antibiotic coverage, and close follow-up are critical to preventing complications.

References

1. Diaz JH. Skin and Soft Tissue Infections Following Marine Injuries and Exposures in Travelers. Journal of Travel Medicine. 2014;21(3):207-213.
2. Baddour, MD, FIDSA, FAHA LM. Soft Tissue Infections following Water Exposure. Uptodate.com. Published 2026. Accessed May 2, 2026. 
3. CDC. Clinical Overview of Vibriosis. Vibrio Infection (Vibriosis). Published May 16, 2024. Accessed May 1, 2026.