Clinical characteristics, antimicrobial susceptibility, and diagnostic performance of the LRINEC score for necrotizing fasciitis in Vibrio vulnificus infection: a 19-case retrospective study in Putian, China

Abstract

Vibrio vulnificus infection is a life-threatening marine-associated disease that can progress rapidly. Regional differences have been reported in its clinical manifestations and antimicrobial resistance patterns. However, baseline epidemiological and microbiological data on this infection remain lacking in Putian, a coastal city in southeastern China. This study aimed to summarize the clinical characteristics, antimicrobial susceptibility profiles, and factors associated with prognosis in V. vulnificus infection and to assess the diagnostic performance of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. We retrospectively analyzed 19 patients with culture-proven V. vulnificus infection admitted to the Affiliated Hospital of Putian University from May 2019 to August 2025. Data on epidemiology, clinical manifestations, laboratory findings, antimicrobial susceptibility, and treatment strategies were collected. Patients were categorized according to the presence of necrotizing fasciitis and clinical outcome. All data were analyzed descriptively. Most patients were middle-aged or older men with underlying comorbidities, and infections occurred mainly in summer. Inflammatory and coagulation abnormalities were common, and 63.2% of patients developed septic shock. The treatment-abandonment rate was 36.8%. All 19 clinical isolates were susceptible to the 17 tested antimicrobial agents; no intermediate, resistant, or multidrug-resistant strains were identified. Six empirical combination regimens provided complete in vitro coverage against the isolates. Patients with necrotizing fasciitis and those who abandoned treatment showed more severe abnormalities in inflammatory, coagulation, and organ-function indicators. The LRINEC score had a high false-negative rate and limited diagnostic performance for V. vulnificus -associated necrotizing fasciitis. V. vulnificus infection in this region progresses aggressively and is frequently complicated by septic shock. Local isolates remained susceptible to conventional antimicrobial agents, and empirical regimens provided complete in vitro coverage. The LRINEC score has important limitations and should not be used as an independent screening tool. Diagnosis should integrate exposure history, clinical manifestations, laboratory findings, and systemic symptoms. Timely surgical debridement is critical for patient management.