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A previously healthy 70-year-old man presented with a rapidly progressive and fulminant infection due to Vibrio damsela after suffering a knife cut while filleting bluefish at the New Jersey Shore. Despite appropriate antibiotic therapy and localized wound exploration, the patient died. To our knowledge, this is the first reported case of V damsela sepsis with simultaneous isolation of the organism from both blood and wound. We are reporting this case to heighten physicians' awareness of this infection and the importance of early management with antibiotics and surgical consultation. (Arch Intern Med. 1993;153:1838-1840)

• All patients receiving cefoxitin and cefamandole were prospectively reviewed for appropriate and inappropriate utilization. There were two eight-week survey periods. In period 1, 81 (70%) of 115 patients received cefoxitin appropriately and six (40%) of 15 patients received cefamandole appropriately. In patients receiving antibiotics inappropriately, 12 (35%) of the 34 receiving cefoxitin and eight (89%) of the nine receiving cefamandole had infections that could have been treated with less expensive, equally efficacious antibiotics. Changes in antibiotic therapy were made in 79% of patients based on our recommendations. The estimated annual cost saving for these antibiotics was $40,290. During period 2, 73 (91%) of 80 patients were given cefoxitin appropriately and 14 (61%) of 23 patients received cefamandole appropriately. Forty-three percent of those receiving cefoxitin and 33% of those receiving cefamandole inappropriately could have been treated with a less expensive, equally efficacious antibiotic. In 88% of patients, the attending physicians followed our recommendations. ( Arch Intern Med 1985;145:1978-1981)