Soft tissue infections due to dog and cat bites
- Larry M Baddour, MD, FIDSA, FAHA
Larry M Baddour, MD, FIDSA, FAHA
- Professor of Medicine
- Mayo Clinic College of Medicine
Issues related to soft tissue infections resulting from dog and cat bites will be reviewed here. Cat scratch disease, soft tissue infections due to human bites, and bites in children are discussed separately. (See "Microbiology, epidemiology, clinical manifestations, and diagnosis of cat scratch disease" and "Soft tissue infections due to human bites" and "Clinical manifestations and initial management of animal and human bites".)
In North America, animal bites account for about 1 percent of emergency department visits and 10,000 inpatient admissions annually; approximately 1 in every 775 persons seeks emergency care for dog bites each year [1-3]. In a study of 769 dog bite victims evaluated over a two-year period in a community hospital emergency department, wound infection was evident in 2.5 percent of cases upon presentation, and wound infections were diagnosed in 2.1 percent of cases at follow-up . In one large retrospective pediatric series that included 1592 patients who presented with human and nonhuman bites, the infection rates for dog and cat bites were 14.6 and 37.1 percent, respectively . Similarly, others report infection in up to one-fifth of animal bites [6,7].
Men are bitten more often by dogs than women, while women are bitten more often by cats than men [8,9]. Animal bites are more common among children than adults. (See "Clinical manifestations and initial management of animal and human bites".)
The frequency of dog bite injuries varies with breed. German shepherd and mixed breeds account for many dog bites, while sporting dogs are less commonly implicated . The pit bull breed of the Staffordshire terrier has been associated with the majority of dog bite–related deaths in the United States; death usually results from exsanguination due to the number and severity of bites.
The predominant pathogens in animal bite wounds are the oral flora of the biting animal and human skin flora [10,11]. About 85 percent of bites harbor potential pathogens, and the average wound yields five types of bacterial isolates; 60 percent have mixed aerobic and anaerobic bacteria . Skin flora such as staphylococci and streptococci are isolated in about 40 percent of bites. (See "Zoonoses from dogs" and "Zoonoses from cats".)
- Dire DJ. Emergency management of dog and cat bite wounds. Emerg Med Clin North Am 1992; 10:719.
- Centers for Disease Control and Prevention (CDC). Nonfatal dog bite-related injuries treated in hospital emergency departments--United States, 2001. MMWR Morb Mortal Wkly Rep 2003; 52:605.
- Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA 1998; 279:51.
- Dire DJ, Hogan DE, Riggs MW. A prospective evaluation of risk factors for infections from dog-bite wounds. Acad Emerg Med 1994; 1:258.
- Jaindl M, Grünauer J, Platzer P, et al. The management of bite wounds in children--a retrospective analysis at a level I trauma centre. Injury 2012; 43:2117.
- Callaham M. Controversies in antibiotic choices for bite wounds. Ann Emerg Med 1988; 17:1321.
- Morgan M, Palmer J. Dog bites. BMJ 2007; 334:413.
- MacBean CE, Taylor DM, Ashby K. Animal and human bite injuries in Victoria, 1998-2004. Med J Aust 2007; 186:38.
- Hon KL, Fu CC, Chor CM, et al. Issues associated with dog bite injuries in children and adolescents assessed at the emergency department. Pediatr Emerg Care 2007; 23:445.
- Talan DA, Citron DM, Abrahamian FM, et al. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med 1999; 340:85.
- Goldstein EJ, Citron DM, Wield B, et al. Bacteriology of human and animal bite wounds. J Clin Microbiol 1978; 8:667.
- Goldstein EJ. New horizons in the bacteriology, antimicrobial susceptibility and therapy of animal bite wounds. J Med Microbiol 1998; 47:95.
- Goldstein EJ. Bite wounds and infection. Clin Infect Dis 1992; 14:633.
- Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59:147.
- Fleisher GR. The management of bite wounds. N Engl J Med 1999; 340:138.
- Oehler RL, Velez AP, Mizrachi M, et al. Bite-related and septic syndromes caused by cats and dogs. Lancet Infect Dis 2009; 9:439.
- Abrahamian FM. Dog Bites: Bacteriology, Management, and Prevention. Curr Infect Dis Rep 2000; 2:446.
- Goldstein EJ, Citron DM, Richwald GA. Lack of in vitro efficacy of oral forms of certain cephalosporins, erythromycin, and oxacillin against Pasteurella multocida. Antimicrob Agents Chemother 1988; 32:213.
- Baptiste KE, Williams K, Willams NJ, et al. Methicillin-resistant staphylococci in companion animals. Emerg Infect Dis 2005; 11:1942.
- Sing A, Tuschak C, Hörmansdorfer S. Methicillin-resistant Staphylococcus aureus in a family and its pet cat. N Engl J Med 2008; 358:1200.
- Brakenbury PH, Muwanga C. A comparative double blind study of amoxycillin/clavulanate vs placebo in the prevention of infection after animal bites. Arch Emerg Med 1989; 6:251.
- Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med 1994; 23:535.
- Callaham M. Prophylactic antibiotics in dog bite wounds: nipping at the heels of progress. Ann Emerg Med 1994; 23:577.