Medline ® Abstracts for References 5,6
of 'Soft tissue infections due to dog and cat bites'
The management of bite wounds in children--a retrospective analysis at a level I trauma centre.
Jaindl M, Grünauer J, Platzer P, Endler G, Thallinger C, Leitgeb J, Kovar FM
Injury. 2012;43(12):2117. Epub 2012 May 16.
INTRODUCTION: Animal bite wounds are a significant problem, which have caused several preventable child deaths in clinical practice in the past. The majority of bite wounds is caused by dogs and cats, and also humans have to be considered to lead to those extreme complicated diagnosis in the paediatric patient population. Early estimation of infection risk, adequate antibiotic therapy and, if indicated, surgical treatment, are cornerstones of successful cures of bite wounds. However, antibiotic prophylaxis and wound management are discussed controversially in the current literature. In our study, we retrospectively investigated the bite source, infection risk and treatment options of paediatric bite wounds.
METHODS: A total of 1592 paediatric trauma patients were analysed over a period of 19 years in this retrospective study at a level I trauma centre, Department of Trauma Surgery, Medical University of Vienna, Austria. Data for this study were obtained from our electronic patient records and follow-up visits. In our database, all paediatric patients triaged to our major urban trauma centre have been entered retrospectively.
RESULTS: During the 19-year study period, 1592 paediatric trauma patients met the inclusion criteria. The mean age was 7.7 years (range 0-18.9), 878 (55.2%) were males and 714 (44.8%) were females. In our study population, a total of 698 dog bites (43.8%), 694 human bites (43.6%), 138 other bites (8.7%) and 62 cat bites (3.9%) have been observed. A total of 171 wounds (10.7%) have been infected. Surgical intervention was done in 27 wounds (1.7%).
CONCLUSION: Gender-related incidence in bite wounds for dog and cat could be detected. Second, our findings for originator of bite wounds reflect the findings in the published literature. Total infection rate reached 10.7%, primary antibiotic therapy was administered in 221 cases (13.9%) and secondary antibiotic therapy in 20 (1.3%) cases. Observed infection rate of punctured wounds and wounds greater than 3 cm was 3 times higher than for all other wounds. Our findings need to be proven in further prospective clinical trials.
Department of Trauma Surgery, Medical University of Vienna, Austria.
Controversies in antibiotic choices for bite wounds.
Ann Emerg Med. 1988;17(12):1321.
In the last decade much progress has been made in our understanding of animal bites. Two major areas of remaining controversy are discussed. Recent study of human bites has shown that the early literature depicting all human bites as having an extraordinarily high infection and complication rate was biased by its emphasis on human bites of the hand that presented late with infection already present. These bites, the so-called closed-fist injuries (CFI), do indeed have a poor prognosis, but it may be as much due to their location and initial neglect as to the source of the injury. Human bites elsewhere do not seem to have any higher risk than animal bites, which have an infection rate of about 10%. Human bites of the face, lips, and ears are at very low risk for infection (less than 3%) if properly treated. The CFI should be identified early and aggressively irrigated and debrided (if possible). CFI wounds can be treated on an outpatient basis if uninfected and less than 24 hours old. The economical outpatient antibiotics of choice for CFI are penicillin plus dicloxacillin; the former is needed to cover Eikenella corrodens and the latter to cover Staphylococcus aureus, both common in these wounds. Diabetics with hand infection frequently have Gram-negative infection and may warrant parenteral aminoglycosides. Second- and third-generation cephalosporins are very effective but should be reserved for special situations due to their expense. Prophylactic antibiotics are not indicated for typical bite wounds, which are low risk. The choice of antibiotic (when needed) in other bite wounds is a matter of confusion, because the only scientific data available are in vitro sensitivities, which are a very poor and crude reflection of the clinical reality. Antibiotic effectiveness in vivo is dependent on a complex summation of absorption, tissue levels (not just serum levels), host immune defenses, and the interrelationships between bacterial species present. For dog bite wounds, dicloxacillin and cephalexin are both good choices because they cover most of the broad spectrum of infecting pathogens; dicloxacillin is significantly cheaper.(ABSTRACT TRUNCATED AT 400 WORDS)
Division of Emergency Medicine, University of California, San Francisco 94143-0208.