Bite wound infection-Biters, Balms, Bandages Flashcards
What are serious complications that can result from animal bites?
- Sepsis
- Endocarditis
- Meningitis; brain abscess
- Fatal infections associated with capnocytophaga
- Rabies
What are the micro-organisms present at site of animal (dog or cat) bite?
*Animal bite wound Microbiology
- Gram + bacteria
-Staphylococcus aureus
-Streptococcus (alpha n beta haemolytic) - Gram - bacteria
-Capnocytophaga carnimosus
-Pasteurella (P. maltocida / P. septica)»»Found in 50-70% of healthy animals
*Pasteurella are associated with osteomyelitis and septic arthitis
What are the features of cat bite wound?
- Sharp feline teeth puncture the skin»>small but deep wounds
Human bite infections can result from 2 ways. Which are those?
- Self bite- ‘Paronychia’ (infection of the skin around the nail coz you bite yourself when eating a nail
- Bite inflicted by others- (clenched fist injury)
What organism or bacteria spp cause paroncychia?
- oropharyngeal flora
How to treat paronychia?
- Through incision and drainage
What are the micro-organisms present in wounds caused by human bite?
- Streptococcus pyogens
- Viridans streptococci
- Staphylococcus aures
- Eikenella corrodens
- Anaerobes
Elaborate on clenched fist injuries?
- Traumatic lacerations mostly in the 3rd and 4th metacarpophalangeal joints of dominant hand.
(*Human oropharyngeal flora is the organism to cause infection at the site)
> > > > Infection then spreads into subcutaneous tissues and web spaces.
- Eikenella corrodens (gram - bacillus in the human gingival plaque) is the common cause of web space infections and osteomyelitis/
What is the antimicrobial therapy for clenched fist wound infections?
- amoxicillin
- clavulanate
How are the bite wound infections diagnosed in the lab?
- Graim stain( to learn whether they are gram - or gram +
- Culture of infected wounds
-Include anaerobic culture if: abcesses, generalised sepsis, severe cellulitis, foul ordor exidate
-Blood cultures - Microscopic examination
What are the steps to follow on bite wound management?
- History
- Physical examination; lab; imaging: X-rays, U/S, CT scans
- Irrigation (sterile saline or distilled water), debridement
- Wound closure – only fresh uninfected wounds on face, else primary wound closure not indicated. Use adhesive strips to approximate edges
- Antimicrobial:
-Prophylaxis
-Treatment
(Most bite pathogens covered by amoxicillin clavulanate (co-amoxiclav) - Detailed report
- Elevation if edema; Immobilization
- Tetanus prophylaxis, rabies vaccine + Ig (Rabies Immunoglobulin = RIG) as
necessary - Consider hospitalization
What is the recommended prophylaxis after animal bite?
- Rabies prophylaxis
- Tetanus prophylaxis
What is the recommended prophylaxis after human bite?
- Hepatitis B vaccine and Immunoglobulins (if the person who bite you has surface antigen for hepatitis B)
Just Hepatitis B vaccine only if the status of the person who bites you is not known
When to give prophylaxis or early antimicrobial therapy after bite wounds?
- Moderate to severe injury less than 8 hours old, especially if
oedema / crush injury present - Possible bone or joint penetration
- Hand wounds
- Immune-compromised patients (including mastectomy, liver
disease, or steroid therapy) - Wound is adjacent to a prosthetic joint
- Wound is in the genital area
- Coverage should be Gram-negatives, Gram-positives incl. S
aureus and anaerobes
When to consider hospitalization after bite wound infections?
*The indications of hospitalization
- Fever, sepsis, spread of cellulitis
- Significant edema, crush injuries, loss of function
- Significant bites to specific anatomic sites
(penetrating injuries of tendons, joints, open
fractures, damage to cartilage; CNS; injuries to eyes,
ears, nose, hands; severely disfiguring lesions
requiring extensive repair and grafting
