Wound infections II Flashcards
Grossly what differentiates dog and cat bites?
Cat-hands upper extremities, more prone to infection, deep abscesses and osteomyelitis
Dog-Depressed/open skull fractures, severe scalp and intracranial bleeding
What are the most common pathogens in dog/cat bites?
Pasteurella (50% dogs, 75% cats)
Capnocytophagia canimorsus
Anaerobes -Bacteroides, Fusobacteria, Porphyromonas, Prevotella, Propionibacteria, Peptostreprococci
Skin flora- staphylococci, streptococci (40%)
What are the symptoms of capnocytophagia canimorsus infection?
dog or cat bite (normal flora) Severe infection in immunocompromised -Fevers myalgias, rash, GI complaints, sepsis Myocarditis, endocarditis, meningitis Rarely bacteremia (25-60% mortality)
What kills capnocytophagia canimorsus?
Amoxocillin (Augmentin)
resistant to TMP/SMX
What kills Pasteurella multocida?
Beta-lactams, azithromycin
AVOID erythromycin, clindamycin
What animal carries most infective Pasteurella multocida?
50-90% of cats in their nasopharynx
What does a P. multocida infection look like?
incubation of 15 hrs.
local cellulitis and low-grade fevers
Complications: abscess, septic arthritis, osteomyelitis, pneumonia, endocarditis, meningitis
What is proper management of animal bite wounds?
-Irrigation: saline and debridement Surgical evaluation Leave wound open, delayed primary closure, except complex facial wounds -Elevation -Antibiotics
When after an animal bite are prophylactic antibiotics indicated?
Deep puncture wounds Venous/lymphatic compromise Mod-severe wounds with crush injury On hands or near joints/bone Require surgical repair Immunocompromised
What’s the oral antibiotic of choice for dog/cat bites?
Amoxicillin-clavulanate alternates: Doxy/TMP-SMX/Penicillin VK/Cefuroximine/Moxifloxacin PLUS Metro/clindamycin
Whats the IV antibiotic of choice for dog/cat bites?
Ampicillin-sulbactam or Piperacillin-tazobactam
B-lactam with B-lactamase inhibitors
What are the two types of human bites?
Clenched fist
Occlusive
What infections often result from human bites?
Strep, staph, anaerobes
Eikenella corrodens
Potentially: HSV, HBV, HCV, HIV
What causes cat scratch disease? how is it treated?
Bartonella henselae
Azithromycin if disseminated or severe
(most resolve spontaneously)
What are the circumstances of most pig-related trauma? How do you treat them?
Gored by boar on thighs
Polymicrobial: staph, strep, multocida, Actinobacillus suis
Amoxicillin-clavulanate +/- cipro
What can you get from a monkey bite that you’re very concerned about? What do you do about it?
Herpes B 5-21 day incubation
Valacyclovir prophylaxis
Acyclovir, Ganciclovir
What are the 3 clinical phases of rabies/
1-flu like illness, discomfort, prickling/itching at site
2-anxiety, confusion, Delerium, insomnia, hydrophobia
3-coma, death
How do you treat rabies?
Clean wound aggressively
Rabies immune globulin around wound
Vaccine on days 0, 3, 7, 14, 28
What are the symptoms of tetanus?
Toxin interferes with neuromuscular release (blocks inhibitors)
Unopposed muscle contraction, spasm, lockjaw
Generalized spasms
Seizures
How do you treat tetanus?
Tetanus immune globulin Tetanus toxoid booster aggressive wound care antibiotics mechanical ventilation Sedation Muscle relaxants
Describe a tetanus prone wound
>6 hours old Sellate, avulsion >1cm depth Missile, crush, burn Contaminants and devitalized tissue present
What defines a wound infection?
- Patient has organisms cultured from tissue or drainage at affected site
- Patient has purulent drainage at affected site
- Patient has an abscess or other evidence of infection during surgery or histopathology
- Patient has two of the following at the site with no other recognized cause: pain/tenderness, redness, swelling, or heat
What percentage of war wounds typically get infected?
30%
20% of those have multiple repeat infections
What are early wound infections?
Beta hemolytic streptococci Aerobic Spore-formers Bacillius subtilus Staph epidermitis C. perfringens (gram negative rods)
What are late wound infections?
GAS (gram positive cocci)
Coliforms
Pseudomonas
What are the predominate problem bacterial group for recent war wounds?
GNR
travel with patients
result in nosocomial spread
If something doesn’t look infected should you culture it?
No
What is Acinetobacter and why is it a problem?
Gm -, aerobic, rods
naturally MDR to include Colistin
Found in Iraqi and Afghan soil
What are some non-antibiotic ways of preventing wound infections?
Debridement:
- Saline lavage
- High volume, low pressure
- Repeat washouts
Negative pressure wound therapy appears to promote healing and decrease infection
What antibiotics are used as prophylactics for wound infections?
IV Cefazolin +/- Metro
OR
Clindamycin, Levo/cipro+Metro