Wound infections II

Question 1

Grossly what differentiates dog and cat bites?

Answer 1

Cat-hands upper extremities, more prone to infection, deep abscesses and osteomyelitis
Dog-Depressed/open skull fractures, severe scalp and intracranial bleeding

Question 2

What are the most common pathogens in dog/cat bites?

Answer 2

Pasteurella (50% dogs, 75% cats)
Capnocytophagia canimorsus
Anaerobes -Bacteroides, Fusobacteria, Porphyromonas, Prevotella, Propionibacteria, Peptostreprococci
Skin flora- staphylococci, streptococci (40%)

Question 3

What are the symptoms of capnocytophagia canimorsus infection?

Answer 3

dog or cat bite (normal flora)
Severe infection in immunocompromised
-Fevers myalgias, rash, GI complaints, sepsis
Myocarditis, endocarditis, meningitis
Rarely bacteremia (25-60% mortality)

Question 4

What kills capnocytophagia canimorsus?

Answer 4

Amoxocillin (Augmentin)

resistant to TMP/SMX

Question 5

What kills Pasteurella multocida?

Answer 5

Beta-lactams, azithromycin

AVOID erythromycin, clindamycin

Question 6

What animal carries most infective Pasteurella multocida?

Answer 6

50-90% of cats in their nasopharynx

Question 7

What does a P. multocida infection look like?

Answer 7

incubation of 15 hrs.
local cellulitis and low-grade fevers
Complications: abscess, septic arthritis, osteomyelitis, pneumonia, endocarditis, meningitis

Question 8

What is proper management of animal bite wounds?

Answer 8

-Irrigation: saline and debridement
Surgical evaluation
Leave wound open, delayed primary closure, except complex facial wounds
-Elevation
-Antibiotics

Question 9

When after an animal bite are prophylactic antibiotics indicated?

Answer 9

Deep puncture wounds
Venous/lymphatic compromise
Mod-severe wounds with crush injury
On hands or near joints/bone
Require surgical repair
Immunocompromised

Question 10

What’s the oral antibiotic of choice for dog/cat bites?

Answer 10

Amoxicillin-clavulanate
alternates:
Doxy/TMP-SMX/Penicillin VK/Cefuroximine/Moxifloxacin
PLUS
Metro/clindamycin

Question 11

Whats the IV antibiotic of choice for dog/cat bites?

Answer 11

Ampicillin-sulbactam or Piperacillin-tazobactam

B-lactam with B-lactamase inhibitors

Question 12

What are the two types of human bites?

Answer 12

Clenched fist

Occlusive

Question 13

What infections often result from human bites?

Answer 13

Strep, staph, anaerobes
Eikenella corrodens
Potentially: HSV, HBV, HCV, HIV

Question 14

What causes cat scratch disease? how is it treated?

Answer 14

Bartonella henselae
Azithromycin if disseminated or severe
(most resolve spontaneously)

Question 15

What are the circumstances of most pig-related trauma? How do you treat them?

Answer 15

Gored by boar on thighs
Polymicrobial: staph, strep, multocida, Actinobacillus suis
Amoxicillin-clavulanate +/- cipro

Question 16

What can you get from a monkey bite that you’re very concerned about? What do you do about it?

Answer 16

Herpes B 5-21 day incubation
Valacyclovir prophylaxis
Acyclovir, Ganciclovir

Question 17

What are the 3 clinical phases of rabies/

Answer 17

1-flu like illness, discomfort, prickling/itching at site
2-anxiety, confusion, Delerium, insomnia, hydrophobia
3-coma, death

Question 18

How do you treat rabies?

Answer 18

Clean wound aggressively
Rabies immune globulin around wound
Vaccine on days 0, 3, 7, 14, 28

Question 19

What are the symptoms of tetanus?

Answer 19

Toxin interferes with neuromuscular release (blocks inhibitors)
Unopposed muscle contraction, spasm, lockjaw
Generalized spasms
Seizures

Question 20

How do you treat tetanus?

Answer 20

Tetanus immune globulin
Tetanus toxoid booster
aggressive wound care
antibiotics
mechanical ventilation
Sedation
Muscle relaxants

Question 21

Describe a tetanus prone wound

Answer 21

>6 hours old
Sellate, avulsion
>1cm depth
Missile, crush, burn
Contaminants and devitalized tissue present

Question 22

What defines a wound infection?

Answer 22

1. Patient has organisms cultured from tissue or drainage at affected site
2. Patient has purulent drainage at affected site
3. Patient has an abscess or other evidence of infection during surgery or histopathology
4. Patient has two of the following at the site with no other recognized cause: pain/tenderness, redness, swelling, or heat

Question 23

What percentage of war wounds typically get infected?

Answer 23

30%

20% of those have multiple repeat infections

Question 24

What are early wound infections?

Answer 24

Beta hemolytic streptococci
Aerobic Spore-formers
Bacillius subtilus
Staph epidermitis
C. perfringens
(gram negative rods)

Question 25

What are late wound infections?

Answer 25

GAS (gram positive cocci)
Coliforms
Pseudomonas

Question 26

What are the predominate problem bacterial group for recent war wounds?

Answer 26

GNR
travel with patients
result in nosocomial spread

Question 27

If something doesn’t look infected should you culture it?

Answer 27

No

Question 28

What is Acinetobacter and why is it a problem?

Answer 28

Gm -, aerobic, rods
naturally MDR to include Colistin
Found in Iraqi and Afghan soil

Question 29

What are some non-antibiotic ways of preventing wound infections?

Answer 29

Debridement:

• Saline lavage
• High volume, low pressure
• Repeat washouts

Negative pressure wound therapy appears to promote healing and decrease infection

Question 30

What antibiotics are used as prophylactics for wound infections?

Answer 30

IV Cefazolin +/- Metro

OR
Clindamycin, Levo/cipro+Metro