RESUMO
INTRODUCTION: Clinical and bacteriological features of cobra (Naja) bites are still relatively unknown in Vietnam. This study aimed to characterize the clinical and bacteriological characteristics of local wounds in patients with presumed Naja spp bite, as well as their antibiotic treatment. METHODS: A cross-sectional study was performed on presumed Naja bite patients who were admitted to Bach Mai Hospital in Hanoi, Vietnam. In vitro bacterial isolation, blood tests, and lesion measure were conducted, and antibiotic susceptibilities of localized bite wounds were assessed. The Mann-Whitney test was used to examine the difference in clinical characteristics between patients experiencing presumed Naja atra bites and Naja kaouthia bites. Data are presented as percentages or median with interquartile range, as appropriate. Statistical significance was accepted at P<0.05. RESULTS: Among 46 patients, all had typical clinical features of Naja bite. The median bite-to-hospital time was 6 h (interquartile range 4.0-11.3). The dominant organisms isolated from local wounds were Morganella morganii (11/36) and Enterococcus faecalis (25/36). All cultures were susceptible to ciprofloxacin. No difference was found with regard to pain, swelling circumference, swelling spread, or necrotic area between patients bitten by presumed Naja atra and Naja kaouthia (P>0.05). CONCLUSIONS: Wound necrosis and infection were important clinical issues in presumed Naja spp snake bites. Morganella morganii and Enterococcus faecalis were dominant in local wound swabs of such cases. Ciprofloxacin should be an effective first-line antibiotic for patients with presumed Naja bite.
Assuntos
Antibacterianos/uso terapêutico , Naja , Mordeduras de Serpentes , Animais , Estudos Transversais , Humanos , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/etiologia , Mordeduras de Serpentes/microbiologia , Especificidade da Espécie , VietnãRESUMO
BACKGROUND: Snakebites represent a significant health problem in tropical countries, with an annual incidence of 2.7 million cases worldwide. The incidence of secondary infections after snake bites is also high and is usually caused by bacteria from the oral cavity of snakes. Morganella morganii has been identified as an important cause of infections and has been guiding antibiotic therapy in several regions of Brazil and the world. METHODOLOGY/PRINCIPAL FINDINGS: We performed a retrospective cross-sectional evaluation of snakebites in hospitalized patients between January 2018 and November 2019 and selected those with secondary infection in their medical records. During the period, 326 cases of snakebites were treated, and 155 (47.5%) of them eventually had secondary infections. However, only seven patients underwent culture of soft tissue fragments, in which three cases were negative culture results, while Aeromonas hydrophila was identified in four cases. Of these, 75% were resistant to ampicillin/sulbactam, 50% had intermediate sensitivity to imipenem, and 25% had intermediate sensitivity to piperacillin/tazobactam. Trimethoprim/sulfamethoxazole (TMP-SMX) was not tested on any strain. Of the 155 cases that progressed to secondary infections, 48.4% (75) were empirically treated with amoxicillin/clavulanate, 41.9% (65) with TMP-SMX, and 32 (22%) of these 144 cases required a change to a second regimen, and 10 of these 32 patients required a third therapeutic regimen. CONCLUSION: Wild animals act as reservoirs of resistant bacteria because their oral cavity favors biofilm formation, which explains the finding of A. hydrophila with a reduced sensitivity profile in this study. This fact is essential for the appropriate choice of empirical antibiotic therapy.
Assuntos
Coinfecção , Mordeduras de Serpentes , Animais , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/epidemiologia , Mordeduras de Serpentes/microbiologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Coinfecção/tratamento farmacológico , Brasil/epidemiologia , Estudos Retrospectivos , Estudos Transversais , Antibacterianos/farmacologia , Antibacterianos/uso terapêuticoRESUMO
Snakebite is a common occurrence in Hangzhou, and identifying bacteria in wounds is very important for snakebite treatment. To define the pattern of wound bacterial flora of venomous snakebites and their susceptibility to common antibiotics, we reviewed the medical charts of patients admitted with snakebite at Hangzhou TCM Hospital from January 2019 to December 2020. A total of 311 patients were enrolled in this study. Among them, bacteria culture was positive in 40 patients, and 80 organisms were isolated. The most frequent pathogens were Morganella morganii and Staphylococcus aureus. According to the results of susceptibility testing, a majority of the isolates were resistant to some common first-line antibiotics, such as ampicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, cefoxitin, and cephazolin. Quinolones, however, have shown a better antibacterial effect. In conclusion, snakebite wounds involve a wide range of bacteria. Fluoroquinolones, such as levofloxacin and ciprofloxacin, could be an alternative for empirical treatment in patients with snakebite when the effect of other antibiotics is poor.
Assuntos
Mordeduras de Serpentes , Amoxicilina/farmacologia , Ampicilina/farmacologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias , Cefazolina/farmacologia , Cefoxitina/farmacologia , Ciprofloxacina/farmacologia , Ácido Clavulânico , Fluoroquinolonas/farmacologia , Humanos , Levofloxacino/farmacologia , Testes de Sensibilidade Microbiana , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/epidemiologia , Mordeduras de Serpentes/microbiologia , Sulbactam/farmacologia , Peçonhas/farmacologiaRESUMO
OBJECTIVE: To determine the pattern of oral bacterial flora and their sensitivity to antibiotics in freshly captured native snakes in Hong Kong SAR, People's Republic of China. METHODS: Healthy native snakes were captured and kept in a designated centre. Snake species were identified by experienced herpetologists. Mouth swabs were taken by the veterinarian using strict aseptic techniques. The snakes were released back to the wild immediately after the above procedure. Swabs were sent for microbiological studies of bacterial culture and antibiotic sensitivity. RESULTS: 47 venomous snakes of the families Colubridae, Elapidae and Viperidae and 53 non-medically important snakes were captured. 406 bacterial isolates of 72 different species were cultured: these included gram negative and positive bacterial species and also anaerobic bacterial species. With the exception of the white-lipped pit viper (Cryptelytrops albolabris), venomous snakes harboured more pathogenic bacteria and total bacteria species compared to the non-medically important species. Of the venomous snakes, the Chinese cobra (Naja atra) harboured the largest number of bacterial species. In the present study, all gram negative bacteria associated with wound infection were sensitive to levofloxacin, netilmicin and piperacillin/tazobactam. Many gram negative bacteria in the study were not sensitive to cefuroxime axetil. Amoxicillin/clavulanic acid was an appropriate choice to cover Enterococcus faecalis and anaerobes. CONCLUSION: In the presence of wound infection from snakebite injury in Hong Kong, first line empirical antibiotics include amoxicillin/clavulanic acid plus levofloxacin. Prophylactic antibiotics may be considered in selected cases of Chinese cobra (N. atra) bite, otherwise prophylactic antibiotics are not recommended in snakebite unless tissue necrosis is present.
Assuntos
Bactérias/isolamento & purificação , Boca/microbiologia , Serpentes/microbiologia , Animais , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/etiologia , Estudos Transversais , Farmacorresistência Bacteriana , Hong Kong , Humanos , Testes de Sensibilidade Microbiana , Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/microbiologia , Mordeduras de Serpentes/terapia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologiaRESUMO
Naja atra is a major venomous snake found in Taiwan. The bite of this snake causes extensive wound necrosis or necrotizing soft tissue infection. Conventional microbial culture-based techniques may fail to identify potential human pathogens and render antibiotics ineffective in the management of wound infection. Therefore, we evaluated 16S Sanger sequencing and next-generation sequencing (NGS) to identify bacterial species in the oropharynx of N. atra. Using conventional microbial culture methods and the VITEK 2 system, we isolated nine species from snakebite wounds. On the basis of the 16S Sanger sequencing of bacterial clones from agar plates, we identified 18 bacterial species in the oropharynx of N. atra, including Morganella morganii, Proteus vulgaris, and Proteus mirabilis, which were also present in the infected bite wound. Using NGS of 16S metagenomics, we uncovered more than 286 bacterial species in the oropharynx of N. atra. In addition, the bacterial species identified using 16S Sanger sequencing accounted for only 2% of those identified through NGS of 16S metagenomics. The bacterial microbiota of the oropharynx of N. atra were modeled better using NGS of 16S metagenomics compared to microbial culture-based techniques. Stenotrophomonas maltophilia, Acinetobacter baumannii, and Proteus penneri were also identified in the NGS of 16S metagenomics. Understanding the bacterial microbiota that are native to the oropharynx of N. atra, in addition to the bite wound, may have additional therapeutic implications regarding empiric antibiotic selection for managing N. atra bites.
Assuntos
Metagenômica , Naja naja , RNA Ribossômico 16S/genética , Mordeduras de Serpentes/microbiologia , Infecção dos Ferimentos/microbiologia , Adulto , Idoso , Animais , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Pessoa de Meia-Idade , Orofaringe/microbiologia , Mordeduras de Serpentes/tratamento farmacológico , Taiwan , Infecção dos Ferimentos/tratamento farmacológicoRESUMO
Wound necrosis and secondary infection are common complications after Naja atra bites. Clinical tools to evaluate the infection risk after Taiwan cobra bites are lacking. In this Cobra BITE study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with Taiwan cobra snakebites. Patients with wound infection lacking tissue necrosis were included in developing Cobra BITE score utilizing univariate and multiple logistic regression, as patients with wound necrosis require antibiotics for infection treatment. 8,295,497 emergency department visits occurred in the span of this study, with 195 of those patients being diagnosed as having cobra bites. Of these patients, 23 had wound necrosis, and 30 had wound infection, resulting in a wound infection rate of 27.2% (53/195). Enterococcus faecalis and Morganella morganii were the main bacteria identified in the culture report regardless of whether patients' wounds had necrosis. As per our Cobra BITE score, the three factors predicting secondary wound infection after cobra bites are hospital admission, a white blood cell count (in 103/µL) × by neu-trophil-lymphocyte ratio value of ≥114.23, and the use of antivenin medication. The area under the receiver operating characteristic curve for the Cobra BITE score system was 0.88; ideal sensitivity and specificity were 0.89 and 0.76. This scoring system enables the assessment of wound infections after N. atra bites, and it could be modified and improved in the future for other Naja spp. bites.
Assuntos
Antibacterianos/uso terapêutico , Antivenenos/uso terapêutico , Venenos Elapídicos/antagonistas & inibidores , Enterococcus faecalis/efeitos dos fármacos , Morganella morganii/efeitos dos fármacos , Naja naja , Mordeduras de Serpentes/tratamento farmacológico , Infecção dos Ferimentos/tratamento farmacológico , Adulto , Idoso , Animais , Técnicas de Apoio para a Decisão , Venenos Elapídicos/imunologia , Enterococcus faecalis/isolamento & purificação , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Morganella morganii/isolamento & purificação , Necrose , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/microbiologia , Resultado do Tratamento , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/microbiologiaRESUMO
Snakebites from Taiwan habus (Protobothrops mucrosquamatus) and green bamboo vipers (Viridovipera stejnegeri) account for two-thirds of all venomous snakebites in Taiwan. While there has been ongoing optimization of antivenin therapy, the proper management of superimposed bacterial wound infections is not well studied. In this Bacteriology of Infections in Taiwanese snake Envenomation (BITE) study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with snakebites from these two snakes. We further developed a BITE score to evaluate the probability of wound infections and guide antibiotic usage in this patient population. All snakebite victims who presented to the emergency departments of seven training and research hospitals and received at least one vial of freeze-dried hemorrhagic antivenin between January 2001 and January 2017 were identified. Patient biodata, laboratory investigation results, and treatment modalities were retrieved. We developed our BITE score via univariate and multiple logistic regression analyses. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the BITE score. Out of 8,295,497 emergency department visits, 726 patients presented with snakebites from a Taiwan habu or a green bamboo viper. The wound infection rate was 22.45%, with seven positive wound cultures, including six polymicrobial infections. Morganella morganii, Enterococcus spp., Bacteroides fragilis, and Aeromonas hydrophila were most frequently cultured. There were no positive blood cultures. A total of 33.0% (n = 106) of snakebite patients who received prophylactic antibiotics nevertheless developed wound infections, while 44.8% (n = 73) of wound infection patients were satisfactorily treated with one of the following antibiotics: amoxicillin/clavulanic acid, oxacillin, cefazolin, and ampicillin/sulbactam. With the addition of gentamicin, the success of antibiotic therapy increased by up to 66.54%. The prognostic factors for the secondary bacterial infection of snakebites were white blood cell counts, the neutrophil lymphocyte ratio, and the need for hospital admission. The area under the ROC curve for the BITE score was 0.839. At the optimal cut-off point of 5, the BITE score had a 79.58% accuracy, 82.31% sensitivity, and 79.71% specificity when predicting infection in snakebite patients. Our BITE score may help with antibiotic stewardship by guiding appropriate antibiotic use in patients presenting with snakebites. It may also be employed in further studies into antibiotic prophylaxis in snakebite patients for the prevention of superimposed bacterial wound infections.
Assuntos
Infecções Bacterianas/diagnóstico , Crotalinae , Técnicas de Apoio para a Decisão , Mordeduras de Serpentes/diagnóstico , Infecção dos Ferimentos/diagnóstico , Adulto , Idoso , Animais , Antibacterianos/uso terapêutico , Antivenenos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Tomada de Decisão Clínica , Venenos de Crotalídeos , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Retrospectivos , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/epidemiologia , Mordeduras de Serpentes/microbiologia , Taiwan/epidemiologia , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/microbiologiaRESUMO
OBJECTIVE: To determine the oral bacterial flora associated with two common local venomous snakes in Hong Kong, namely the Chinese cobra (Naja atra) and the bamboo pit viper (Trimeresurus albolabris). DESIGN: Cross-sectional study. SETTING: A non-government organisation and a regional hospital in Hong Kong. SUBJECTS: Thirty-two Chinese cobras and seven bamboo pit vipers. MAIN OUTCOME MEASURES: Species identification of bacteria in the oral cavity of both snakes and their antibiotic susceptibilities. RESULTS: The oral cavity of Chinese cobra harbour a wide range of pathogenic bacteria, including: Gram-negative bacterial species like Morganella morganii, Aeromonas hydrophila and Proteus, and Gram-positive bacteria like Enterococcus faecalis, coagulase-negative Staphylococcus as well as anaerobic species (clostridia). The oral cavity of the Chinese cobra is more likely than that of the bamboo pit viper to harbour pathogenic bacteria associated with snakebite infection (P<0.001). The median number of pathogenic bacteria per snake was significantly higher in the Chinese cobra (P<0.001). All pathogenic Gram-negative bacteria isolated were susceptible to levofloxacin. Amoxicillin/clavulanate provided good coverage against pathogenic Gram-positive bacteria (Enterococcus faecalis) and anaerobes. CONCLUSION: 'Prophylactic' antibiotic treatment for Chinese cobra bites may be beneficial, owing to the multiple pathogenic bacteria in its oral cavity and the higher risk of ensuing necrosis. The regimen of levofloxacin plus amoxicillin/clavulanate appears promising for this purpose, but further study is required to confirm its clinical utility in patients.
Assuntos
Elapidae/microbiologia , Boca/microbiologia , Trimeresurus/microbiologia , Animais , Estudos Transversais , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Estações do Ano , Mordeduras de Serpentes/microbiologiaRESUMO
Secondary bacterial infections following Viperidae snakebite envenomation in children are common. Among 75 patients admitted because of snakebites at the only pediatric hospital in Costa Rica, 16 (21.3%) had a culture-confirmed secondary bacterial infection. Morganella morganii (37.5%), Aeromonas hydrophila (31.2%), and Providencia rettgeri (18.7%) were the most common pathogens. Empiric prophylaxis is still recommended and should be based on local etiological agents and antimicrobial susceptibilities.
Assuntos
Infecções Bacterianas/etiologia , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/microbiologia , Viperidae , Animais , Bactérias/classificação , Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Coinfecção/etiologia , Costa Rica , Feminino , Hospitais , Humanos , MasculinoRESUMO
AIM: Serratia marcescens wound infection after snakebite is often associated with aggressive presentations. However, the virulence determinants remain understudied. MATERIALS & METHODS: Whole-genome sequencing was performed on S. marcescens VGH107, an isolate from wound infection secondary to Trimeresurus mucrosquamatus bite. Comparative genomics approach coupled with multivirulent-locus sequencing typing was applied to systematically predict potential virulence factors. RESULTS: Multivirulent-locus sequencing typing indicated VGH107 falls within the cluster of high pathogenic strains. Comparative analysis identified virulence genes unique in VGH107, including ecpD and ecpE genes for periplasmic chaperone-pilus subunit complex and cdiA and cdiB genes for contact-dependent growth inhibition system. CONCLUSION: The data established here provide foundation for further research regarding the virulence and resistance of S. marcescens.
Assuntos
Genoma Bacteriano/genética , Infecções por Serratia/microbiologia , Serratia marcescens/genética , Serratia marcescens/patogenicidade , Mordeduras de Serpentes/microbiologia , Trimeresurus/microbiologia , Infecção dos Ferimentos/microbiologia , Animais , DNA Bacteriano/genética , Farmacorresistência Bacteriana Múltipla/genética , Genes Bacterianos , Humanos , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Filogenia , Análise de Sequência de DNA , Infecções por Serratia/etiologia , Mordeduras de Serpentes/complicações , Taiwan , Fatores de Virulência/genética , Infecção dos Ferimentos/etiologiaRESUMO
OBJECTIVES: Carbapenem resistance mediated by New Delhi metallo-ß-lactamase 1 (NDM-1) and its variants has caused a major public-health concern worldwide. Here we report for the first time an Escherichia coli isolate positive for a novel variant (NDM-11). METHODS: blaNDM genes were investigated in E. coli by PCR and sequencing, and blaNDM variants were further characterised. The susceptibility pattern of novel blaNDM-11 towards different antimicrobials was compared with blaNDM-1 by cloning and expression in E. coli TOP10. RESULTS: A total of 33 carbapenem-resistant E. coli isolates were screened by PCR for the presence of blaNDM, of which 15 (45.5%) were positive. Sequencing of the PCR products revealed 10 isolates with NDM-1 and 5 isolates with NDM variants (one each of NDM-4, NDM-8 and NDM-11 and two NDM-5). Other resistance genes, including blaTEM-1, blaCTX-M-15, blaVIM, plasmid-encoded AmpC blaCMY-2 and 16S methyltransferases (rmtB and rmtC), were also associated with NDM variants in different combinations. The blaNDM variants were located on a transferable IncF-type plasmid of >100kb. Pulsed-field gel electrophoresis (PFGE) showed that all five E. coli isolates were unrelated, and multilocus sequence typing (MLST) revealed that they all belonged to ST131. Expression of the blaNDM-1 and blaNDM-11 genes in E. coli TOP10 showed no significant difference in MICs to various ß-lactams, including carbapenems. CONCLUSIONS: This study underlines the spread of NDM variants with other antimicrobial resistance genes in E. coli in South India. It also describes a novel NDM variant (blaNDM-11) having an antimicrobial resistance pattern similar to blaNDM-1.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , beta-Lactamases/genética , Proteínas de Bactérias/genética , Técnicas de Tipagem Bacteriana , Carbapenêmicos/farmacologia , Escherichia coli/classificação , Infecções por Escherichia coli/microbiologia , Variação Genética , Humanos , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Plasmídeos , Mordeduras de Serpentes/microbiologia , Infecção dos Ferimentos/microbiologia , beta-Lactamas/farmacologiaRESUMO
BACKGROUND: Necrotizing fasciitis following venomous snakebites is uncommon. The purpose of this study was to describe the initial clinical features of necrotizing fasciitis after snakebites, and to identify the risk factors for patients with cellulitis who later developed necrotizing fasciitis. METHODS: Sixteen patients with surgically confirmed necrotizing fasciitis and 25 patients diagnosed with cellulitis following snakebites were retrospectively reviewed over a 6-year period. Differences in patient characteristics, clinical presentations, snake species and laboratory data were compared between the necrotizing fasciitis and the cellulitis groups. RESULTS: None of the 41 patients died after being bitten by a snake. Twenty-nine patients (70.7%) were bitten by a cobra. Enterococcus species and Morganella morganii were the most common pathogens identified in wound cultures. Relative to the cellulitis group, the necrotizing fasciitis group had significantly higher rates of hemorrhagic bullae (p=0.000), patients with underlying chronic disease (p=0.019), white blood cell counts (p=0.035), segmented white cell counts (p=0.02), and days of hospitalization (p=0.001). CONCLUSIONS: Victims of venomous snakebites should be admitted for close monitoring of secondary wound infections. The risk factors of developing necrotizing fasciitis from cellulitis following snakebites were associated with chronic underlying diseases and leukocytosis (total white blood-cell counts ≥10000cells/mm3 and ≥80% of segmented leukocyte forms). Physicians should be alert to a worsening wound condition after a snakebite, and surgical interventions should be performed for established necrotizing fasciitis with the empirical use of third-generation cephalosporins plus other regimens.
Assuntos
Fasciite Necrosante/diagnóstico , Mordeduras de Serpentes/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Animais , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/microbiologia , Elapidae , Enterococcus , Enterococcus faecalis/isolamento & purificação , Fasciite Necrosante/etiologia , Fasciite Necrosante/microbiologia , Fasciotomia , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Morganella morganii/isolamento & purificação , Estudos Retrospectivos , Fatores de Risco , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/microbiologia , Taiwan , Centros de Atenção TerciáriaRESUMO
BACKGROUND: Snakebites can produce severe local and systemic septic complications as well as being associated with significant overall morbidity and even mortality. OBJECTIVE: A prospective audit was undertaken to determine the bacterial causation of wound infection secondary to snakebite, and attempt to quantify the burden of disease. METHODS: The audit was undertaken at Ngwelezane Hospital, which provides both regional and tertiary services for north-eastern KwaZulu-Natal Province, South Africa, over a 4-month period. Records of patients who required surgical debridement for extensive skin and soft-tissue necrosis were analysed. At the time of debridement, tissue samples of necrotic or infected tissue were sent for bacteriological analysis as standard of care. Microbiology results were analysed. RESULTS: A total of 164 patients were admitted to hospital for management of snakebite, of whom 57 required surgical debridement and 42 were included in the final microbiological analysis. Children were found to be the most frequent victims of snakebite; 57.8% of patients in this study were aged ≤10 years and 73.7% ≤15 years. Culture showed a single organism in 32/42 cases, two organisms in 8 and no growth in 2. Eight different types of organisms were cultured, five of them more than once. Thirty-five specimens (83.3%) grew Gram-negative Enterobacteriaceae, the most frequent being Morganella morganii and Proteus species. Thirteen specimens (31.0%) grew Enterococcus faecalis. Gram-negative Enterobacteriaceae showed 31.4% sensitivity to ampicillin, 40.0% sensitivity to amoxicillin plus clavulanic acid, 34.3% sensitivity to cefuroxime, 97.1% sensitivity to ceftriaxone, and 100% sensitivity to ciprofloxacin, gentamicin and amikacin. E. faecalis was 92.3% sensitive to amoxicillin, 92.3% sensitive to amoxicillin plus clavulanic acid, 100% sensitive to ciprofloxacin, 92.3% resistant to erythromycin and 100% resistant to ceftriaxone. CONCLUSION: Children are particularly vulnerable to snakebite, and the consequences can be devastating. While the majority of patients in this study were shown to have secondary bacterial infection, debridement and subsequent wound management is considered the mainstay of treatment. Common organisms are Enterobacteriaceae and enterococci. There appears to be a role for antibiotics in the management of these patients. A good antibiotic policy is strongly advocated.
Assuntos
Mordeduras de Serpentes/microbiologia , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/cirurgia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Desbridamento , Farmacorresistência Bacteriana , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Estudos Prospectivos , Mordeduras de Serpentes/epidemiologia , África do Sul/epidemiologia , Infecção dos Ferimentos/epidemiologiaRESUMO
A total of 112 cases of Naja atra envenomation were examined at two referring hospitals: Taichung Veterans General Hospital in central Taiwan and Taipei Veterans General Hospital (VGH-TP) in northern Taiwan. Overall, 77% (86/112) of cases developed clinically suspected wound infections and 54% (61/112) required surgery secondary to tissue necrosis, finger or toe gangrene, and/or necrotizing fasciitis. Morganella morganii was the most abundant gram-negative bacterial strain isolated from bite wounds, followed by Proteus spp., Aeromonas hydrophila, Pseudomonas aeruginosa, and Providencia spp. in descending order; Enterococcus spp. were the most common gram-positive bacteria and Bacteroides spp. were the only anaerobic bacteria. A few episodes of bacteremia were caused by Bacteroides and Shewanella spp. There were no significant variations in the distribution of bacterial species between these two hospitals except for a higher incidence of M. morganii, Enterococcus spp., and polymicrobial infection observed at VGH-TP, which may have been related to variations in the fecal flora of prey and oral flora of individual snakes in different geographic areas in Taiwan. According to the susceptibility test involving various pathogens, first-line drug options for the management of N. atra snakebite wound infections may include monotherapy with ureidopenicillin or combination therapy with aminopenicillin and a third-generation cephalosporin or fluoroquinolone. A prospective evaluation of empiric antibiotic therapy for the management of N. atra snakebite should be considered.
Assuntos
Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Elapidae , Mordeduras de Serpentes/microbiologia , Infecção dos Ferimentos/microbiologia , Animais , Antibacterianos/administração & dosagem , Bactérias/classificação , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/patologia , Humanos , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/epidemiologia , Taiwan/epidemiologia , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/epidemiologiaRESUMO
Hand bites from domestic animals are extremely common. Though many may initially appear benign, it is important for treating physicians to be aware of the factors that place patients sustaining animal bites at additional risk for infection. As clinicians, we must be able to efficiently diagnose and treat these patients properly to avoid the morbidity that animal bites can provoke. The current paper reviews the evaluation and management of domestic animal bites to the hand.
Assuntos
Mordeduras e Picadas/cirurgia , Traumatismos da Mão/cirurgia , Mãos/cirurgia , Animais de Estimação , Infecção dos Ferimentos/cirurgia , Animais , Aves , Mordeduras e Picadas/diagnóstico , Mordeduras e Picadas/microbiologia , Mordeduras e Picadas/fisiopatologia , Gatos , Cães , Furões , Mãos/fisiopatologia , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/microbiologia , Traumatismos da Mão/fisiopatologia , Humanos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/microbiologia , Mordeduras de Serpentes/fisiopatologia , Mordeduras de Serpentes/cirurgia , Serpentes , Resultado do Tratamento , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/fisiopatologiaRESUMO
Venom and oropharyngeal swabs from freshly captured Malayan pit vipers (Calloselasma rhodostoma) in southern Thailand and captive specimens in England were cultured aerobically and anaerobically to identify the bacterial flora which might contaminate wounds inflicted by bites of this species. The snakes' mouths contained a wider range of organisms than their venoms, especially gut-related Gram-negative rods such as Enterobacter and Pseudomonas species and some staphylococci and clostridia. There were fewer positive cultures from captive snakes. C. rhodostoma venom inhibited the growth of group A streptococci and, to a lesser extent, that of Staphylococcus aureus and Clostridium perfringens but not that of 2 Gram-negative organisms. Secondary bacterial infection is an important complication of snake bite, especially of necrotic wounds. A combination of gentamicin with benzyl penicillin would have prevented infection with, or treated, most of the bacteria isolated from snake venoms and mouths in Thailand.
Assuntos
Bactérias/isolamento & purificação , Venenos de Crotalídeos , Orofaringe/microbiologia , Serpentes/microbiologia , Animais , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Vesícula/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Mordeduras de Serpentes/microbiologiaRESUMO
Culture of fang, fang sheath and venom of fifteen healthy freshly captured Bothrops jararaca were analyzed. The bacteria most frequently encountered were group D streptococci (12 snakes), Enterobacter sp. (6), Providencia rettgeri (6), Providencia sp. (4), Escherichia coli (4), Morganella morganii (3) and Clostridium sp. (5). The bacteria observed are similar to those found in the abscesses from Bothrops bitten patients. Since these snake mouth bacteria may be inoculated during the snake bite, bacterial multiplication and infection may occur under favorable conditions.
Assuntos
Infecções Bacterianas/etiologia , Venenos de Crotalídeos , Boca/microbiologia , Serpentes/microbiologia , Animais , Humanos , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/microbiologiaRESUMO
Thirty-eight cases of abscess secondary to pit viper envenomation are reviewed. The incidence of abscess formation was 9%. Results of aerobic cultures revealed growth of enteric, coliform organisms in 22 of 25 isolates obtained from previously unopened abscesses. Clinical evidence for co-existent anaerobic infection is presented. No cases of tetanus were encountered. Clinical and laboratory findings of patients in the study are correlated with a review of bacteriologic investigations of the oral flora of venomous snakes. Use of antibiotics effective against aerobic coliforms and histotoxic anaerobic organisms for prophylaxis and/or treatment of infectious complications of pit viper envenomation are recommended.
Assuntos
Abscesso/microbiologia , Mordeduras de Serpentes/microbiologia , Abscesso/tratamento farmacológico , Abscesso/etiologia , Antibacterianos/uso terapêutico , Humanos , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/tratamento farmacológicoRESUMO
Bite wounds are common injuries that are often mistakenly considered innocuous by both patients and physicians. These wounds consist of laserations, evulsions, punctures, and scratches. While many of these wounds require minimal or no therapy, a significant number results in infections, which may even be life-threatening. The bacteria associated with bite-wound infections generally originate from the oropharyngeal flora of the biting animal. The clinical presentation and appropriate treatment of infected bite wounds vary according to the causative microorganisms. This review focuses on dog, cat, small rodents, monkey, and snake bite-wound infections, risk factors, bacteriology, antimicrobial susceptibility patterns of the causative organisms, and recommended treatment strategies.
Assuntos
Mordeduras e Picadas/complicações , Infecção dos Ferimentos/microbiologia , Animais , Capnocytophaga , Gatos , Cães , Infecções por Bactérias Gram-Negativas/microbiologia , Haplorrinos , Humanos , Testes de Sensibilidade Microbiana , Orofaringe/microbiologia , Infecções por Pasteurella/microbiologia , Fatores de Risco , Roedores , Mordeduras de Serpentes/microbiologiaRESUMO
Shewanella wound infections after snake bites are rare. We report the case of a Shewanella algae wound infection associated with a cobra bite in a 27-year-old woman. The isolate was confirmed by sequencing of the 16S ribosomal DNA gene. This case expands the reported spectrum of infection caused by S. algae and raises the possibility that S. algae could be a causative pathogen in wound infections resulting from snake bites.