Human Bite Wounds

- Discussion:
      - clenched fist injury 
      - infections of the hand
             - bacteriology of hand infections:
             - bites distal to the wrist are at higher risk for malignant infections due to the proximity of superficial spaces, flexor tendons, and joints; 
             - besides considering tetatnus also consider Hep B.
      - need to treat for staph, strep, and eikenella infections;
      - prophylactic treatment: augmentin / amoxicillin or with allergy (cipro + clindamycin)
      - w/ estabilished infection: unasyn or with allergy  (cipro + clindamycin) or ceftriaxone 
      - offending organisms:
             - see: bacteriology of hand infections;
             - strep - viridans strep, grp a strep, staph aureus, eikenella corrodens, bacteriodes, fusobacterium, actinomycetes, spirochetes;
             - alpha-hemolytic streptococci are the most frequent isolates from human bite wounds;
             - anaerobic bacteria are commonly found in all types of infected bites;
             - borrelia vincentii is a spirochete that may appear in association w/ w/ bacteroides;
             - in bites inflicted by hospitalized patients, consider enterobacteriaceae
             - Eikenella corrodens in hand infections.

- references:
       - A 4-year review of human bite injuries presenting to emergency medicine and proposed evidence-based guidelines.
       - Hand infections. Bacteriology and treatment: a prospective study.
       - Human bites of the hand: twenty years of experience
       - Human bites in children. A six-year experience.
       - Osteomyelitis of the hand after a human bite.
       - A functional treatment method for interphalangeal pyogenic arthritis. 
       - Bacteriology of human and animal bite wounds.
       - Management of human and animal bite wound infection: an overview
       - Natural course of the human bite wound: incidence of infection and complications in 434 bites and 803 lacerations in the same group of patients.
       - Factors associated with delay to emergency department presentation, antibiotic usage and admission for human bite injuries
       - Comparison of the epidemiology of human bites evaluated at three US pediatric emergency departments.
       - The human bite injury: a clinical audit and discussion regarding the management of this alcohol fuelled phenomenon
       - Dog-bite lacerations: a controlled trial of primary wound closure
       - Primary closure of mammalian bites

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, February 6, 2013 4:21 pm