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.
Snakebites are of important public health concern as they can progress in severity and they may cause death, especially in populations with low socioeconomic status or in rural areas of tropical countries. In this retrospective cross-sectional study, we evaluated the clinical-epidemiological profiles of patients admitted for snakebites envenoming at a Reference Hospital in Goiás State, Brazil, from January 2018 to November 2019 with criteria and definitions for venomous accidents notified by the Epidemiological Surveillance Center. Of 326 reported cases, 268 (82.2%) involved Bothrops, 56 (17.9%) involved Crotalus, and 1 (0.3%) involved an elapid. The remaining case (0.3%) was caused by an unidentified snake, as the clinical signs were suggestive of both Bothrops and Crotalus envenomation and the patient received bivalent antivenom serum. Most snakebites occurred in men (n= 252, 77%) and in individuals from rural areas (n= 215, 65.9%). Pain occurred in 315 (96.9%) patients and edema in 274 (84.3%), being more common in the bothropic accidents. In the crotalic accidents, pain occurred in 50 (89.3%) patients and edema in 24 (44.9%). The snakebite severity was considered mild in 107 (32.8%), moderate in 129 (39.8%), and severe in 90 (27.6%) patients. Acute renal injury was the most common systemic complication, occurring in 64 patients (19.9%), while secondary infection was the most important local complication, occurring in 155 (47.5%) patients. Most cases were classified as moderate or severe, probably because our tertiary level hospital service handles with more complex cases. Additionally, a significant number of crotalic accidents had a local presentation, indicating that the venom of snakes in the region has a particular composition.
KEY WORDS: Ophidian envenomation; Crotalus; Bothrops; secondary infection.
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