Secondary infection profile after snakebite treated at a tertiary referral center in the Brazilian Amazon

Mendes, Viviane Kici da Graça; Pereira, Handerson da Silva; Elias, Ignês Cruz; Soares, Gean Souza; Santos, Mônica; Talhari, Carolina; Cordeiro-Santos, Marcelo; Monteiro, Wuelton Marcelo; Sachett, Jacqueline de Almeida Gonçalves

doi:10.1590/0037-8682-0244-2021

Cited by 8 publications

(12 citation statements)

References 12 publications

(37 reference statements)

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“…11 The median age of the patients was similar to that found in Australia (33 years) 12 and another study from Colombia (31.7 years) 4 but lower than that reported in other countries (41.0-52.0 years), [13][14][15][16] with a predominance of men, as identified in the different studies (59.3-80.8%). 4,[12][13][14][15][16][17][18][19][20][21][22][23][24][25] In this cohort of patients, the genus of the snake that was most identified was Bothrops, which is consistent with the epidemiological surveillance data of the country. 4,5 A third of all patients could not identify the genus of the snake, a difficulty that also occurs in other countries but in higher proportions (49.0-54.7%).…”

Section: Discussionsupporting

confidence: 88%

Clinical characteristics and use of antibiotics in a group of patients with snake bites in Colombia

Valladales-Restrepo,

Rojas-Ramirez,

Santander-Pai

et al. 2023

Therapeutic Advances in Infection

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Introduction: Millions of snake bites occur worldwide each year. Clinical practice guidelines generally do not recommend the use of prophylactic antibiotics. Objective: To determine the sociodemographic, clinical, and pharmacological variables and the use of antibiotics in a group of patients with snake bites in Colombia. Methods: A retrospective cross-sectional study was carried out. Patients affiliated with a Colombian health insurer who presented with snake bites between 2015 and 2022 were included. The cases were identified from the National Public Health Surveillance System. Sociodemographic, clinical and pharmacological variables were identified. Descriptive and bivariate analyses were performed. Results: A total of 643 patients were analyzed, with a median age of 30.8 years, and 74.7% were men. The most frequently identified genus of snake was Bothrops (88.8%), and most incidents were classified as mild ophidian accidents (61.6%). A total of 59.7% of patients received snake antivenom. A total of 13.8% and 2.2% of the patients had cellulitis or abscesses, respectively. A total of 63.5% received antibiotics (50.6% for prophylaxis and 12.9% for treatment), especially cephalexin (25.9%), and most of the antibiotic management was considered inappropriate (91.7%). Conclusion: Most patients with snake bites received antibiotics, especially for prophylactic purposes, a clinical behavior that goes against current evidence. The use of antibiotics with an unsuitable spectrum for the microorganisms that are usually found in the wounds of these patients is frequent. The development of local clinical practice guidelines is required to help reduce the overprescription of antibiotics, as the excessive use of antimicrobials is the main determinant of antimicrobial resistance.

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Section: Discussionsupporting

confidence: 88%

Clinical characteristics and use of antibiotics in a group of patients with snake bites in Colombia

Valladales-Restrepo,

Rojas-Ramirez,

Santander-Pai

et al. 2023

Therapeutic Advances in Infection

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“…Secondary infection and necrosis are prevalent complications of snakebites; they have been observed in 40% of Bothrops jararaca bites with envenomation. These complications may be attributable to the proteolytic action of Bothrops venom, acting in combination with bacteria present in the snake's oral cavity 9,17,18. In addition, bacteria present in skin or clothing of the victim may be a source of infection associated with necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] In addition, secondary bacterial infections are observed in approximately 40% of Bothrops snakebites in the Brazilian Amazon. 5,9,10 Clinical manifestations of a snakebite begin with bleeding due to trauma from the animal's fangs; subsequent local manifestations range from a painless, hyperemic injury to severe pain and swelling at the location of the bite within minutes after the event. According to the Brazilian Ministry of Health's Manual of Diagnosis and Treatment, the main complications of snakebites are (a) compartment syndrome in severe cases due to ischemia, tissue necrosis, and neuropathy (the most important manifestations of compartment syndrome are intense pain, paresthesia, hypothermia of the distal segment, cyanosis, and motor coordination deficit), (b) abscesses due to bacterial infections, and (c) necrosis due to the proteolytic action of Bothrops venom.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of a Snakebite Injury With Secondary Bacterial Infection

Sachett

Vieira

Soares

et al. 2023

Journal of Wound, Ostomy &Amp; Continence Nursing

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BACKGROUND:Pit viper snakebites are challenging as they often cause tissue injury and secondary bacterial infection that may impair full recovery of the affected limb. We describe the evolution of a snakebite injury with secondary infection and the use of specialized dressings to achieve tissue repair and complete closure of the wound. CASE: Ms E., a 45-year-old woman, was bitten by a pit viper that began as a small lesion and progressed to necrosis, cellulitis, edema, and hyperemia of the perilesional skin, local inflammation, and infection. We implemented a combination of topical hydrogel therapy with calcium alginate and hydrofiber with 1.2% silver to promote autolytic debridement, combat local infection, and provide a moist wound environment. The wound required daily local treatment for 2 months due to extensive tissue damage, combined with the proteolytic action of the bothropic venom. CONCLUSION: The care of wounds caused by snakebites is a challenge for the health care team due to tissue loss resulting from the action of the venom and secondary bacterial infection. Close follow-up with the use of systemic antibiotics and topical therapies proved effective in minimizing tissue loss in this case.

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“…Generally, SBEs caused by Bothrops snakes are characterized by local (pain, swelling, blisters, and bleeding from the bite site) and systemic (abnormal clotting, spontaneous bleeding and kidney failure) manifestations [ 9 ]. Other complications include bacterial infections, necrosis, compartment syndrome, and amputations [ 10 – 12 ]. To prevent severe cases, antivenom must be administered quickly.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes after snakebite envenomations: A retrospective cohort in the Brazilian Amazonia

et al. 2022

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Snakebite envenomations (SBEs) in pregnant women can result in adverse maternal or neonatal effects, such as abortion, placental abruption, preterm labor, fetal malformations, and maternal, fetal or neonatal deaths. Despite the high incidence of SBEs in the Brazilian Amazon, there is no literature on the impact of SBEs on pregnancy outcomes. The objective of this study was to describe clinical epidemiology and outcomes associated with SBEs in women of childbearing age and pregnant women in the state of Amazonas, Western Brazilian Amazon, from 2007 to 2021. Information on the population was obtained from the Reporting Information System (SINAN), Mortality Information System (SIM) and Live Birth Information System (SINASC) for the period from 2007 to 2021. A total of 36,786 SBEs were reported, of which 3,297 (9%) involved women of childbearing age, and 274 (8.3%) involved pregnant women. Severity (7.9% in pregnant versus 8.7% in non-pregnant women) (P = 0.87) and case-fatality (0.4% in pregnant versus 0.3% in non-pregnant women) rates were similar between groups (P = 0.76). Pregnant women who suffered snakebites were at higher risk for fetal death (OR: 2.17, 95%CI: 1.74–2.67) and neonatal death (OR = 2.79, 95%CI: 2.26–3.40). This study had major limitations related to the completeness of the information on the pregnancy outcomes. Although SBE incidence in pregnant women is low in the Brazilian Amazon, SBEs increased the risk of fetal and neonatal deaths.

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Secondary infection profile after snakebite treated at a tertiary referral center in the Brazilian Amazon

Cited by 8 publications

References 12 publications

Clinical characteristics and use of antibiotics in a group of patients with snake bites in Colombia

Clinical characteristics and use of antibiotics in a group of patients with snake bites in Colombia

Treatment of a Snakebite Injury With Secondary Bacterial Infection

Pregnancy outcomes after snakebite envenomations: A retrospective cohort in the Brazilian Amazonia

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