Wound infections secondary to snakebite in central Taiwan

Abstract

Abstract:There are very few microbiological data on wound infections following snakebites. The objective of this study was to investigate the treatment of secondary infection following snakebites in central Taiwan. Microbiological data and antibiotic sensitivity of wound cultures were retrospectively analyzed from December 2005 to October 2007 in a medical center in central Taiwan. A total of 121 snakebite patients participated in the study. Forty-nine (40.5%) subjects were bitten by cobra (Naja atra); 34 of them had secondary infection, and 24 of them (70.6%) needed surgical intervention. Cobra bites caused more severe bacterial infection than other snakebites. Morganella morganii was the most common pathogen, followed by Aeromonas hydrophila and Enterococcus. Gram-negative bacteria were susceptible to amikacin, trimethoprim/sulfamethoxazole, cefotaxime, cefepime, ciprofloxacin, and piperacillin/tazobactam. Enterococcus were susceptible to ampicillin, gentamicin, penicillin and vancomycin. It is reasonable to choose piperacillin/tazobactam, quinolone, second-or third-generation cephalosporin for empirical therapy following snakebite. Surgical intervention should be considered for invasive soft tissue infections.

Bacteriology of Naja atra Snakebite Wound and Its Implications for Antibiotic Therapy

“…3 In Taiwan, bacteriology studies of N. atra bite wounds remain scarce and fragmented. [4][5][6] Although studies of the oral bacteriology of N. atra have been conducted in Hong Kong,7,8 little is known about snakebite wound bacteriology and the effects of geographic differences in the same species. [9][10][11] To better understand the bacteriology of N. atra bite wounds, we retrospectively analyzed 112 cases from two referring medical centers: Taichung Veterans General Hospital (VGH-TC) in central Taiwan and Taipei Veterans General Hospital (VGH-TP) in northern Taiwan.…”

“…Huang and others analyzed 17 cases of snakebite with wound infections, including 16 caused by N. atra snakebite and one by T. stejnegeri, and isolated 13 bacterial species. 5 Morganella morganii, Enterococcus spp., and A. hydrophila were the most common aerobic species and Bacteroides spp. were the only anaerobic species isolated in that study.…”

Can surgical need in patients with Naja atra (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?

“…3,6,7 Although an equine-derived bivalent F(ab)2 antivenin has been produced by the Centers for Disease Control, ROC (Taiwan) to neutralise the venom of N atra, the surgical intervention rate remains high. 1,8 The main objective of this study was to investigate the clinical presentations and predictors for surgery in patients with N atra envenomation. Due to high wound infection rates, the isolated bacteria from surgical wounds and the antimicrobial susceptibility were also analysed.…”

The identification of bacterial flora in oral cavity of snakes

“…Consequently, it may cause shock, acute renal failure, coagulopathy, and heart muscle damage (Dehghani et al 2012). Most complications caused by snakebite are due to poisoning effects such as hemorrhagic or neurotoxicogen effects which may be associated with secondary bacterial infections which are also being presented by non-venomous snakebites (Tagwireyi et al 2001;Hejnar et al 2007;Fonseca et al 2009;Huang et al 2012;Neil et al 2012). The commonest manifestation of a snakebite infection is abscess.…”

“…Some bacterial infections are expected as the main cause of mortality (Jorge et al 2004;Fonseca et al 2009). The species of bacteria in snakes' oral cavity are the key elements for the kind of infection (Huang et al 2012). Like other creatures, snakes' oral cavity is a suitable place for bacterial growth some of which are as the normal oral flora.…”