Appropriate antibiotics in dog bite injuries: an audit study

Abstract

Background: Dog bite injuries are a common presentation to Accident and Emergency. In the United Kingdom ~250,000 people attend emergency units each year as a result of dog wounds. Currently, there is a lack of consistency in the approach and management of such wounds across plastic surgery units in the United Kingdom. Method: A retrospective review of medical record of patients who were admitted under the care of the Plastic Surgery Department at University Hospital North Midlands NHS Foundation Trust with dog-bite wounds between January and December 2018. Results: Of the 69 patients that were included in the study, 14 (20%) of them had been prescribed antibiotics that were ineffective and against antimicrobial guidelines. Following liaison with the antimicrobial governance team and input from NICE guidelines, the trust’s MicroGuide Antibiotic Prescribing Guidelines App was updated. A reaudit from November 2019 to February 2020 showed that there was 100% compliance with guidance. Conclusion: Updating the University Hospital of North Midlands NHS Trust’s MicroGuide antibiotic prescribing guidelines for the treatment of dog-bite injuries resulted in 100% of patients being treated with the correct antibiotic. Given the polymicrobial nature of animal-bite wounds, and the high levels of resistance demonstrated by organisms commonly found in such injuries, this increased compliance with guidelines helps minimize patient suffering, morbidity, length of stay, and disability, while reducing costs incurred. The intervention should be implemented within other units within the United Kingdom who similarly lack clear, detailed guidelines, in order to maximize treatment continuity and patient outcomes nationwide.

Use of antibiotics in patients who were attacked by animals that can transmit rabies

“…This problem has also been documented in other countries; for example, in Australia, Birdsey et al (2016) reported that 38.1% of patients were not treated in accordance with the Australian Therapeutic Guidelines for animal bites; among these patients, 18.7% were prescribed a non‐recommended antibiotic, 11.9% had indications for antibiotics but did not receive a prescription, and 7.5% were prescribed an antibiotic without indications. Similarly, in Australia, Baxter et al (2020) reported that in 27.5% of cases, antibiotics were used without clinical criteria, and in the United Kingdom, Al Omran et al (2020) reported that 20.0% of patients received ineffective antibiotics, based on clinical practice guidelines.…”

The potential for the double risk of rabies and antimicrobial resistance in a high rabies endemic setting: detection of antibiotic resistance in bacterial isolates from infected dog bite wounds in Uganda

“…Amoxicillin/clavulanic acid is the first-choice agent both for prophylaxis and treatment for DBW patients who are not penicillin allergic [ 48 ]. The present study demonstrated that amoxicillin/clavulanic acid was resistant to only 14% of the isolates, which was lower in some earlier studies [ 31 , 49 ].…”

“…However, the observed differences in the levels of susceptibility between amoxicillin/clavulanic acid and oxacillin may require further investigation. Furthermore, beyond UCG, Metronidazole is recommended to treat infection in DBWs [ 18 , 44 ] especially for those allergic to penicillin [ 48 ]. In this study, all isolates were resistant to metronidazole which is known to be generally effective against Gram-negative anaerobes.…”

Unfallchirurgisch Relevantes zu Bissverletzungen von Mensch und Tier

“…Es ist bei Bisswunden grundsätzlich davon auszugehen, dass eine polymikrobielle Kontamination des Wundgebietes vorliegt [ 22 , 23 ]. Die Breite des Erregerspektrums korreliert mit der Schwere der resultierenden Infektion: Bei Hundebissen sind die häufigsten Erreger (30–60 %) Pasteurella -Spezies, hämolysierende Streptokokken, Staphylococcus aureus sowie Mischinfektionen mit Anaerobiern [ 23 , 24 ]. Infektionserreger nach Katzenbissen sind in über 50 % der Fälle Pasteurella multocida meist mit aerob-anaerober Mischinfektion [ 23 ].…”