Contributing Factors for Complications and Outcomes in Patients With Snakebite

Hsieh, Yu Hsuan; Hsueh, Jung Hua; Liu, Wen‐Chung; Yang, Kuo Chung; Hsu, Kuei‐Chang; Lin, Cheng Ta; Ho, Yen Yi; Chen, Lee Wei

doi:10.1097/sap.0000000000001002

Cited by 19 publications

(30 citation statements)

References 23 publications

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“…s . stejnegeri bites [ 5 ], unlike the figures of 0.2% to 1.36% reported in worldwide studies [ 18 ] and < 1.1% in the present study. The method of diagnosing ACS was not mentioned in the study by Hsieh et al [ 5 ].…”

Section: Discussioncontrasting

confidence: 91%

“…However, the severity of these symptoms has not been reported in previous studies [ 4 ]. Furthermore, the coagulopathy, high proportion (20%) of acute compartment syndrome and fasciotomy after bite [ 5 ], and the potential risk factors associated with wound necrosis have not been well established. The Taiwan government produces the only globally available antivenom for T .…”

Section: Introductionmentioning

confidence: 99%

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Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis

Chiang

Tsai

Liu

et al. 2020

J. Venom. Anim. Toxins incl. Trop. Dis

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Background: Trimeresurus stejnegeri stejnegeri bite induces tissue swelling, pain, thrombocytopenia, rhabdomyolysis, and acute renal failure. However, the incidence of coagulopathy, factors associated with wound necrosis, and the appropriate management of this condition have not been well characterized yet. Materials: This study included patients bitten by T . s . stejnegeri that were admitted to the study hospitals from 2001 to 2016. Patient characteristics, laboratory data, and management approaches were compared in victims with and without wound necrosis. Results: A total of 185 patients were evaluated: three patients (1.6%) were asymptomatic; whereas tissue swelling and pain, local ecchymosis, wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and renal impairment were present in 182, 53, 13, 15, 10, 1, and 3 patients, respectively. One patient died from coagulopathy and hemorrhagic shock. Antivenom was administered to all envenomed patients at a median time of 1.8 h after the bite. The median total dose of antivenom was five vials. Chi-square analysis showed that bitten fingers, using cold packs during first aid, presence of bullae or blisters, lymphangitis or lymphadenitis, local numbness and suspected infection to be significantly associated with wound necrosis. After adjustment using a multivariate logistic regression model, only cold packs as first aid, bulla or blister formation, and wound infection remained significant. Conclusions: The main effects of T . s . stejnegeri envenomation are tissue swelling, pain, and local ecchymosis. We do not recommend the use of cold packs during first aid to reduce wound pain, as this may be a risk factor for wound necrosis. In addition, patients with bulla or blister formation should be carefully examined for subsequent wound necrosis. Antiplatelet use may worsen systemic bleeding. No severe rhabdomyolysis or renal failure was observed in this large case series, we therefore considered that they were not prominent effects of T . s . stejnegeri bite.

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Section: Discussioncontrasting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Envenomation by Trimeresurus stejnegeri stejnegeri: clinical manifestations, treatment and associated factors for wound necrosis

Chiang

Tsai

Liu

et al. 2020

J. Venom. Anim. Toxins incl. Trop. Dis

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“…Wound infection following snakebite usually accounts for 9-77% of the bitten patients, as described in several studies (Table 4). 5,6,8,[12][13][14][15] The large differences in the reported prevalence of secondary infections in snakebites between different studies can be related to variations in the criteria used to establish the presence of infection. A strict criterion is the laboratory isolation and identification of bacteria from the affected tissues or blood in envenomed patients.…”

Section: Discussionmentioning

confidence: 99%

Infectious Complications Following Snakebite by Bothrops lanceolatus in Martinique: A Case Series

Resiere

Mehdaoui

Nevière

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Infections secondary to snakebite occur in a number of patients and are potentially life-threatening. Bothrops lanceolatus bites in Martinique average 30 cases per year and may result in severe thrombotic and infectious complications. We aimed to investigate the infectious complications related to B. lanceolatus bite. A retrospective singlecenter observational study over 7 years (2011-2018) was carried out, including all patients admitted to the hospital because of B. lanceolatus bite. One hundred seventy snake-bitten patients (121 males and 49 females) were included. Thirty-nine patients (23%) presented grade 3 or 4 envenoming. Twenty patients (12%) developed wound infections. The isolated bacteria were Aeromonas hydrophila (3 cases), Morganella morganii (two cases), group A Streptococcus, and group B Streptococcus (one case each). Patients were treated empirically with third-generation cephalosporin (or amoxicillin-clavulanate), aminoglycoside, and metronidazole combinations. Outcome was favorable in all patients. The main factor significantly associated with the occurrence of infection following snakebite was the severity of envenoming (P < 0.05). Our findings clearly point toward the frequent onset of infectious complications in B. lanceolatus-bitten patients presenting with grade 3 and 4 envenoming. Thus, based on the bacteria identified in the wounds, we suggest that empiric antibiotic therapy including third-generation cephalosporin should be administered to those patients on hospital admission.

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“…Wound infection following snakebite usually accounts for 9 to 77% of the bitten patients, as described in several studies [2,[4][5][6][7][8]. The large differences in the reported prevalence of secondary infections in snakebites can be related to variations in the criteria used to establish the presence of infection.…”

mentioning

confidence: 99%

“…In addition, a high proportion of microbiological cultures are negative because of systematic preemptive use of antibiotics in snake bitten patients. The main involved bacteria are Enterococcus faecalis, Aeromonas hydrophila and Morganella morganii [2,[4][5][6][7][8][9].…”

mentioning

confidence: 99%