Die Therapie von Bissverletzungen der Hand und des Handgelenkes - Ist eine Antibiotika-Prophylaxe in jedem Fall notwendig?1

Abstract

Animal bites make up a large proportion of the injuries treated in an emergency department. Due to the type of injury, the variety of wounds and the contamination with aerobic and anaerobic organisms, they deserve special attention. In this study, we reviewed 98 patients (55 male/43 female) with bite wounds to the hand and wrist treated between 1995 and 2000. They were either treated conservatively (n = 65) or surgically (n = 33) depending on the clinical findings. In 18 of 33 cases, the reason for surgical treatment was an infection. A primary antibiotic prophylaxis, usually with cephalosporines, was administered in 47 of 98 cases. Results were analysed retrospectively. An infection developed in 32 patients. In six of these patients, an infection developed despite primary antibiotic prophylaxis. Operative treatment became necessary in four of these six cases. Twenty-six of 32 patients were treated without primary antibiotic prophylaxis. Surgical treatment was required in around half (n = 14) of these patients, while the other 12 patients were treated conservatively with antibiotic therapy.Twenty-one of 26 patients presented with bite wounds that were already infected. Microbiological examination revealed a variety of microbes, usually a mixed infection with Pasteurella multocida was found. All organisms were susceptible to treatment with second or third generation cephalosporines.A total of 15 patients had to be operated due to deeper injuries to the bone, extensive soft-tissue injury, or because of injury to a tendon and the tendon sheath. In most patients, a good to acceptable functional result was achieved. Primary antibiotic prophylaxis does not prevent the development of infection. Nevertheless, because of the inherently high infection risk associated with bite wounds to the hand and wrist, prophylaxis should be carried out. In case of severe damage to the soft tissue or signs of infection, early surgical therapy should be considered.

Prevention of post-operative infections after surgical treatment of bite wounds

“…The routine administration of antibiotics in treating bite wounds has only little [40] to no effect [41], [42]. This also applies to hand injuries [41].…”

“…This also applies to hand injuries [41]. In cases of primary wound closure, antibiotics have no effect on the rate of infection [19].…”

MRSA-Infektion der Hand immuninkompetenter Patienten

“…Die Entnahme eines Abstrichpr ä parates intraoperativ zum Keimnachweis ist obligat. Die Indikation zu einer zus ä tzlichen antimikrobielle Therapie ist bei immunkompetenten Patienten abh ä ngig von der Infektsituation und -lokalisation zu stellen [4] . In Einzelf ä llen kann ein chirurgisches Wunddebridement mit einer off enen Wundbehandlung ausreichend sein.…”

Operative Interventionen bei Infektionen an der Hand

“…Allgemeinerscheinungen bis zur Sepsis sind möglich. Bei riskanteren Verletzungen wie bei Tierbissen handelt es sich meist um Mischinfektionen, um Infektionen mit anderen oft multiresistenten Erregern wie Pasteurella multocida der Katzen [2,7]. Durch die bereits erfolgte Wirtspassage sind die Keime besonders gefährlich mit hoher Virulenz und Resistenz.…”