Pediatric emergency medicine trisk 2030 2030
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crush injuries with infection-prone devitalized tissue, a result of the enormous
pressures (200 to 400 lb/square inch) dogs can generate in their bites. However,
only 5% to 10% of dog bites become infected, probably because the resulting
lacerations and abrasions are so accessible to good wound hygiene. The risk of
infection is directly related to the location of the bite, with highest risk in bites of
the hands and feet. The feline bite is a deep puncture wound that is difficult to
irrigate or cleanse, hence its high infection rate (up to 50% in some series). The
penetration of tendons, vessels, facial compartments, and bones also increases the
risk of infection. The hand offers all these anatomic components in a relatively
small cross-sectional area, hence its increased risk of infection, regardless of the
biting species.
Aerobic and anaerobic bacteria indigenous to mammalian oral flora are
inoculated into the wound during biting. The most commonly isolated bacteria in
infected cat and dog bite wounds are Staphylococcus aureus and Pasteurella
species, a gram-negative rod. In one series, Pasteurella multocida and Pasteurella
canis were found in 50% and 80% of infected dog and cat wounds, respectively.
Other more common bacteria have also been isolated: streptococci, coagulasenegative staphylococci, S. aureus, and enteric bacteria. Anaerobic bacteria are
usually recovered only in mixed cultures with aerobes.
Human bite infections are mixed bacterial infections, with Streptococcus
viridans or S. aureus being the predominant organism. Anaerobic bacteria,
especially Bacteroides and Peptostreptococcus species, are commonly cultured.
More serious morbidity in infected human bite wounds of the hand has been
associated with S. aureus and Eikenella corrodens, a facultative anaerobe.
Finally, the multiple systemic diseases that may be transmitted by mammalian
bites need to be considered.
Clinical Assessment
Mammalian bite wounds cause a spectrum of tissue injuries from trivial to lifethreatening. Scratches, abrasions, contusions, punctures, lacerations, and their
complications are commonly seen in the ED. The complications usually involve
secondary infections that can be severe and lead to sepsis, meningitis,
endocarditis, and peritonitis, or damage to structures that underlie the bite.
Dog bites are insignificant lesions in at least half of the cases that come to
medical attention, 5% to 10% warrant suturing, and 2% require hospital
admission. Other than bites on the hand, the rate of secondary infection in dog
bites given good local care approximates that of nonbite wounds.
Young children suffer more serious canine injuries, especially in the head and
neck region. On rare occasions, life-threatening injuries occur, including
