Mammalian Bites: Infection Prevention and Management

Abstract

Purpose of Review

This article reviews approaches to the evaluation and treatment of patients with mammalian bites presenting to the Emergency Department with an emphasis on infectious complication prevention and management.

Recent Findings

Recent studies questioned the wisdom of leaving all bite wounds open, while reinforcing extreme caution with primary closure of wounds in areas of the body where infection development is likelier and more consequential. Nuances have also emerged as far as prophylactic antibiotics are concerned.

Summary

Once an initial trauma assessment and stabilization have been completed in the patient with an animal bite, attention is drawn to management of the wound. Initial evaluation includes a careful history and physical, supplemented by radiographic evaluation as indicated. Especially after attacks by large dogs, or if the patient is a small child, advanced imaging such as a CT scan may be necessary to evaluate the full extent of the injuries. All but the most superficial wounds should be copiously irrigated with either tap water or a virucidal solution, such as povidone-iodine if rabies or other viral exposure is a concern. Gaping wounds, or wounds in cosmetically sensitive areas, can be closed primarily if the presentation is not delayed and no host factors for increased infection risk, such as poorly controlled diabetes, are identified. Complex wounds, especially those on the hands and face, often require the involvement of plastic surgery, and on occasion admission to the operating room for proper management. Antibiotic prophylaxis is almost universally indicated in hand or foot wounds or after bites from cats. Tetanus vaccination status should be ascertained and updated as indicated. Different viruses can be transmitted after mammalian bites, ranging from zoonotic rabies and Herpes B virus to human-borne hepatitis and HIV viruses. Often, this exposure necessitates chemoprophylaxis, which may be lifesaving. Patients and their families may need education on behavioral modifications and precautions to prevent future injuries from animal attacks. Finally, socioeconomic determinants of health must be considered, such as concerns for a patient’s ability to adhere to treatment plans, wound care, and follow-up.