Best evidence topic report. Are antibiotics indicated following human bites?

Fifteen-minute consultation: Management of mammalian bites in children - from local wound care to prophylactic antibiotics

Animal and human bites are a common reason for emergency consultation, especially in children. The most common complication of bite wounds is local infection. Systemic infections are much rarer. The key in reducing the risk of infection after a mammalian bite is local wound management with either primary or delayed closure. The benefit of administering prophylactic antibiotics is controversial.In this review, we provide a summary of the current evidence for the management of mammalian bites in children, including recommendations for appropriate investigations, wound management, administration of prophylactic and therapeutic antibiotics and the prevention of systemic infections.

Presentation and treatment of animal and human bite injuries at a Swiss tertiary emergency department: a cross-sectional study

BACKGROUND

Animal and human bite injuries are a relevant health problem worldwide. With the increasing number of pets, bite injuries are becoming more frequent. Previous studies on animal and human bite injuries in Switzerland were completed several years ago. The aim of the present study was to provide a detailed overview of patients with bite injuries admitted to a tertiary emergency department in Switzerland in terms of demographics, injury patterns and treatment strategies.

METHODS

A 9-year cross-sectional analysis of patients presenting to the emergency department of Bern University Hospital in the period January 2013 to December 2021 following an animal or human bite injury.

RESULTS

A total of 829 patients with bite injuries were identified, including 70 for postexposure prophylaxis only. Their median age was 39 (IQR 27-54) years and 53.6% were female. Most patients were bitten by a dog (44.3%), followed by cats (31.5%) and humans (15.2%). Most bite injuries were mild (80.2%); severe injuries were mainly found in dog bites (28.3%). Most patients were treated within six hours after human (80.9%) or dog (61.6%) bites; after cat bites, patients often presented with a delay (74.5%) and signs of infection (73.6%). Human bite wounds were superficial in the majority of cases (95.7%), rarely showed signs of infection (5.2%) at the time of presentation and hospitalisation was never required.

CONCLUSIONS

Our study provides a detailed overview of patients admitted to an emergency department of a tertiary Swiss University Hospital after an animal or human bite. In summary, bite injuries are common among patients who present to the emergency department. Therefore, primary and emergency care clinicians should be familiar with these injuries and their treatment strategies. The high risk of infection, particularly in cat bites, may warrant surgical debridement in the initial treatment of these patients. Prophylactic antibiotic therapy and close follow-up examinations are recommended in most cases.

Biting the hand that feeds you: Management of human and animal bites

Bites from animal and humans represent a very small proportion of all the patients presenting to emergency departments, However, they require prompt medical and surgical intervention in order to minimise the risk of infection, that may lead to limb and life-threatening complications. In this review article we synthesise the existing literature for treatment of human and animal bites and offer practical considerations when managing bite injuries.

Restorative management of human bite injuries to the face: Case series

Facial skin wounds are common problems seen and treated by emergency centers around the world. Among all wounds, cat and dog bites are frequently seen. Human bite injuries are both deceptive and difficult in their presentation and management. The injuries have a disfiguration effect with possible psychological impact on the patient. The aim of this paper is to compare experience with human bites of the face in our surgical unit, with other similar trials in term of reasons for the circumstances of injuries, age, and sex of the patients, site of injury, pan-time between consultation and treatment, incidence of infection and surgical management. Data in terms of age, gender distribution, circumstances of injury, location of injuries, evolution of surgical management and complications were recorded. We report here a series of 10 cases of human bite wounds to the face, admitted to our department, and treated with different reconstruction procedures.

Human bite injuries to the head and neck: current trends and management protocols in England and Wales

INTRODUCTION

Human bite injuries can be challenging in their presentation to the examining physician. In a study by Merchant et al., 18% of patients presenting with a human bite injury had suffered wounds to the head and neck region. Current trends in their initial management at presentation to emergency departments throughout England and Wales will be discussed in this paper.

MATERIALS AND METHOD

A postal survey was sent out to 100 A&E lead clinicians. This was followed up by telephone enquiries to improve the response rate. The collated results of the survey were entered onto a spreadsheet (Microsoft Excel©) for the purpose of statistical review.

RESULTS

A 68% response rate from A&E departments throughout England and Wales demonstrated a lack of consensus in the initial management and subsequent treatment of human bite injuries. Written protocols are in place for human bite injuries in 54.4% of units. In 100% of units, initial management involves irrigation +/- debridement of the wound, though there is a lack of agreement on the surgical management of the wound. 77.9% of units follow 'needle stick protocols' when stratifying risk for blood-borne viruses.

CONCLUSION

Human bites pose a number of unique problems, ranging from cellulitis to the transmission of communicable diseases. The maxillofacial surgeon has the added dilemmas surrounding subsequent repair and reconstruction. Appreciation of the complexity of human bite injuries will ensure optimal care for the patient. We propose a set of guidelines developed 'in-house' to assist in the management of human bite injuries.

Bite injuries to the hand: microbiology, virology and management

Bites to the human hand, be it from a pet, a stray animal or even a fellow human, may often have dire consequences for the person suffering the insult. Bites by mammals are a common problem and they account for up to 1% of all visits to hospital emergency rooms, in the UK. Clenched fist injuries to the mouth ('fight bite') are notorious for being the worst human bites. Bite injuries of the hand and their related infections must be monitored vigilantly and managed proactively, by experts in this field of surgery. In this review article we discuss the associated microbiology and virology of these injuries as well as their management.

Chronic osteomyelitis secondary to human bite: a case report

ABSTRACT

We report a case of a human bite that was initially inadequately treated and progressed to chronic osteomyelitis, finally resulting in digital amputation. Human bites are seemingly innocuous, but if neglected, may lead to subsequent infection and morbidity. Persistence of symptoms should alert the practitioner to the possibility of infection extending to the soft tissue or bone. Bacteriological studies commonly yield mixed aerobic and anaerobic flora. Early debridement and antibiotic treatment may prevent development of severe soft tissue or bone infection.

KEY WORDS

human bite, osteomyelitis, amputation.

Postoperative care of the facial laceration

The purpose of this investigation is to examine factors involved in the postoperative care of traumatic lacerations. An evidence-based comprehensive literature review was conducted. There are a limited number of scientifically proven studies that guide surgeons and emergency room physicians on postoperative care. Randomized controlled trials must be conducted to further standardize the postoperative protocol for simple facial lacerations.

A 4-year review of human bite injuries presenting to emergency medicine and proposed evidence-based guidelines

Human bite injuries are a common injury, roughly accounting for around 0.1% of attendances to Emergency Medicine departments. Morbidities associated with such injuries are legion. Of paramount importance is the potential for infection of the wound site, both bacterial and viral. A retrospective 4-year review of 3136 case notes was conducted, identifying 421 human bites. This amounts to one every 3 days! The majority of those bitten were young males (male:female ratio=3:1; 44% comprising the age group 16-25 years). The management of these wounds was found to be poor. 17% of patients did not receive any antibiotic cover; 21% of patients either did not have tetanus prophylaxis administered when required or had a tetanus booster when they were already covered; 34% of patients either did not receive a hepatitis B booster when one was required or received one when they were already covered. This lack of effective documentation, along with errors in addressing prophylaxis of the infective agents, may have profound medico-legal consequences. The author believes that the findings will be reproduced in other centres and in view of the inadequacies highlighted by this work, it is necessary to introduce an evidence-based protocol for the comprehensive management of the human bite. Using United Kingdom Department of Health evidence-based guidelines, the author proposes such a pathway.

The classification and principles of management of wounds in trauma

The correct assessment and early management of wounds is vital in achieving a good outcome in both the acute and chronic setting. A robust management plan for the trauma patient depends upon accurate and timely assessment of all injuries and evaluation of key features such as mechanism of injury, pre-hospital findings and intervention, zone of injury, patient characteristics and structures damaged. This article describes the general principles of wound assessment and management, discussing mechanism and zone of injury, debridement techniques, types of irrigation and the use of antibiotic prophylaxis. Particular attention is given to the management of open tibial fractures, fasciotomy wounds, pretibial lacerations and haematomas and bite wounds.

The human bite injury: a clinical audit and discussion regarding the management of this alcohol fuelled phenomenon

BACKGROUND

Human bite injuries are both deceptive and challenging in their presentation and management. They remain a frequent presentation to our unit, most often following late night alcohol fuelled aggression.

AIMS

To audit the management of these wounds, with particular focus on infective complications and outcomes.

METHODS

A three year retrospective chart review was undertaken on all patients referred to the plastic surgery unit from 1 January 2003 through to 31 December 2005.

RESULTS

A total of 92 patients with 96 human bite wounds were identified. The majority were male (92%). Alcohol consumption was documented in 86% of cases. The majority (70%) occurred over the weekend or on a public holiday. Facial injuries made up 70% of injuries with the remainder being to the upper limb. The ear was the most common target of all facial injuries (65%). Infection was documented in 18 cases (20%), with bite injuries to the upper limb and those presenting late (>12 h) having a higher incidence of infection.

CONCLUSIONS

Human bite wounds present a challenge to any emergency department, given the many issues involved in their management. Underestimation of the complexity and potential sequelae of these wounds will result in a suboptimal outcome for the patient.