Animal Bite-associated Infections

Microbiology and Treatment

Nicole Thomas; Itzhak Brook

Expert Rev Anti Infect Ther. 2011;9(2):215-226.

Clinical Findings/Infectious Complications

Clinical signs for development of bite-associated infection may be subtle, with increased pain and tenderness around the wound as the first indication. Injuries may initially have edema, erythema, ecchymosis and even serosanguinous drainage, but generally begin to improve within 2 days of the bite. Further swelling, erythema, red streaking (lymphangitis) and warmth as well as local lymphadenopathy are indicators of a progressive infection. Fever is often a late finding, as is purulent drainage.

The hand is the most likely site to develop infection and long-term disability. It is reported that up to 40% of hand bites become infected.^[3] This is due to the complex anatomy and superficial location of the bones, joints and tendons.

Bite wounds may develop into deeper-seated infections, and may disseminate systemically. In addition to bite location and depth, host factors such as immunodeficiency or immunocompromised status, diabetes, peripheral vascular disease and alcohol abuse may contribute to complications such as soft tissue or muscle abscesses, osteomyelitis, septic arthritis, tenosynovitis, bacteremia/sepsis, endocarditis and even intracranial abscess.^[4,5]

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Cite this: Animal Bite-associated Infections - Medscape - Feb 01, 2011.

Abstract and Introduction
Clinical Findings/Infectious Complications
Human Bites
Dog Bites
Cat Bites
Nonhuman Primate Bites
Rodent Bites
Bat Bites
Ungulate Bites
Bear Bites
Reptile Bites
Marine Organism Bites
Management
Conclusion
Expert Commentary
Five-year View
References
Sidebar

Table 1. Microbiology and antimicrobial therapy of bite infections.
Animal	Organism	Empiric antibiotic therapy
Human	Eikenella corrodens Viridans Streptococci Staphylococus aureus Coagulase-negative Staphylococus Corynebacterium Bacteroides Peptostreptococcus Hepatitis B/C HIV	Oral Amoxicillin/clavulanate (Augmentin®, GlaxoSmithKline, Brentford, UK) OR Moxifloxacin (only suitable for patients >18 years of age) Intravenous Ampicillin/sulbactam OR Piperacillin/tazobactam OR Cefoxitan OR Ertapenem PCN allergic Moxifloxacin (only suitable for patients >18 years of age); Doxycycline (only suitable for patients >8 years of age) OR Metronidazole or clindamycin PLUS Trimethoprim/sulphamethoxazole OR Another fluoroquinolone (ciprofloxacin/levofloxacin)
Dog	S. aureus/intermedius Pasteurella canis/multocida Capnocytophaga canimorsus Streptococcus spp. Moraxella spp. Clostridium spp. Bacteroides Fusarium	Same as human
Cat	Pasteurella multocida Streptococcus spp. (especially S. pyogenes) S. aureus Moraxella spp. Fusobacterium Bacteroides Porphyromonas	Same as human
Nonhuman primates	Mixed flora (aerobic/anaerobic) Streptococcus spp. Neisseriae spp. Haemophilus influenzae Enterobacteriaceae Simian Herpes B	Same as human + Valacyclovir
Rodents	Streptobacillus moniliformis Spirillum minus Salmonella spp. Staphylococcus Leptospira Pasteurella Corynebacterium Fusobacterium	Same as human
Ungulates	Polymicrobial Actinobacillus spp. Pasteurella spp. Staphylococcus spp. Viridans Streptococci (Streptococcus equi)	Same as human
Reptiles (i.e., crocodiles/alligators)	Aeromonas hydrophila Pseudomonas Proteus vulgaris Enterobacter Citrobacter Burkholderia Serratia spp. Mixed anaerobes	Ceftazadime + PCN + metronidazole OR Ceftriaxone + doxycycline + metronidazole
Marine organisms fish	Vibrio spp. Mycobacterium marinum Erysipilothrix rhusiopathiae Aeromonas hydrophila	Doxycycline OR Ciprofloxaxin OR Third-generation cephalosporin OR Extended-spectrum penicillin

PCN: Penicillin.
Data taken from [28].

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