Florian M Kovar
Medical University of Vienna, Austria
Title: Management of bite wounds in children and adults – An analysis of over 5.000 cases at a level I trauma centre
Biography
Biography: Florian M Kovar
Abstract
Introduction: Bite wounds account for 5% of the total traumatic wounds evaluated in the ED (emergency department) and approximately 1% of all ED visits. Dog, cats, or humans provoke most mammalian bite wounds. Early estimation of infection risk, adequate antibiotic therapy and if indicated surgical treatment, are cornerstones of successful cure of bite wounds. However, antibiotic prophylaxis and wound management are still discussed controversial in the current literature. In our study we retrospectively investigated those aspects. Methods: 5.248 consecutive trauma patients were collected prospectively and analyzed retrospectively over a period of 15 years in this study at a Level I Trauma Center, Department of Trauma Surgery, Medical University of Vienna, Austria. Data for this study were obtained from our electronic patient records and follow up visits. For antibiotic therapy, amoxicillin/clavulinate (Augmentin, Glaxo Smith Kline) and in case of allergy clindamycin (Dalacin, Pfizer) were administered according to age and dosage recommended by the producer. Results: During the 15 year study period, 5.248 trauma patients met the inclusion criteria. The mean age was 33.8 years (range 0 to 97), 2.620 (49.9%) were males and 2.628 (50.1%) were females. In our study population a total of 2.530 dog-bites (48.2%), 930 cat-bites (17.8%), 357 other-animal bites (6.8%), 426 human-bites (8.1%), and 1.005 human self bites (19.2%) have been observed. A total of 995 wounds (19.0%) have been infected. Surgery was done in 132 wounds (2.5%). Conclusion: Total infection rate for sutured wounds (7.6%), and surgery were (35.6%), versus (19.4%) for open treatment. Observed infection rate of puncture wounds and wounds greater than 3 cm was 1.5 times higher than for all other wounds in the present study. Total infection rates within 24hours to antibiotic administration was 29.3%, compared to 65.0% <48 hours, and 81.1% <72 hours. Time interval also influenced the overall outcome showing a 2.6 increase in acceptable and 1.3 increase in poor outcome after 72 hours. We could demonstrate, that prophylactic antibiotics in all cases as recommended by some authors, and primary combinations of different antibiotics does not have any benefit, but might lead to higher resistance rates in patients.