Abstract
Wound necrosis and secondary infection are common complications after Naja atra bites. Clinical tools to evaluate the infection risk after Taiwan cobra bites are lacking. In this Cobra BITE study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with Taiwan cobra snakebites. Patients with wound infection lacking tissue necrosis were included in developing Cobra BITE score utilizing univariate and multiple logistic regression, as patients with wound necrosis require antibiotics for infection treatment. 8,295,497 emergency department visits occurred in the span of this study, with 195 of those patients being diagnosed as having cobra bites. Of these patients, 23 had wound necrosis, and 30 had wound infection, resulting in a wound infection rate of 27.2% (53/195). Enterococcus faecalis and Morganella morganii were the main bacteria identified in the culture report regardless of whether patients’ wounds had necrosis. As per our Cobra BITE score, the three factors predicting secondary wound infection after cobra bites are hospital admission, a white blood cell count (in 103/µL) × by neu-trophil-lymphocyte ratio value of ≥114.23, and the use of antivenin medication. The area under the receiver operating characteristic curve for the Cobra BITE score system was 0.88; ideal sensitivity and specificity were 0.89 and 0.76. This scoring system enables the assessment of wound infections after N. atra bites, and it could be modified and improved in the future for other Naja spp. bites.
Highlights
Taiwan, a subtropical island, has many types of snakes; of these, six species of venomous snakes are considered clinically important: Naja atra (Taiwan cobra or Chinese cobra), Bungarus multicinctus, Protobothrops mucrosquamatus (Taiwan habu), Trimeresurus stejnegeri, Deinagkistrodon acutus, and Daboia siamensis
Data on 195 patients with cobra bites were retrieved from data on 8,295,497 emergency department (ED) visits from January 2001 to May 2017
When comparing pathogens isolated from necrosis and nonnecrosis wounds, we found that patients of the necrosis wound group were more to be prone to have polymicrobial and more complicated wound infection
Summary
A subtropical island, has many types of snakes; of these, six species of venomous snakes are considered clinically important: Naja atra (Taiwan cobra or Chinese cobra), Bungarus multicinctus, Protobothrops mucrosquamatus (Taiwan habu), Trimeresurus stejnegeri (green bamboo viper), Deinagkistrodon acutus (hundred pacer viper), and Daboia siamensis (eastern Russell’s viper). While other species of cobra cause neurological complications, Taiwan cobra bites do not; they cause wound tissue damage/necrosis due to the actions of cytotoxins in the venom, and confer a high risk of wound infection [2,3,4]. There are no clinical parameters that can predict or assesses the clinical severity of the cobra bites patients. There are no clinical parameters that can predict o2roaf 1s3-
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