Abstract
There are very few microbiological data on wound infections following snakebites. The objective of this study was to investigate the treatment of secondary infection following snakebites in central Taiwan. Microbiological data and antibiotic sensitivity of wound cultures were retrospectively analyzed from December 2005 to October 2007 in a medical center in central Taiwan. A total of 121 snakebite patients participated in the study. Forty-nine (40.5%) subjects were bitten by cobra (Naja atra); 34 of them had secondary infection, and 24 of them (70.6%) needed surgical intervention. Cobra bites caused more severe bacterial infection than other snakebites. Morganella morganii was the most common pathogen, followed by Aeromonas hydrophila and Enterococcus. Gram-negative bacteria were susceptible to amikacin, trimethoprim/sulfamethoxazole, cefotaxime, cefepime, ciprofloxacin, and piperacillin/tazobactam. Enterococcus were susceptible to ampicillin, gentamicin, penicillin and vancomycin. It is reasonable to choose piperacillin/tazobactam, quinolone, second- or third-generation cephalosporin for empirical therapy following snakebite. Surgical intervention should be considered for invasive soft tissue infections.
Highlights
There are six main kinds of venomous snakes in Taiwan, including Naja atra, Bungarus multicinctus, Trimeresurus mucrosquamatus, Trimeresurus stejnegeri, Deinagkistrodon acutus, and Daboia russelii siamensis [1]
Forty-nine (40.5%) patients were bitten by Naja atra, which is the most common type of venomous snakebite in central Taiwan
The origin of the bacteria in the mouth of the snakes is an important determinant for wound infection
Summary
There are six main kinds of venomous snakes in Taiwan, including Naja atra (cobra), Bungarus multicinctus, Trimeresurus mucrosquamatus, Trimeresurus stejnegeri, Deinagkistrodon acutus, and Daboia russelii siamensis [1]. Antivenom administration is the standard therapy for snakebite. Complications often occur following snakebite because of toxic hemorrhagic or neurotoxic effects with secondary bacterial infection. Exploring the bacteria responsible for the infections was the objective of this study. Very few microbiological data on wound cultures following snakebites in Taiwan have been reported. There are challenges in predicting bacterial species and the sensitivity of antibiotics. In light of these considerations, medical records of snakebite patients in a 1300-bed teaching hospital in central Taiwan were retrospectively reviewed and analyzed from December 2005 to October 2007
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