Wound infections secondary to snakebite in central Taiwan

Li-Wen Huang (1), Jiaan-Der Wang (2, 3), Jin-An Huang (1), Sung-Yuan Hu (4, 5), Lee-Min Wang (1, 6), Yu-Tse Tsan (4, 5, 7)

(1) Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; (2) Division of Pediatric Emergency, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; (3) Institute of Biochemistry and Biotechnology, Chung San Medical University, Taichung, Taiwan, Republic of China; (4) Division of Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; (5) School of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; (6) Division of Emergency Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; (7) Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan, Republic of China.

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 andEnterococcus. 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.

Key words: snakebite, antivenom, venomous, cobra, bacterial infection, bacterial resistance, Taiwan.

COPYRIGHT

© CEVAP 2012

SUBMISSION STATUS

Received: February 8, 2012.

Accepted: May 28, 2012.

Abstract published online: June 4, 2012.

Full paper published online: August 31, 2012.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

CORRESPONDENCE TO

Yu-Tse Tsan, Division of Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China. Phone: 886 4 23592525, ext. 3604. Fax: 886 4 2374 1359. Email: janyuhjer@gmail.com.