Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics—A BITE Study
Abstract
:1. Introduction
2. Results
2.1. Patients’ Characteristics
2.2. Bacteriology and the Possible Influence of Prophylactic Antibiotics
2.3. Antibiotic Susceptibility
2.4. Use of Prophylactic Antibiotics
2.5. Antibiotic Therapy for Infected Snakebite Wounds
2.6. Development of the BITE Score
3. Discussion
3.1. Association of Polymicrobial Infection, Snake Oral Cavity Bacteriology, and Venom Effect on Tissue
3.2. Antibiotic Therapy in Infected Snakebite Wounds
3.3. Factors Associated with a Secondary Bacterial Infection from Taiwan Habu and Green Bamboo Viper Snakebites
3.4. Utility of the BITE Score
3.5. Limitations
4. Conclusions
5. Materials and Methods
5.1. Ethics Statement
5.2. Data Resources and Setting
5.3. Enrolment of Patients
5.4. Management Protocol for Patients Presenting with Snakebites
5.5. Definition of Wound Infection
5.6. Statistical Analysis and Development of the BITE Score
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Patients | p-Value | |
---|---|---|---|
No Wound Infection (n = 563) | Wound Infection (n = 163) | ||
Demographic Characteristics | |||
Age | 51.88 (17.42) | 52.76 (18.04) | 0.57 |
Male, n (%) | 400 (71.05) | 106 (65.03) | 0.17 |
Laboratory Variables # | |||
WBC (1000/μL) * | 8.15 (3.59) | 9.47 (3.97) | 0.0008 |
Band | 0.07 (0.72) | 0.11 (0.74) | 0.58 |
Segment * | 62.26 (14.03) | 67.54 (14.33) | 0.0003 |
Lymphocyte * | 29.59 (12.43) | 24.63 (12.53) | 0.0001 |
Neutrophil/lymphocyte ratio * | 3.26 (3.63) | 4.56 (5.19) | 0.01 |
Hb (g/dL) | 14.35 (1.66) | 14.08 (1.74) | 0.11 |
RDW | 18.38 (11.18) | 18.98 (11.70) | 0.60 |
PLT (1000/μL) | 211.60 (61.00) | 214.50 (62.75) | 0.63 |
Prothrombin time | 11.69 (7.11) | 11.37 (3.15) | 0.49 |
APTT | 28.16 (7.14) | 27.38 (3.59) | 0.11 |
Cr (mg/dL) | 0.93 (0.57) | 0.94 (0.97) | 0.90 |
BUN (mg/dL) | 14.98 (8.20) | 14.72 (6.99) | 0.80 |
ALT/GPT (U/L) | 27.44 (29.31) | 23.42 (12.87) | 0.06 |
AST/GOT | 33.17 (36.37) | 40.49 (59.34) | 0.39 |
Creatine kinase | 388.00 (520.50) | 1201.40 (3895.60) | 0.24 |
Myoglobin | 168.90 (417.30) | 245.20 (770.40) | 0.49 |
K (mEq/L) | 3.74 (0.38) | 3.78 (0.43) | 0.45 |
Na (mEq/L) * | 140.00 (2.11) | 139.10 (2.51) | 0.0022 |
Glucose (mg/dL) | 130.60 (47.57) | 144.00 (53.49) | 0.11 |
Treatment Modalities | |||
Antivenin dose (vial) &* | 2 (1–3) | 2 (1–4) | <0.0001 |
Prophylactic antibiotics * | 215 (38.6) | 106 (62.72) | <0.0001 |
Hospitalization | |||
Hospital admission, n (%) * | 98 (17.41) | 132 (80.98) | <0.0001 |
Length of hospitalization (day) * | 4.87 (3.50) | 9.50 (8.04) | <0.0001 |
No. | Microorganism | Suggested Antibiotic Sensitivity | |||
---|---|---|---|---|---|
Aerobic Gram-Positive | Aerobic Gram-Negative | Anaerobic | |||
1 | Enterococcus faecalis | Morganella morganii | Bacteroides fragilis | Ampicillin | Clindamycin |
2 | Enterococcus faecalis | Morganella morganii | Ampicillin | ||
Aeromonas hydrophila | Ceftriaxone | ||||
3 | Enterococcus faecalis | Morganella morganii | Ampicillin | ||
4 | Corynebacterium jeikeium | Enterobacter cloacae CR strain | Fluoroquinolone | ||
5 | Coagulase negative Staphylococcus | Vancomycin | |||
6 | Viridans streptococcus | Oxacillin | |||
Staphylococcus aureus | Vancomycin | ||||
Staphylococcus saprophyticus | Stenotrophomonas maltophilia | Enterobacter cloacae | Fluoroquinolone | ||
Peptostreptococcus micros | |||||
7 | Staphylococcus aureus | Oxacillin | |||
Corynebacterium jeikeium | Fluoroquinolone | ||||
Corynebacterium spp. |
Variable | β | Odds Ratio | 95% Confidence Interval | Points ※ |
---|---|---|---|---|
Intercept | −1.06 | |||
WBC (1000/μL) × neutrophil-lymphocyte ratio ≥ 19.84 | 0.37 | 2.112 | (1.289, 3.462) | 1 |
Admission | 1.38 | 15.65 | (9.27, 26.42) | 4 |
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Lin, C.-C.; Chen, Y.-C.; Goh, Z.N.L.; Seak, C.-K.; Seak, J.C.-Y.; Shi-Ying, G.; Seak, C.-J.; SPOT Investigators. Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics—A BITE Study. Toxins 2020, 12, 575. https://doi.org/10.3390/toxins12090575
Lin C-C, Chen Y-C, Goh ZNL, Seak C-K, Seak JC-Y, Shi-Ying G, Seak C-J, SPOT Investigators. Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics—A BITE Study. Toxins. 2020; 12(9):575. https://doi.org/10.3390/toxins12090575
Chicago/Turabian StyleLin, Chih-Chuan, Yen-Chia Chen, Zhong Ning Leonard Goh, Chen-Ken Seak, Joanna Chen-Yeen Seak, Gao Shi-Ying, Chen-June Seak, and SPOT Investigators. 2020. "Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics—A BITE Study" Toxins 12, no. 9: 575. https://doi.org/10.3390/toxins12090575