ENVIRONMENTAL EMERGENCIES■ Closed-fist injury requires aggressive irrigation and wound exploration. If
there is evidence for deeper structure involvement, surgical consult and
admission are indicated.
■ Consider HIV, hepatitis B prophylaxis.
CATBITES
The majority of untreated cat bites become infected.
Common organisms:
■ P. multocida
■ A highly virulent Gram-negative anaerobic rod →infection develops
within 24 hours.
■ The other common organism is S. aureus.
TREATMENT
■ General treatment, as above
■ Most wounds are puncture wounds and should be left open.
■ Antibiotic prophylaxis is recommended for allcat bite wounds: amoxicillin/
clavulanate, cefuroxime.
■ P. multocidais highly sensitive to penicillin.
DOGBITES
Approximately 5% of dog bites become infected.
Common organisms:
■ S. aureus
■ P. multocida
■ Bacteroidessp.
■ Fusobacteriumsp.
■ C. canimorsus
■ Gram-negative rod →overwhelming sepsis, DIC, and cutaneous gan-
grene at bite site.
TREATMENT
■ General treatment, as above
■ Antibiotic prophylaxis of choice: amoxicillin/clavulanate
RODENTBITES
Rat-bite fever
■ Results from infection with S. moniliformis andS. minus
SYMPTOMS/EXAM
■ Abrupt onset of fevers/chills, headache, and subsequent rash
■ Associated with brain, myocardial, and soft-tissue abscesses
Multiple other diseases can be transmitted via rodent bites including lepto-
spirosis, tularemia, sporotrichosis, plague.
Rapid onset of infection
<24 hours after a cat bite =
P. multocida.All cat bite wounds should
receive antibiotic prophylaxis.Gangrenous wound or
overwhelming sepsis following
dog bite = C. canimorsus.Antibiotic prophylaxis of
choice for bite wounds =
amoxicillin/clavulanate.Rat-bite fever is associated
with brain, myocardial, and
soft-tissue abscesses.