A “Shark Encounter”: Delayed Primary Closure and Prophylactic Antibiotic Treatment of a Great White Shark Bite

Emergency Management Strategies and Antimicrobial Considerations for Nonmammalian Marine Vertebrate Penetrating Trauma in North America, the Caribbean, and Hawaii: A Review Article

“…The literature search revealed 8 articles pertaining to shark-related injuries in North America and the Caribbean. 6 -13 These included 5 case reports 6,7,9,10,12 and 3 retrospective case series. 8,11,13 Treatments in all cases included wound irrigation, exploration, and debridement.…”

“…The initial antibiotic regimen was successful in 1 case in which an IV first-generation cephalosporin (cefradine) was used to treat Vibrio carchariae infection. 6 In 2 cases, antibiotics were prescribed prophylactically, and neither patient developed an infection: in 1 case, the patient received oral cephalexin and ciprofloxacin, 7 and in the other, topical mupirocin ointment. 10 In 1 retrospective case series, 6 of 11 patients were treated with antibiotics, including monotherapy with ciprofloxacin (3 patients), doxycycline (2 patients), or clindamycin (1 patient).…”

“…Antibiotics were administered in all case reports describing shark-related injuries. Antibiotics given were topically in 1 case (mupirocin ointment), 10 orally in 1 case (cephalexin and ciprofloxacin), 7 and intravenously in the remaining 3 cases (ceftriaxone, 12 cefazolin, metronidazole, clindamycin, 9 first-generation cephalosporin 6 ). Empiric antibiotic regimens were changed after wound culture in 2 cases; monotherapy with ceftriaxone was converted to a dual-drug regimen of vancomycin and ticarcillin after wound cultures grew Acinetobacter, Bacillus, Staphylococcus epidermidis, and Bacteroides in 1 case, 12 and a multidrug regimen of cefazolin, metronidazole, and clindamycin was converted to vancomycin, ceftazidime, caspofungin, and metronidazole after wound cultures grew Candida glabrata, Bacillus pumilus, and Bacillus megaterium.…”

“…Shark teeth and the barbs of catfish, stingray, and Scorpaenidae are radiopaque, though fragments of the integumentary sheath can be radiolucent, and may be better detected by bedside ultrasound. 7,50,51 In a retrospective review of 119 stingray injuries at a single institution, the authors reported no retained barbs detected by radiography. 34 However, 1 case report described a patient who sustained a stingray puncture wound to the arm, resulting in a permanent neurologic deficit in the hand.…”

“…Although most wounds heal without complication, local infection, necrotizing fasciitis, septicemia, permanent neurological deficits, and vascular injuries have been described. [2][3][4][5][6][7] This review describes the management of marine nonmammalian vertebrate penetrating traumatic injuries in North America, the Caribbean, and Hawaii.…”