Clinical Features, Bacteriology, and Antibiotic Treatment Among Patients with Presumed Naja Bites in Vietnam

Abstract

IntroductiondClinical and bacteriological features of cobra (Naja) bites are still relatively unknown in Vietnam. This study aimed to characterize the clinical and bacteriological characteristics of local wounds in patients with presumed Naja spp bite, as well as their antibiotic treatment.MethodsdA cross-sectional study was performed on presumed Naja bite patients who were admitted to Bach Mai Hospital in Hanoi, Vietnam. In vitro bacterial isolation, blood tests, and lesion measure were conducted, and antibiotic susceptibilities of localized bite wounds were assessed. The Mann-Whitney test was used to examine the difference in clinical characteristics between patients experiencing presumed Naja atra bites and Naja kaouthia bites. Data are presented as percentages or median with interquartile range, as appropriate. Statistical significance was accepted at P<0.05.ResultsdAmong 46 patients, all had typical clinical features of Naja bite. The median bite-to-hospital time was 6 h (interquartile range 4.0e11.3). The dominant organisms isolated from local wounds were Morganella morganii (11/36) and Enterococcus faecalis (25/36). All cultures were susceptible to ciprofloxacin. No difference was found with regard to pain, swelling circumference, swelling spread, or necrotic area between patients bitten by presumed Naja atra and Naja kaouthia (P>0.05).ConclusionsdWound necrosis and infection were important clinical issues in presumed Naja spp snake bites. Morganella morganii and Enterococcus faecalis were dominant in local wound swabs of such cases. Ciprofloxacin should be an effective first-line antibiotic for patients with presumed Naja bite.

Morganella morganii, an Emerging Cause of Bloodstream Infections

“…However, the potential for Morganella morganii to acquire other resistance determinants has been increasingly recognized ( 7 ). Recent studies have found extensively resistant strains in sewage samples and among a range of animal sources ( 8 – 13 ). As a result of its ability to cause invasive disease, the presence of bla AmpC and virulence factors, and its propensity to acquire resistance determinants, Morganella morganii has been labeled an emerging “superbug” ( 6 ).…”

Use of Antibiotics following Snakebite in the Era of Antimicrobial Stewardship

“…We also focused our review on the criteria for recommending antibiotic use. Several studies proposed the prophylactic use of antibiotics in SBE owing to the likelihood of bacterial infections in this pathology [ 16 , 32 , 35 ]. In contrast, most studies emphasize that the prophylactic use of antibiotics should be avoided, and instead suggest that they should be used only when there is evidence of infection in these patients.…”

Wound Infection of Snakebite from Venomous Protobothrops mucrosquamatus, Viridovipera stejnegeri and Naja atra in Taiwan: Validation of BITE and Cobra BITE Scoring Systems and their Bacteriological Differences in Wound Cultures

“…Resiere et al [ 18 ] suggested that amoxicillin with clavulanic acid was not suitable for treating snakebites and that third-generation cephalosporin may be administered if required. Ngoc et al [ 19 ] conducted a study in in Vietnam and examined the wound culture reports of Naja species’ snakebites. They observed that E. faecalis exhibited sensitivity to all antibiotics and M. morganii was sensitive to cephalosporin, quinolone, and carbapenem.…”