Epidemiology of secondary infection after snakebites in center-west Brazil

Abstract

Background Snakebites represent a significant health problem in tropical countries, with an annual incidence of 2.7 million cases worldwide. The incidence of secondary infections after snake bites is also high and is usually caused by bacteria from the oral cavity of snakes. Morganella morganii has been identified as an important cause of infections and has been guiding antibiotic therapy in several regions of Brazil and the world. Methodology/Principal findings We performed a retrospective cross-sectional evaluation of snakebites in hospitalized patients between January 2018 and November 2019 and selected those with secondary infection in their medical records. During the period, 326 cases of snakebites were treated, and 155 (47.5%) of them eventually had secondary infections. However, only seven patients underwent culture of soft tissue fragments, in which three cases were negative culture results, while Aeromonas hydrophila was identified in four cases. Of these, 75% were resistant to ampicillin/sulbactam, 50% had intermediate sensitivity to imipenem, and 25% had intermediate sensitivity to piperacillin/tazobactam. Trimethoprim/sulfamethoxazole (TMP-SMX) was not tested on any strain. Of the 155 cases that progressed to secondary infections, 48.4% (75) were empirically treated with amoxicillin/clavulanate, 41.9% (65) with TMP-SMX, and 32 (22%) of these 144 cases required a change to a second regimen, and 10 of these 32 patients required a third therapeutic regimen. Conclusion Wild animals act as reservoirs of resistant bacteria because their oral cavity favors biofilm formation, which explains the finding of A. hydrophila with a reduced sensitivity profile in this study. This fact is essential for the appropriate choice of empirical antibiotic therapy.

Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002–2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database

“…stejnegeri and P . mucrosquamatus ) developed wound infections, which is consistent with previous studies conducted by Mao et al [ 32 , 33 ], and lower than the study conducted by João Victor Soares Coriolano Coutinho et al[ 42 ]. Although the incidence of wound infection might still have been overestimated in this study, we believed the overestimate was likely to be of limited magnitude.…”

“…mucrosquamatus (crotaline) bites, with rates of 11.4% and 27.4%, respectively [ 32 , 33 ]. In this study, which utilized the NHIRD, we used criteria similar to those in a recent report to identify SBE wound infections [ 42 ]. Our findings indicate that 20.3% of patients who received FH antivenom (i.e., antivenom for T .…”

“…On the other hand, wound infections are less common in T. s. stejnegeri and P. mucrosquamatus (crotaline) bites, with rates of 11.4% and 27.4%, respectively [32,33]. In this study, which utilized the NHIRD, we used criteria similar to those in a recent report to identify SBE wound infections [42]. Our findings indicate that 20.3% of patients who received FH antivenom (i.e., antivenom for T. s. stejnegeri and P. mucrosquamatus) developed wound infections, which is consistent with previous studies conducted by Mao et al [32,33], and lower than the study conducted by João Victor Soares Coriolano Coutinho et al [42].…”

“…Anaphylactic reaction to antivenom administration was defined as being given epinephrine intravenously for shock, bronchospasm, or angioedema within 1 day following the first dose [ 41 ]. Wound infection and antibiotic use were defined as having erysipelas, cellulitis, fasciitis, or myositis and receiving oral or intravenous antibiotics within 7 days, respectively [ 42 ]. Surgery was defined as undergoing incision, division, excision, debridement, transplantation, reconstruction, grafts, or amputation within 14 days.…”

Use of Antibiotics following Snakebite in the Era of Antimicrobial Stewardship

“…In the studies reviewed here, broad-spectrum antibiotics were generally used, either alone or, more often, as combinations, with a predominance of third-generation cephalosporins, ampicillin, metronidazole, clindamycin, and occasionally oral ciprofloxacin ( Table 1 ). There is no consensus regarding which antibiotics to use in SBE, and several studies recommend selecting the antibiotics based on the predominant bacteria of the mouth of snakes [ 16 , 30 , 40 , 51 ]. In addition, care should be taken to consider the possible adverse effects of some antibiotics in the context of the pathophysiology of envenoming.…”