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  • Bacteriology (Table 27-1): includes organisms similar to those involved in dog bites. Pasteurella multocida and Bartonella henselae (the agent of cat-scratch disease) are important cat-associated pathogens.

    TABLE 27-1MANAGEMENT OF WOUND INFECTIONS FOLLOWING ANIMAL AND HUMAN BITES

    Biting Species Commonly Isolated Pathogens Preferred Antibiotic(s)a Alternative in Penicillin-Allergic Pt Prophylaxis Advised for Early Uninfected Wounds Other Considerations
    Dog Staphylococcus aureusPasteurella multocida, anaerobes, Capnocytophaga canimorsus Amoxicillin/clavulanate (250–500 mg PO tid) or ampicillin/sulbactam (1.5–3.0 g IV q6h) Clindamycin (150–300 mg PO qid) plus either TMP-SMX (1 DS tablet PO bid) or ciprofloxacin (500 mg PO bid) Sometimesb Consider rabies prophylaxis.


    Biting Species Commonly Isolated Pathogens Preferred Antibiotic(s)a Alternative in Penicillin-Allergic Pt Prophylaxis Advised for Early Uninfected Wounds Other Considerations
    Dog Staphylococcus aureusPasteurella multocida, anaerobes, Capnocytophaga canimorsus Amoxicillin/clavulanate (250–500 mg PO tid) or ampicillin/sulbactam (1.5–3.0 g IV q6h) Clindamycin (150–300 mg PO qid) plus either TMP-SMX (1 DS tablet PO bid) or ciprofloxacin (500 mg PO bid) Sometimesb Consider rabies prophylaxis.
    Cat P. multocidaS. aureus, anaerobes Amoxicillin/clavulanate or ampicillin/sulbactam as above Clindamycin plus TMP-SMX as above or a fluoroquinolone Usually Consider rabies prophylaxis. Carefully evaluate for joint/bone penetration.

    MANAGEMENT OF WOUND INFECTIONS FOLLOWING ANIMAL AND HUMAN BITES

  • Clinical features: P. multocida infections can cause rapidly advancing inflammation and purulent discharge within a few hours after the bite. Because of deep tissue penetration by narrow, sharp feline incisors, cat bites are more likely than dog bites to cause septic arthritis or osteomyelitis.

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    • Epidemiology: Cat bites and scratches result in infection in >50% of cases.

     

     

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