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Cat bites are the second most frequent animal bites. About 45-63% of cat bites cause injuries to the hand.2 Compared with dog bites, cat bites have an incidence rate of less than 1/6. However, the infection rate is more than doubled when a cat bite occurs.3Review리뷰consideration고려DISCUSSION토론전체 결과를 로드할 수 없음다시 시도
In animal bites, the occurrence of direct wounds by teeth and direct inoculation of bacteria occur more frequently than secondary infections by wounds.4 In the case of cat bites, the sharper and thinner teeth are the reason for this high rate of infection. Since cat tooth is easy to penetrate the joint capsule and bone, deep infections such as infectious arthritis and osteomyelitis can easily occur. Even if an infection occurs, it is often not detected early.
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In case of a cat bite injury, strong cellulitis usually occurs locally within 12-24 hours after the bite and an abscess may occur. Johnson et al. have reported that local osteomyelitis may also occur.5 It has also been reported that 37% of cat bite patients require hospitalization and 12% of patients require surgical treatment.6 In addition, Veitch et al. have reported that 1% of all hospitalized patients for hand infections are caused by complications of cat bites.7
Pasteurella multocida is the most identified in results of culture for patients with cat bite wounds.8 This is because Pasteurella multocida is present in the normal flora of the oral cavity in more than 90% of felines.9Westling et al. have performed a study on 78 cat bite patients and reported that Pasteurella multocida is identified in 70% of cases.10 Mitnovetski et al. have reported thatPasteurella multocida is found most frequently in culture of cat bite wounds.6,7 Pasteurella multocida can easily cause death. There are cases where it shows false negatives during culture. Serology itself cannot differentiate between current infection and past exposure. The fastest and most accurate identification method is polymerase chain reaction (PCR). However, even if there is a deep infection caused by a cat bite, 7-8% of cases might not be culturable.11 In the present case, no bacteria were identified in the culture test performed for samples collected during surgery. However, false negatives cannot be ruled out. Talan et al. have reported that a bite wound can be considered to be infected if it meets one or more of three main criteria (fever, abscess, and lymphangitis) and if it meets 4 or more of five sub-criteria (erythema more than 3 cm from the margin of the wound, tenderness, edema, purulent discharge, and a white blood cell count of 12,000 /ml or more.11 Hospitalization should be considered for patients with severe cellulitis, systemic symptoms of infection (fever, vomiting, confusion), clear evidence of bone, joint, ligament, or nerve involvement, rapid spread of infection within 24-48 hours, or unresponsive to oral medications.2 However, there are cases with an incubation period for months or years without symptoms. In the case of our patient, there was no fever. In addition, ESR and CRP were normal. However, symptoms such as erythema, tenderness, and edema were found.
Mitnovetski et al. have reported that early and appropriate treatment is very important for patients with cat bites.9 If it is determined that an infection is present, immediate treatment is required. If osteomyelitis is suspected as in the present patient, surgical treatment and appropriate antibiotic treatment should be combined to remove the infected tissue. Treatment can be largely divided into treatment of wounds caused by direct damage and treatment of infection by the causative strain. It is based on opening the wound at an early stage. After that, whether to suture should be decided while observing the progress at intervals of 1-2 days. Early disinfection of the wound, keeping it open, and administering appropriate antibiotics usually yield good results. In order to use appropriate (accurate) antibiotics, a bacterial culture test is required. Since it takes 24-48 hours to know the result of bacterial culture, prophylactic antibiotic treatment is necessary. Prophylactic antibiotic treatment after 48 hours will result in poor prognosis. As a prophylactic antibiotic, penicillin is mainly used. It is more effective to prescribe the 2nd and 3rd generation cephalosporin class antibiotics than the 1st generation.6 In most patients, treatment is completed with only 10-14 days of antibiotic administration for superficial wounds. Intravenous administration of antibiotics for 6 weeks is required for wounds that have invaded bones or joints. The use of prophylactic antibiotics for small wounds can reduce the frequency of infection from 28% to 2%.12We administered the second-generation cephalosporin intravenously for up to 2 weeks after the surgery followed by oral antibiotics for 4 weeks.
For cat bite patients, it is effective to prescribe appropriate antibiotics before results of culture, even for wounds that are considered insignificant. It is also important to actively implement surgical incisions and debridement resections if infection is suspected. Talan은 다음과 같은 경우에 물린 상처가 감염되었다고 판단했습니다.
Talan was determined that following the bite wound is infected if: 0.8
Talan은 다음과 같은 경우 물린 상처가 감염된 것으로 확인되었습니다. 0.8
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It was also suggested that hospitalization should be considered for patients who do not respond to oral medications.2
또한 경구 약물에 반응하지 않는 환자의 경우 입원을 고려해야 한다고 제안되었습니다.2
In addition, patients unresponsive to oral medications suggested that the hospital consider 0.2
또한 경구 약물에 반응하지 않는 환자는 병원에서 0.2를 고려할 것을 제안했습니다.
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Conclusion
In the case of a cat bite patient, even if the external wound is small, it is necessary to observe it closely while prescribing an appropriate antibiotic. If symptoms persist and infection is present, aggressive treatment including debridement may be effective for a cat bite patient.
References
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2. Goldstain EJC. Bite wounds and infection. Clin. Infect. Dis. 1992;14:633 -40
3. Dire DJ. Emergency management of dog and cat bite wounds. Emerg Med Clin North Am 1992;10:719e36.
4. Aziz H, Rhee P, Pandit V, Tang A, Gries L, Joseph B. The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds. J Trauma Acute Care Surg. 2015;78:641-8.
5. Johnson RH, Rumans LW. Articular and skeletal infections caused by pasterurella multocida. JAMA 1977;237:146-7
6. Mitnovetski S, Kimble F. Cat bites of the hand. Anz J Surg 2004;74:859-62
7. Veitch JM, Omer GE. Case report: treatment of cat bite injuries of the hand. J. Trauma 1979; 19:201-2.
8. Lloret A, Egberink H, Addie D, Belák S, Boucraut-Baralon C, Frymus T, et al. Pasteurella multocida infection in cats: ABCD guidelines on prevention and management. J Feline Med Surg. 2013;15:570-2.
9. Freshwater A. Why your housecat”s trite little bites could cause you quite a fright: a study of domestic felines on the occurrence and antibiotic susceptibility of Pasteurella multocida. Zoonoses Public. Health 2008;55:507-13.
10. Westling K, Farra A, Cars B, Ekblom AG, Sandstedt K, Settergren B, et al. Cat bite wound infections: a prospective clinical and microbiological study at three emergency wards in Stockholm, Sweden. J Infect. 2006;53:403-7.
11. Talan DA, Citron DM, Abrahamian FM, moran GJ, Goldstain EJ. Bacteriologic analysis of infected god and cat bites. N Engl J Med. 1999;340:85-92
12. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev. 2001;2:CD001738.