Rationale:

• Patients with systemic signs of infection may be bacteremic and require intravenous antibiotics.
• Infections of the joint space, bone, or tendon are difficult to cure in the outpatient setting.
• Hand bite infections require surgical debridement and meticulous care for proper healing to occur.
• Immunocompromised individuals can have severe infections that may be poorly responsive to outpatient management.
• When outpatient management of bite wound infections fails, patients may harbor resistant organisms that require further evaluation by medical subspecialists.
• Poor adherence to wound care can lead to septic arthritis, osteomyelitis, and amputation.

Evidence:

• A review of 39 cases of Capnocytophaga canimorsus septicemia from dog bites revealed that 13 (33%) patients were previously in good health and 12 (31%) patients died (24).
• Hyperglycemia impairs polymorphonuclear leukocyte function and may thereby increase the risk of severe infection in patients with mammalian bites, according to one review article (25).
• Approximately one third of 111 patients seen for evaluation of dog or cat hand bites required at least one surgical procedure (33).
• A retrospective study of 14 patients admitted for Pasteurella multocida animal bite wound infections revealed that 10 patients were administered inappropriate antibiotics before hospitalization (26).
• A retrospective review of eight patients admitted for human hand bite infections showed that management failed in six patients initially treated in the outpatient setting, including treatment with oral antibiotics (34).
• In a prospective study of 100 human “fight-bite” injuries of the hand, the time until admission of the 18 patients who ultimately required amputation was 9.2 days in comparison to 4.6 days in those with healing without amputation (23).
• Twenty-three of 24 patients admitted with hand osteomyelitis from a human bite wound did not receive adequate surgical debridement within 24 hours of the injury (29).
• According to a retrospective review, 60% of patients admitted with human bite infections missed subsequent follow-up appointments (35).

Comments:

• None.