Dire D J
Department of Emergency Medicine, Darnall Army Community Hospital, Fort Hood 76544-5063.
Ann Emerg Med. 1991 Sep;20(9):973-9. doi: 10.1016/s0196-0644(05)82975-0.
In the last ten years, many emergency medicine specialists have studied animal bite wounds. The majority of these studies have addressed the controversies of prescribing prophylactic antibiotics or suturing wounds. This study was undertaken to determine risk factors for cat bite wound infections.
Prospective survey.
Community hospital emergency medicine residency program.
One hundred eighty-six consecutive patients with 216 cat bite/scratch wounds over a two-year period.
A standardized wound cleaning protocol with debridement and suturing, if indicated, was used. Variables analyzed included patient age and gender; wound age, type, number, location, and depth; prehospital therapy; emergency department therapy; and antibiotics used.
The mean patient age was 19.5 +/- 15.9 years. The mean time interval from wounding to ED treatment was 10.2 +/- 39.2 hours. By anatomical sites, there were 33 (15%) head/neck, 48 (22%) arm, 97 (45%) hand, ten (5%) truncal, and 28 (13%) lower extremity wounds. By wound type, there were 122 (56%) punctures, 54 (25%) abrasions, 37 (17%) lacerations, and two (1%) avulsions. One hundred fifty (71%) of the wounds were partial thickness, and 62 (29%) were full thickness. Twenty-four (12.9%) of the patients had clinical evidence of wound infection on arrival to the ED. Five (2.7%) developed clinical evidence of infection despite ED treatment. None of the 14 (7.5%) patients with only "claw" injuries developed infection. The overall patient infection rate for those with cat "bites" was 15.6%. Factors associated with wound infections included older age (P less than .001), longer time intervals until ED treatment (P less than .0001), wounds inflicted by "pet" cats (P = .001), attempting wound care at home (P = .0004), having a more severe wound (P = .01), and having a deeper wound (P = .0001). Data from 148 patients who had only "bite" wounds and did not have clinical evidence of infection on initial presentation to the ED also were analyzed for wound infection risk factors. Wound infections were more likely to develop in patients with lower extremity wounds who did not receive prophylactic oral antibiotics (P = .071) and those with puncture wounds who did not receive prophylactic oral antibiotics (P = .085).
In this study, wound type and wound depth were the most important factors in determining the likelihood of developing wound infection regardless of whether the patient was prescribed prophylactic oral antibiotics.
在过去十年中，许多急诊医学专家对动物咬伤伤口进行了研究。这些研究大多涉及预防性使用抗生素或伤口缝合的争议。本研究旨在确定猫咬伤伤口感染的危险因素。
前瞻性调查。
社区医院急诊医学住院医师培训项目。
在两年期间，连续纳入186例患者，共216处猫咬伤/抓伤伤口。
采用标准化的伤口清洁方案，必要时进行清创和缝合。分析的变量包括患者年龄和性别；伤口的时间、类型、数量、位置和深度；院前治疗；急诊科治疗；以及使用的抗生素。
患者的平均年龄为19.5±15.9岁。从受伤到急诊科治疗的平均时间间隔为10.2±39.2小时。按解剖部位划分，头部/颈部伤口33处（15%），手臂伤口48处（22%），手部伤口97处（45%），躯干伤口10处（5%），下肢伤口28处（13%）。按伤口类型划分，穿刺伤122处（56%），擦伤54处（25%），裂伤37处（17%），撕脱伤2处（1%）。150处（71%）伤口为部分厚度，62处（29%）为全层厚度。24例（12.9%）患者在到达急诊科时具有伤口感染的临床证据。5例（2.7%）患者尽管在急诊科接受了治疗，但仍出现感染的临床证据。14例仅为“抓伤”的患者（7.5%）均未发生感染。猫“咬伤”患者的总体感染率为15.6%。与伤口感染相关的因素包括年龄较大（P<0.001）、到急诊科治疗的时间间隔较长（P<0.0001）、被“宠物”猫咬伤（P=0.001）、在家自行处理伤口（P=0.0004）、伤口较严重（P=0.01）以及伤口较深（P=0.0001）。对148例仅为“咬伤”伤口且在初次就诊于急诊科时无感染临床证据的患者的数据也进行了伤口感染危险因素分析。未接受预防性口服抗生素治疗的下肢伤口患者（P=0.071）和未接受预防性口服抗生素治疗的穿刺伤患者（P=0.085）更易发生伤口感染。
在本研究中，无论患者是否接受预防性口服抗生素治疗，伤口类型和伤口深度都是决定伤口感染可能性的最重要因素。
