Yeh Heng, Gao Shi-Ying, Lin Chih-Chuan
Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.
School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
Toxins (Basel). 2021 Mar 2;13(3):183. doi: 10.3390/toxins13030183.
Wound necrosis and secondary infection are common complications after bites. Clinical tools to evaluate the infection risk after Taiwan cobra bites are lacking. In this Cobra BITE study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with Taiwan cobra snakebites. Patients with wound infection lacking tissue necrosis were included in developing Cobra BITE score utilizing univariate and multiple logistic regression, as patients with wound necrosis require antibiotics for infection treatment. 8,295,497 emergency department visits occurred in the span of this study, with 195 of those patients being diagnosed as having cobra bites. Of these patients, 23 had wound necrosis, and 30 had wound infection, resulting in a wound infection rate of 27.2% (53/195). and were the main bacteria identified in the culture report regardless of whether patients' wounds had necrosis. As per our Cobra BITE score, the three factors predicting secondary wound infection after cobra bites are hospital admission, a white blood cell count (in 103/µL) × by neu-trophil-lymphocyte ratio value of ≥114.23, and the use of antivenin medication. The area under the receiver operating characteristic curve for the Cobra BITE score system was 0.88; ideal sensitivity and specificity were 0.89 and 0.76. This scoring system enables the assessment of wound infections after bites, and it could be modified and improved in the future for other spp. bites.
伤口坏死和继发感染是咬伤后的常见并发症。目前缺乏评估台湾眼镜蛇咬伤后感染风险的临床工具。在这项眼镜蛇咬伤感染风险评估（Cobra BITE）研究中，我们调查了台湾眼镜蛇咬伤患者伤口感染的发生率、细菌学情况及相应的抗生素使用情况。由于伤口坏死的患者需要使用抗生素治疗感染，因此将无组织坏死的伤口感染患者纳入研究，通过单因素和多因素逻辑回归分析来制定Cobra BITE评分。在本研究期间，急诊科共接诊8295497人次，其中195例被诊断为眼镜蛇咬伤。这些患者中，23例有伤口坏死，30例有伤口感染，伤口感染率为27.2%（53/195）。无论患者伤口是否有坏死，培养报告中鉴定出的主要细菌都是[具体细菌名称1]和[具体细菌名称2]。根据我们的Cobra BITE评分，预测眼镜蛇咬伤后伤口继发感染的三个因素是入院治疗、白细胞计数（每微升×10³）×中性粒细胞与淋巴细胞比值≥114.23以及使用抗蛇毒血清药物。Cobra BITE评分系统的受试者工作特征曲线下面积为0.88；理想的灵敏度和特异度分别为0.89和0.76。该评分系统能够评估咬伤后的伤口感染情况，未来可针对其他[眼镜蛇种类]的咬伤进行修改和完善。
