de Melker H E, de Melker R A
Rijksinstituut voor Volksgezondheid en Milieuhygiëne, Centrum voor Infectieziekten Epidemilogie, Bilthoven.
Ned Tijdschr Geneeskd. 1996 Mar 30;140(13):709-13.
To determine, on the basis of published research on dog bites, risk groups and localisations, risk factors for wound infection, effectiveness of prophylactic antibiotics and indications and contraindications for primary closure of the bite wounds.
Literature study.
Search in Medline (1975-October 1994) on "dog" and "bite(s)" and selection using methodological inclusion and exclusion criteria.
Incidence of dog bites is highest in younger children and in hands/arms. The infection rate amounts to 3-17%. Risk factors for wound infection include hand/arms, puncture wounds, delay of presentation and possibly older age. The effectiveness of prophylactic antibiotics appears to be limited. There is no evidence that the infection rate after primary closure of wounds is higher. Cleaning and debridement are important.
More attention should be paid to prevention of dog bites, especially in children. Most important is adequate cleaning of the wounds. Antibiotics should be given on indication only, such as hand wounds, puncture deep wounds and immune compromised patients. Primary closure is not contraindicated.
基于已发表的关于犬咬伤的研究，确定伤口感染的风险人群、部位、危险因素、预防性抗生素的有效性以及咬伤伤口一期缝合的适应证和禁忌证。
文献研究。
在医学期刊数据库（1975年至1994年10月）中检索“犬”和“咬伤”，并根据方法学纳入和排除标准进行筛选。
犬咬伤的发生率在年幼儿童以及手部/手臂部位最高。感染率为3%至17%。伤口感染的危险因素包括手部/手臂、穿刺伤、就诊延迟以及可能的高龄。预防性抗生素的有效性似乎有限。没有证据表明伤口一期缝合后的感染率更高。清洁和清创很重要。
应更加重视预防犬咬伤，尤其是在儿童中。最重要的是对伤口进行充分清洁。抗生素仅在有指征时使用，如手部伤口、深部穿刺伤和免疫功能低下的患者。一期缝合并非禁忌。
