Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 153 No. 6 (2023)

Presentation and treatment of animal and human bite injuries at a Swiss tertiary emergency department: a cross-sectional study

  • Simone Ehrhard
  • Mirjam Keller
  • Linda Morgenstern
  • Martin Müller
  • Meret E. Ricklin
  • Jolanta Klukowska-Rötzler
  • Aristomenis K. Exadaktylos
  • Dominik A. Jakob
DOI
https://doi.org/10.57187/smw.2023.40093
Cite this as:
Swiss Med Wkly. 2023;153:40093
Published
20.06.2023

Summary

BACKGROUND: Animal and human bite injuries are a relevant health problem worldwide. With the increasing number of pets, bite injuries are becoming more frequent. Previous studies on animal and human bite injuries in Switzerland were completed several years ago. The aim of the present study was to provide a detailed overview of patients with bite injuries admitted to a tertiary emergency department in Switzerland in terms of demographics, injury patterns and treatment strategies.

METHODS: A 9-year cross-sectional analysis of patients presenting to the emergency department of Bern University Hospital in the period January 2013 to December 2021 following an animal or human bite injury.

RESULTS: A total of 829 patients with bite injuries were identified, including 70 for postexposure prophylaxis only. Their median age was 39 (IQR 27–54) years and 53.6% were female. Most patients were bitten by a dog (44.3%), followed by cats (31.5%) and humans (15.2%). Most bite injuries were mild (80.2%); severe injuries were mainly found in dog bites (28.3%). Most patients were treated within six hours after human (80.9%) or dog (61.6%) bites; after cat bites, patients often presented with a delay (74.5%) and signs of infection (73.6%). Human bite wounds were superficial in the majority of cases (95.7%), rarely showed signs of infection (5.2%) at the time of presentation and hospitalisation was never required.

CONCLUSIONS: Our study provides a detailed overview of patients admitted to an emergency department of a tertiary Swiss University Hospital after an animal or human bite. In summary, bite injuries are common among patients who present to the emergency department. Therefore, primary and emergency care clinicians should be familiar with these injuries and their treatment strategies. The high risk of infection, particularly in cat bites, may warrant surgical debridement in the initial treatment of these patients. Prophylactic antibiotic therapy and close follow-up examinations are recommended in most cases.

References

  1. 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 Mar;78(3):641–8. 10.1097/TA.0000000000000531 DOI: https://doi.org/10.1097/TA.0000000000000531
  2. Dendle C, Looke D. Review article: Animal bites: an update for management with a focus on infections. Emerg Med Australas. 2008 Dec;20(6):458–67. DOI: https://doi.org/10.1111/j.1742-6723.2008.01130.x
  3. Jaindl M, Oberleitner G, Endler G, Thallinger C, Kovar FM. Management of bite wounds in children and adults-an analysis of over 5000 cases at a level I trauma centre. Wien Klin Wochenschr. 2016 May;128(9-10):367–75. 10.1007/s00508-015-0900-x DOI: https://doi.org/10.1007/s00508-015-0900-x
  4. Rothe K, Tsokos M, Handrick W. Animal and Human Bite Wounds. Dtsch Arztebl Int. 2015 Jun;112(25):433–42. DOI: https://doi.org/10.3238/arztebl.2015.0433
  5. Frey J, Mindekem R, Kessely H, Doumagoum Moto D, Naïssengar S, Zinsstag J, et al. Survey of animal bite injuries and their management for an estimate of human rabies deaths in N’Djaména, Chad. Trop Med Int Health. 2013 Dec;18(12):1555–62. 10.1111/tmi.12202 DOI: https://doi.org/10.1111/tmi.12202
  6. Wiley JF 2nd. Mammalian bites. Review of evaluation and management. Clin Pediatr (Phila). 1990 May;29(5):283–7. 10.1177/000992289002900506 DOI: https://doi.org/10.1177/000992289002900506
  7. Goldstein EJ. Bite wounds and infection. Clin Infect Dis. 1992 Mar;14(3):633–8. 10.1093/clinids/14.3.633 DOI: https://doi.org/10.1093/clinids/14.3.633
  8. Ostanello F, Gherardi A, Caprioli A, La Placa L, Passini A, Prosperi S. Incidence of injuries caused by dogs and cats treated in emergency departments in a major Italian city. Emerg Med J. 2005 Apr;22(4):260–2. 10.1136/emj.2004.014886 DOI: https://doi.org/10.1136/emj.2004.014886
  9. Morosetti G, Toson M, Piffer C. Lesions caused by animals in the Autonomous Province of South Tyrol in 2010: fact-finding for prevention. Vet Ital. 2013;49(1):37–50.
  10. Bregman B, Slavinski S. Using emergency department data to conduct dog and animal bite surveillance in New York City, 2003-2006. Public Health Rep. 2012;127(2):195–201. 10.1177/003335491212700208 DOI: https://doi.org/10.1177/003335491212700208
  11. Tabbara M, Hatzigianni P, Fux C, Zimmermann H, Exadaktylos AK. Human bite wounds: a swiss emergency department experience. Wounds. 2012 Apr;24(4):85–90.
  12. Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995 Dec;33(6):1019–29. 10.1016/0190-9622(95)90296-1 DOI: https://doi.org/10.1016/0190-9622(95)90296-1
  13. Stefanopoulos PK, Tarantzopoulou AD. Facial bite wounds: management update. Int J Oral Maxillofac Surg. 2005 Jul;34(5):464–72. 10.1016/j.ijom.2005.04.001 DOI: https://doi.org/10.1016/j.ijom.2005.04.001
  14. Conlon HA. Human bites in the classroom: incidence, treatment, and complications. J Sch Nurs. 2007 Aug;23(4):197–201. 10.1177/10598405070230040301 DOI: https://doi.org/10.1177/10598405070230040301
  15. Matter HC, Sentinella Arbeitsgemeinschaft. The epidemiology of bite and scratch injuries by vertebrate animals in Switzerland. Eur J Epidemiol. 1998 Jul;14(5):483–90. 10.1023/A:1007460213308
  16. Rueff F, Bedacht R, Schury G. [Bite injury. Special situation as to clinical aspects, therapy and course of healing]. Med Welt. 1967 Mar;12:663–8.
  17. Ting JW, Yue BY, Tang HH, Rizzitelli A, Shayan R, Raiola F, et al. Emergency department presentations with mammalian bite injuries: risk factors for admission and surgery. Med J Aust. 2016;204(3):114 e1-7. 10.5694/mja15.00653 DOI: https://doi.org/10.5694/mja15.00653
  18. Pfortmueller CA, Efeoglou A, Furrer H, Exadaktylos AK. Dog bite injuries: primary and secondary emergency department presentations—a retrospective cohort study. ScientificWorldJournal. 2013 Sep;2013:393176. 10.1155/2013/393176 DOI: https://doi.org/10.1155/2013/393176
  19. Freshwater A. Why your housecat’s trite little bite could cause you quite a fright: a study of domestic felines on the occurrence and antibiotic susceptibility of Pasteurella multocida. Zoonoses Public Health. 2008 Oct;55(8-10):507–13. 10.1111/j.1863-2378.2008.01152.x DOI: https://doi.org/10.1111/j.1863-2378.2008.01152.x
  20. Kennedy SA, Stoll LE, Lauder AS. Human and other mammalian bite injuries of the hand: evaluation and management. J Am Acad Orthop Surg. 2015 Jan;23(1):47–57. 10.5435/JAAOS-23-01-47 DOI: https://doi.org/10.5435/JAAOS-23-01-47
  21. Benson LS, Edwards SL, Schiff AP, Williams CS, Visotsky JL. Dog and cat bites to the hand: treatment and cost assessment. J Hand Surg Am. 2006 Mar;31(3):468–73. 10.1016/j.jhsa.2005.12.011 DOI: https://doi.org/10.1016/j.jhsa.2005.12.011
  22. Pomares G, Huguet S, Dap F, Dautel G. Contaminated wounds: effectiveness of debridement for reducing bacterial load. Hand Surg Rehabil. 2016 Sep;35(4):266–70. 10.1016/j.hansur.2016.06.001 DOI: https://doi.org/10.1016/j.hansur.2016.06.001
  23. Norton C. Animal and human bites. Emerg Nurse. 2008 Oct;16(6):26–9. 10.7748/en2008.10.16.6.26.c6781 DOI: https://doi.org/10.7748/en2008.10.16.6.26.c6781
  24. Brook I. Management of human and animal bite wound infection: an overview. Curr Infect Dis Rep. 2009 Sep;11(5):389–95. 10.1007/s11908-009-0055-x DOI: https://doi.org/10.1007/s11908-009-0055-x
  25. Esposito S, Picciolli I, Semino M, Principi N. Dog and cat bite-associated infections in children. Eur J Clin Microbiol Infect Dis. 2013 Aug;32(8):971–6. 10.1007/s10096-013-1840-x DOI: https://doi.org/10.1007/s10096-013-1840-x
  26. Myers JP. Bite Wound Infections. Curr Infect Dis Rep. 2003 Oct;5(5):416–25. 10.1007/s11908-003-0022-x DOI: https://doi.org/10.1007/s11908-003-0022-x
  27. Stierman KL, Lloyd KM, De Luca-Pytell DM, Phillips LG, Calhoun KH. Treatment and outcome of human bites in the head and neck. Otolaryngol Head Neck Surg. 2003 Jun;128(6):795–801. 10.1016/S0194-59980300254-7 DOI: https://doi.org/10.1016/S0194-59980300254-7
  28. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev. 2001;(2):CD001738. DOI: https://doi.org/10.1002/14651858.CD001738
  29. Rittner AV, Fitzpatrick K, Corfield A. Best evidence topic report. Are antibiotics indicated following human bites? Emerg Med J. 2005 Sep;22(9):654. 10.1136/emj.2005.028662 DOI: https://doi.org/10.1136/emj.2005.028662
  30. Henton J, Jain A. Cochrane corner: antibiotic prophylaxis for mammalian bites (intervention review). J Hand Surg Eur Vol. 2012 Oct;37(8):804–6. 10.1177/1753193412452204 DOI: https://doi.org/10.1177/1753193412452204

Most read articles by the same author(s)

1 2 > >>