Wound Infections ================ þ Wound Botulism þ Wound Infections vs Prophylactic Antibiotics - see also about marine-induced infections - prophylactic antibiotics don't prevent wound infections in simple wounds [Cummings P, Del Beccaro MA. Antibiotics to prevent infections of simple wounds: a meta-analysis randomized studies.] - Topical antibiotics: do reduce infection rates. - prophylactic antibiotics for oral wounds? Yes, especially if > 24 hours out. [Mark, D. G. and E. J. Granquist (2008). "Are prophylactic oral antibiotics indicated for the treatment of intraoral wounds?" Ann Emerg Med 52(4): 368- 372.] Patients with intraoral and oral-cutaneous wounds commonly present to emergency departments (EDs), usually after sustaining blunt facial trauma. Many of these wounds are minor, small (<1 cm), hemostatic on presentation, and confined to the oral mucosa, requiring no specific intervention. Some of these injuries, however, do require wound repair, in particular large mucosal wounds (1 to 2 cm) and those that communicate with the overlying facial skin ("through-and-through" wounds). Most emergency medicine textbooks consider these larger wounds to be at significant risk for infection because of oral bacterial flora and thus recommend that a course of prophylactic antibiotics be prescribed when primary repair of these wounds is performed in the ED, in addition to routine oral and local wound care. However, studies have shown that other wounds commonly considered to be at significant risk for secondary infection, such as simple lacerations of the hand, do not appear to conclusively benefit from prophylactic antibiotic therapy when careful wound preparation is performed before primary repair. We therefore reviewed the available literature to determine the strength of evidence supporting the use of prophylactic oral antibiotics for intraoral wounds treated and repaired in the ED. - Dog and cat bites? no. Human bites? Yes. Hand wounds? Yes. [Medeiros, I. and H. Saconato (2001). "Antibiotic prophylaxis for mammalian bites." Cochrane Database Syst Rev(2): CD001738. BACKGROUND: Bites by mammals are a common problem and they account for up to 1% of all visits to hospital emergency rooms. Dog and cat bites are the most common and people are usually bitten by their own pets or by an animal known to them. School-age children make up almost a half of those bitten. Prevention of tetanus, rabies and wound infection are the priorities for staff in emergency rooms. The use of antibiotics may be useful to reduce the risk of developing a wound infection. OBJECTIVES: To determine if the use of prophylactic antibiotics in mammalian bites is effective in preventing bite wound infection. SEARCH STRATEGY: Relevant RCTs were identified by electronic searches of MEDLINE, EMBASE, LILACS and the Cochrane Controlled Trials Register databases in November 2000. SELECTION CRITERIA: We included randomised controlled trials which studied patients with bites from all mammals. Comparisons were made between antibiotics and placebo or no intervention. The outcome of interest was the number of infections at the site of bite. DATA COLLECTION AND ANALYSIS: Two reviewers extracted the data independently. All analyses were performed according to the intention-to- treat method. MAIN RESULTS: Eight studies were included. The use of prophylactic antibiotics was associated with a statistically significant reduction in the rate of infection after bites by humans. Prophylactic antibiotics did not appear to reduce the rate of infection after bites by cats or dogs. Wound type, e.g. laceration or puncture, did not appear to influence the effectiveness of the prophylactic antibiotic. Prophylactic antibiotics were associated with a statistically significant reduction in the rate of infection in hand bites (OR 0.10, 95% CI 0.01 to 0.86; NNT = 4, 95% CI 2 to 50). REVIEWER'S CONCLUSIONS: There is evidence from one trial that prophylactic antibiotics reduces the risk of infection after human bites but confirmatory research is required. There is no evidence that the use of prophylactic antibiotics is effective for cat or dog bites. There is evidence that the use of antibiotic prophylactic after bites of the hand reduces infection but confirmatory research is required. þ Can patients diagnose their wound infections? - no. [Seaman, et al. Inability of Patients to Self-Diagnose Wound Infections. J Emerg Med 1991;9(4):215.] This was a prospective study of almost 450 patients from a large community hospital in Fresno, CA. All patients with traumatic wounds were instructed to return to the ED 2-3 days after their initial visit. At that time, they were asked to identify any/all of seven signs (tenderness, erythema, purulent drainage, etc.) of infection. An experienced clinician also judged if indeed there was an infection. In brief, the results: Approximately 5% of the patients were judged to have infected wounds. 8% perecent of the patients who thought they had an infection (ie: identified one or more signs as "positive") did not. 48% (!) of those who did have infections did not perceive or diagnose it. The authors conclude that -- at least in their patient population -- relying on patients to assess whether or not they are developing a wound infection would result in many "missed" cases. þ Wound Infection Rates after Suturing - 1-5% [Baker MD, Lanuti M. The management and outcome of lacerations in urban children. Ann Emerg Med 1990 Sep;19(9):1001-5.] Abstract: [Singer AJ, Hollander JE, Cassara G, Valentine SM, Thode HC Jr, Henry MC Level of training, wound care practices, and infection rates. Am J Emerg Med 1995 May;13(3):265-8.] Abstract: