Human Bite Infections Follow-up

  • Author: Don R Revis Jr, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

Further Inpatient Care

  • Some patients require hospitalization for surgical intervention, intravenous antibiotic administration, and observation.
  • If surgery is not initially performed, admitting the patient allows prompt surgical intervention if no improvement is noted or the clinical situation deteriorates.
  • Indications for hospitalization
    • Any patient with an injury severe enough to require operative exploration should be observed overnight postoperatively. Some may well require a longer stay, but this is dictated by the specific clinical situation.
    • Any patient with systemic manifestations of infection such as fever, chills, or elevated white blood cell count
    • Patients with significant comorbidities
    • Patients with failure to improve with initial outpatient management
    • Patients with a high likelihood of noncompliance (eg, persons who are emotionally disturbed, mentally handicapped, or homeless; persons with chronic alcoholism)
    • Patients with infected hand wounds
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Further Outpatient Care

  • Patients evaluated early, without evidence of infection, and without hand wounds may be treated on an outpatient basis without antibiotics.
    • Patients must return within 48-72 hours for reassessment.
    • The development of any signs or symptoms of infection indicate the need to seek immediate medical attention.
  • Patients with mild-to-moderate infections or hand wounds without infection may also be treated on an outpatient basis with oral antibiotics if they are likely to be compliant with the overall treatment plan.
    • Patients must return within 24-48 hours for reassessment.
    • They must immediately seek medical attention if their clinical condition deteriorates.
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Inpatient & Outpatient Medications

  • Antibiotics administered initially or during hospitalization should be continued for the length of time determined by the treating physician.
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Complications

  • Cosmetic deformity resulting from wound contraction
  • Permanent hand disability secondary to stiffness and/or chronic pain
  • Tenosynovitis
  • Osteomyelitis
  • Septic arthritis
  • Abscess formation
  • Amputation (rare)
  • Transmission of disease
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Prognosis

  • Prognosis is excellent in the compliant patient who promptly seeks medical attention following injury.
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Patient Education

  • Patients must clearly understand the signs and symptoms of wound infection for which they must return for immediate reevaluation. These include but are not limited to fever, odor, drainage, purulence, swelling, cellulitis, warmth, pain, and decreased mobility.
  • Patients must clearly understand the importance of early and regular follow-up care for this seemingly minor injury.
  • Patients must clearly understand the rationale for providing antibiotics and the importance of compliance with this recommendation.
  • Patients must clearly understand the potential complications that may develop even with complete compliance with the care plan.
  • Patients should understand that wound revision for cosmetic or functional purposes might be desirable at a later date.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center and Infections Center. Also, see eMedicine's patient education articles Human Bites and Tetanus.
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Contributor Information and Disclosures
Author

Don R Revis Jr, MD  Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine

Don R Revis Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas J Marrie, MD  Dean of Faculty of Medicine, Dalhousie University Faculty of Medicine, Canada

Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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