Pasteurella Multocida Infection Treatment & Management

  • Author: Alexandre Lacasse, MD, MSc; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

Medical Care

  • Because P multocida infection is mostly encountered in the setting of an injury following an animal bite, physicians must be familiar with the associated microbiological oral flora of certain animals, especially dogs and cats.
  • Most animal bites are polymicrobial, with both aerobic and anaerobic bacteria. Several species can be isolated at once.
  • Several Pasteurella species are associated with dog and cat bites, including P multocida subspecies multocida,P multocida subspecies septica, Pasteurella stomatis, and Pasteurelladogmatis. Pasteurella canis is associated only with dog bites.
  • Other fastidious gram-negative organisms that have been associated with dog and cat bites include Capnocytophaga canimorsus and Capnocytophaga cynodegmi, especially in patients who had undergone previous splenectomy. C canimorsus infection can cause fulminant sepsis and meningitis, whereas C cynodegmi infection usually causes a milder localized inflammation.
  • Several other organisms are associated with cat bites, including Bartonella henselae, Francisella tularensis, and cowpox virus.
  • Medical management of animal bite wounds includes local wound care, standard-protocol tetanus prophylaxis, standard-protocol rabies prophylaxis, and either oral or intravenous empiric antimicrobial treatment.
  • Antimicrobial treatment is discussed in Medication.
  • Local care of bite wounds includes cleansing and removing nonviable tissue.
    • Gently cleanse the skin surrounding the bite wound with an antiseptic solution. To prevent further tissue injury, do not scrub the wound directly.
    • Soaking is of no benefit, but copious irrigation with a small-gauge catheter on a syringe helps remove debris and decreases the concentration of bacteria in contaminated wounds. Debridement and closure are discussed in Surgical Care.
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Surgical Care

The initial assessment of an animal bite includes an estimation of the infection risk. Bites to the head and neck, to the distal extremities, and near joints carry the highest risk of infection. In general, persons with animals bite wounds are at a high risk for infection, especially those who present to medical attention more than 8-10 hours after the injury occurred.

Persons with underlying medical diseases, such as diabetes mellitus, chronic liver disease, asplenia, alcoholism, HIV infection, or other immunodeficiency conditions (including chronic steroid exposure), are at increased risk of infection.

  • After irrigation and cleansing, sharply débride nonviable tissue to reduce the risk of infection and to allow easier suturing by providing a more even edge.
  • Primary suturing of bite wounds is reserved for minor injuries, those at low risk for infection, and those that have been treated within 8-10 hours of injury.
  • Leave all other wounds open until the risk of infection is reduced by cleansing, debridement, and prophylactic antibiotics.
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Consultations

  • General surgeon
  • Orthopedic surgeon
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Activity

  • Elevation is of great importance in the management of limb injuries. Lack of elevation may result in excessive edema, which may produce compartment syndrome and compromise local circulation, to the extent of threatening the viability of the limb.
  • Wounds on extremities should be immobilized and elevated with a sling to reduce edema, which may hamper normal activities.
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Contributor Information and Disclosures
Author

Alexandre Lacasse, MD, MSc  Internal Medicine Faculty, Assistant Director, Medicine Clinic, Infectious Disease Consultant, St Mary's Health Center

Alexandre Lacasse, MD, MSc is a member of the following medical societies: American College of Physicians, American Medical Association, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Gelfand, MD, FACP  Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee

Michael Gelfand, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Southern Medical Association

Disclosure: Nothing to disclose.

Thomas Lafeber, MD  Consulting Staff, Wellstar Infectious Disease LLC

Thomas Lafeber, MD is a member of the following medical societies: American Medical Association, American Society of Transplantation, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

J Robert Cantey, MD  Professor, Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina

J Robert Cantey, MD is a member of the following medical societies: Alpha Omega Alpha, American Society for Clinical Investigation, American Society for Microbiology, Infectious Diseases Society of America, International Society of Travel Medicine, Musculoskeletal Infection Society, Phi Beta Kappa, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Specialty Editor Board

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

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

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

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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