Pasteurella Multocida Infection Treatment & Management
- Author: Sara L Cross, MD; Chief Editor: Michael Stuart Bronze, MD more...
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.
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 animal 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.
See the list below:
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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