Human Bites Workup

Updated: Mar 04, 2021
  • Author: Jeffrey Barrett, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Workup

Approach Considerations

Lab studies

No laboratory studies are required unless bacteremia or sepsis is suspected. If indicated, draw appropriate baseline viral titers from the patient and the assailant. [15]

Radiography

Radiography may be useful, particularly in hand injuries or over bone, to reveal fractures, foreign bodies, or air within a joint. If history indicates that a tooth was broken during the incident, a radiograph may be indicated to examine for it. Radiography of chronic wounds may reveal underlying osteomyelitis.

In closed-fist injuries, an underlying metacarpal head fracture is possible. If such a fracture is identified radiographically, the clinician should strongly consider emergent consultation with a hand surgeon in such cases, as there is a high potential for an adverse outcome.

Wound Cultures

Routine culture of all human bite wounds is unnecessary because such testing is costly, demonstrates no growth in more than 80% of cases, and rarely alters first-line therapy. Wounds subsequently manifesting signs of infection, however, often have bacteriologic profiles differing from the initial cultures. Wound cultures are indicated in wounds manifesting signs of infection (eg, cellulitis, swelling, purulence) and in wounds not showing clinical improvement despite seemingly appropriate antimicrobial therapy.

Obtain and grow aerobic and anaerobic cultures for 7-10 days to identify slow-growing pathogens. This allows quantification and identification of bacterial species and their antibiotic susceptibilities. If possible, obtain cultures prior to the initiation of antimicrobial therapy.