Infections following rattlesnake envenomation and use of antibiotics.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-07-29 DOI:10.1093/trstmh/trae044

Stephen A Klotz, Geoffrey T Smelski, Sarah A Watkins, F Mazda Shirazi

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Abstract

Background: There are 7000-8000 venomous snake bites annually in the USA. Antibiotics are commonly administered to bite victims because infection is difficult to differentiate from local tissue injury following envenomation.

Methods: The Arizona Poison and Drug Information Center (APDIC) in Tucson oversees antivenom administration for 14 Arizona counties. Records (1999-2021) were searched for antibiotic use and confirmed infections after a rattlesnake bite.

Results: There were 4160 calls to APDIC regarding rattlesnakes. After excluding bites to animals, 'dry bites', prisoners and records with missing data, 2059 records were evaluated. Systemic antibiotics were administered to 206 patients (10% of bite victims). Twenty patients (0.97%) had confirmed infections, including cellulitis (n=10), fasciitis (n=4), abscess (n=3) and osteomyelitis (n=3). Five of the victims had positive blood cultures. The presence of tissue necrosis, leukocytosis, fever and elevated fibrinogen levels did not discriminate between toxic effects of venom and infection.

Conclusions: Confirmed infections following a rattlesnake bite are uncommon (0.97% of bites). Physicians should refrain from prescribing antibiotics, as they are not justified for most rattlesnake bite victims and the variety of pathogens encountered precludes use of any single effective antibiotic.

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响尾蛇中毒后的感染和抗生素的使用。

背景：在美国，每年有 7000-8000 人被毒蛇咬伤。由于毒蛇咬伤后很难区分感染和局部组织损伤，因此通常会给咬伤者注射抗生素：方法：位于图森的亚利桑那毒物和药物信息中心（APDIC）负责亚利桑那州 14 个县的抗蛇毒血清管理。对响尾蛇咬伤后使用抗生素和确诊感染的记录（1999-2021 年）进行了检索：APDIC 共接到 4160 个有关响尾蛇的电话。在排除动物咬伤、"干咬伤"、囚犯和数据缺失的记录后，共评估了 2059 条记录。206名患者（占咬伤患者的10%）接受了全身抗生素治疗。20名患者（0.97%）确诊感染，包括蜂窝组织炎（10人）、筋膜炎（4人）、脓肿（3人）和骨髓炎（3人）。其中五名受害者的血液培养呈阳性。组织坏死、白细胞增多、发烧和纤维蛋白原水平升高并不能区分毒液的毒性作用和感染：结论：响尾蛇咬伤后确诊感染的情况并不常见（占咬伤的 0.97%）。医生应避免开具抗生素处方，因为大多数响尾蛇咬伤患者都没有理由使用抗生素，而且所遇到的病原体种类繁多，无法使用任何一种有效的抗生素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.