Animal Bites

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Animal Bites

Leticia Manning Ryan, MD , Robert J. Freishtat, MD, MPH

Basic Information

Definition

Bites may occur from a variety of animals including dogs, cats, and rodents; most are minor and do not require medical attention. An animal bite is medically significant when the injury is severe, if cosmetic appearance or infection of the wound is a concern, or when rabies or tetanus prophylaxis is indicated.

Synonyms

Dog bite
Cat bite

ICD-9-CM Codes

879.8 Open wound

Epidemiology & Demographics

• The true incidence is unknown as most bites are trivial and do not require medical care. An estimated 2 million animal bites occur annually. In 2001, an estimated 368,245 persons were treated in U.S. hospital emergency departments for dog-bite related injuries.
• Children (aged 5 to 9 years) are the most common victims. Younger children are more likely to be male.
• Animal bites tend to occur most often in warm climates or during warm seasons. The majority of dog and cat bites occur with domestic pets. Non-neutered male dogs and aggressive breeds of dogs typically pose a greater risk.

Clinical Presentation

• Identify the specific animal involved, including its whereabouts and immunization status, to consider need for antibiotic and rabies prophylaxis.
• Determine the time elapsed since the injury, which is an important factor in infection control and wound closure.
• Describe the location and type of wound.
• Search for underlying structural damage including neurovascular or tendon injury, joint involvement, and fractures. (Dog bites are most commonly associated with significant occult injury.)
• Bites may result in lacerations, puncture wounds, and superficial abrasions as well as underlying structural damage.

Etiology

• The most common perpetrators of animal bites are dogs, which account for 80% to 90% of animal bites.
• Wound infections are frequently polymicrobial; Pasteurella multocida and Staphylococcus aureus are commonly implicated organisms.

Diagnosis

Differential Diagnosis

• Human bite
• Other penetrating trauma

Workup

• The diagnosis of an animal bite is usually made based on information from history and physical examination.

Laboratory Tests

• No routine laboratory tests are indicated.
• Cultures of a noninfected bite are not helpful in predicting the likelihood or etiology of subsequent infections.

Imaging Studies

• Consider the need for radiographic imaging to evaluate for underlying fractures, particularly with dog bites of the scalp.

Treatment

Nonpharmacologic Therapy

• Copious irrigation, wound cleansing, and débridement should be performed and may prevent infectious complications.
• Fresh nonpuncture wounds can be sutured. Contaminated wounds and puncture wounds should not be closed.
• Tendon or vascular injury should be identified and repaired as needed.

Acute General Rx

• Antibiotic prophylaxis is controversial. Generally, prophylaxis should be considered for dog bites that are more than 12 hours old, difficult to clean, in the hand or foot, or in an infection-susceptible patient. All cat bites should receive prophylaxis.
• Amoxicillin/clavulanate is considered first-line antibiotic prophylaxis.
• Update the patient’s tetanus status if needed.
• Consider the need for rabies prophylaxis.

Chronic Rx

• Three to five days of antibiotic prophylaxis may be adequate, if indicated. Wounds should be closely monitored for signs of infection.

Disposition

• Most patients can be treated as outpatients. Patients with extensive injury may require hospitalization and long-term cosmetic follow-up.
• Follow-up in 24 to 48 hours is useful to monitor for infection.

Referral

• Extensive injury, underlying structural damage, or a cosmetically concerning location may require surgical consultation.
• Follow-up may be indicated for the psychological effects of these traumatic injuries.

Pearls & Considerations

Comments

• Remember to evaluate for occult injury.
• Infection is the most common complication of animal bites; prevention is crucial for a good long-term outcome.
• Bites to the hand and puncture wounds (typically from cats) are the most likely animal bites to become infected.
• Consider cosmetic and psychological issues.

Prevention

• Supervise all children around animals.
• Socialize and appropriately train household pets.
• Consult with a professional before choosing a pet.
• Teach children basic safety around animals.

Patient/Family Education

• Advise patients regarding the risk and signs of infection as well as the need to seek immediate medical care if infection occurs.
• Additional information regarding treatment of animal bites is available at the following Mayo Clinic web site: www.mayoclinic.com/health/first_aid_animal_bites
• Additional information regarding dog bite prevention is available at the following Centers for Disease Control web site: www.cdc.gov/ncipc/duip/biteprevention.htm

Suggested Readings

Centers for Disease Control. Nonfatal dog bite-related injuries treated in hospital emergency departments—United States. MMWR. 2003;52:605.

Garcia VF. Animal bites and Pasteurella infections. Pediatr Rev. 1997;18:127.

Talan DA, et al. Bacteriologic analysis of infected dog and cat bites. N Engl J Med. 1999;340:85.

[/level-membership-for-pediatrics-category][not-level-membership-for-pediatrics-category]

Animal Bites

Leticia Manning Ryan, MD , Robert J. Freishtat, MD, MPH

Basic Information

Definition

Bites may occur from a variety of animals including dogs, cats, and rodents; most are minor and do not require medical attention. An animal bite is medically significant when the injury is severe, if cosmetic appearance or infection of the wound is a concern, or when rabies or tetanus prophylaxis is indicated.

Synonyms

Dog bite
Cat bite

ICD-9-CM Codes

879.8 Open wound

Epidemiology & Demographics

• The true incidence is unknown as most bites are trivial and do not require medical care. An estimated 2 million animal bites occur annually. In 2001, an estimated 368,245 persons were treated in U.S. hospital emergency departments for dog-bite related injuries.
• Children (aged 5 to 9 years) are the most common victims. Younger children are more likely to be male.
• Animal bites tend to occur most often in warm climates or during warm seasons. The majority of dog and cat bites occur with domestic pets. Non-neutered male dogs and aggressive breeds of dogs typically pose a greater risk.

Clinical Presentation

• Identify the specific animal involved, including its whereabouts and immunization status, to consider need for antibiotic and rabies prophylaxis.
• Determine the time elapsed since the injury, which is an important factor in infection control and wound closure.
• Describe the location and type of wound.
• Search for underlying structural damage including neurovascular or tendon injury, joint involvement, and fractures. (Dog bites are most commonly associated with significant occult injury.)
• Bites may result in lacerations, puncture wounds, and superficial abrasions as well as underlying structural damage.

Etiology

• The most common perpetrators of animal bites are dogs, which account for 80% to 90% of animal bites.
• Wound infections are frequently polymicrobial; Pasteurella multocida

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