A small puncture wound, particularly from a human or cat bite, may involve significant injury to the tendon, joint capsule, or articular cartilage. The most common cause of human bites is a tooth-induced injury to the metacarpophalangeal joint as a result of a punch to the mouth (clenched fist injury). The oral flora of humans includes Eikenella corrodens, staphylococci, streptococci, and anaerobes. Patients with clenched fist injuries tend to wait hours or days after the wound occurs before seeking medical attention, which increases the severity of the infection. Animal bites usually contain multiple potential pathogens, including Pasteurella multocida (particularly in cat bites), staphylococci, streptococci, and anaerobes. Serious complications include infectious arthritis Acute Infectious Arthritis Acute infectious arthritis is a joint infection that evolves over hours or days. The infection resides in synovial or periarticular tissues and is usually bacterial—in younger adults, frequently... read more and osteomyelitis Osteomyelitis Osteomyelitis is inflammation and destruction of bone caused by bacteria, mycobacteria, or fungi. Common symptoms are localized bone pain and tenderness with constitutional symptoms (in acute... read more .
(See also Overview and Evaluation of Hand Disorders Overview and Evaluation of Hand Disorders Common hand disorders include a variety of deformities, ganglia, infections, Kienböck disease, nerve compression syndromes, noninfectious tenosynovitis, and osteoarthritis. (See also complex... read more .)
Diagnosis of Infected Bite Wounds
Usually wound cultures
Erythema and pain localized to the bite suggest infection. Tenderness along the course of a tendon suggests spread to the tendon sheath. Pain worsening significantly with motion suggests infection of a joint or tendon sheath.
Although the diagnosis of infected bite wounds of the hand is clinical, x-rays should be taken to detect fracture or teeth or other foreign bodies that could be a nidus of continuing infection.
Treatment of Infected Bite Wounds
Treatment of infected bite wounds of the hand includes surgical debridement, with the wound left open, and antibiotics.
Empiric antibiotics for outpatient treatment usually include monotherapy with amoxicillin/clavulanate 500 mg orally 3 times a day or combined therapy with penicillin 500 mg orally 4 times a day (for E. corrodens, P. multocida, streptococci, and anaerobes) plus either a cephalosporin (eg, cephalexin 500 mg orally 4 times a day) or semisynthetic penicillin (eg, dicloxacillin 500 mg orally 4 times a day) for staphylococci. In areas where MRSA is prevalent, trimethoprim/sulfamethoxazole, clindamycin, doxycycline, or linezolid should be used instead of a cephalosporin. If the patient is allergic to penicillin, clindamycin 300 mg orally every 6 hours can be used.
The hand should be splinted in the functional position and elevated.
Splint in the functional position (20-degree wrist extension, 60-degree metacarpophalangeal joint flexion, slight interphalangeal joint flexion)
Noninfected bite wounds may require surgical debridement and prophylaxis with 50% of the dose of antibiotic used to treat infected wounds.
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