Secondary infection profile after snakebite treated at a tertiary referral center in the Brazilian Amazon

Mendes, Viviane Kici da Graça; Pereira, Handerson da Silva; Elias, Ignês Cruz; Soares, Gean Souza; Santos, Monica; Talhari, Carolina; Cordeiro-Santos, Marcelo; Monteiro, Wuelton Marcelo; Sachett, Jacqueline de Almeida Gonçalves

doi:10.1590/0037-8682-0244-2021

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Short Communication • Rev. Soc. Bras. Med. Trop. 55 • 2022 • https://doi.org/10.1590/0037-8682-0244-2021 copy

Secondary infection profile after snakebite treated at a tertiary referral center in the Brazilian Amazon

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

Bothrops envenomations can often lead to complications, such as secondary infections.

Methods:

This cross-sectional study analyzed the medical records of all patients diagnosed with snakebite.

Results:

A total of 127 patients were included. Clindamycin was the most commonly prescribed antibiotic, with 105 patients (82.7%) receiving it as the primary antibiotic regimen. In 31 (24.4%) individuals, the first-choice antibiotic did not cease the infection.

Conclusions:

Secondary infection is an important complication resulting from snakebites, and evidence-based management of this complication can contribute to better clinical outcomes.

Keywords:
Snakebite; Secondary infection; Bothrops

Variable	Total n (%)
Sex
Male	101 (79.5)
Female	26 (20.5)
Age (years)
0-15	20 (15.7)
16-45	64 (50.4)
46-60	25 (19.7)
>60	18 (14.2)
Occupation
Farmer	28 (22.0)
Student	19 (15.0)
Fisher	4 (3.1)
Driver	2 (1.5)
Others	8 (6.4)
Not informed	66 (52.0)
Location of the snakebite
Upper limbs	13 (10.2)
Lower limbs	111 (87.4)
Head	2 (1.6)
Not informed	1 (0.8)
Zone of occurrence
Rural	104 (81.9)
Urban	5 (3.9)
Periurban	8 (6.3)
Not informed	10 (7.9)
Time until treatment (h)
0-6	67 (60.9)
7-24	31 (28.2)
>24	12 (10.9)
Severity classification
Mild	14 (11.0)
Moderate	62 (48.8)
Severe	28 (22.0)
Not informed	23 (18.2)
Antivenom
Yes	109 (85.8)
No	18 (14.2)
Number of vials*
2-4	15 (13.7)
5-8	62 (56.9)
>9	32 (29.4)
Local manifestations**
Edema	121 (95.3)
Pain	117 (92.1)
Erythema	79 (62.2)
Systemic manifestations**
Vomiting	17 (13.4)
Blurred vision	5 (3.9)
Fever	5 (3.9)
Basic injury**
Erythematous plaque	6 (4.7)
Exulceration	17 (13.4)
Blister	27 (21.3)
Nodule	2 (1.6)
Pustule	3 (2.4)
Ulcer	23 (18.1)
Exudate from the lesion**
Purulent	17 (13.4)
Hemorrhagic	17 (13.4)
Serous	7 (5.5)
Seropurulent	8 (6.3)
Serous/hemorrhagic	16 (12.6)
Not informed	2 (1.6)
Type of tissue in the lesion
Necrosis	41 (32.3)
Granulation	26 (20.5)
Not informed	60 (47.2)
Topical product use
Yes	9 (7.1)
Not given	118 (92.9)

Antibiotic	Primary regimen	Secondary regimen
	n=127 (%)	N=31 (%)
Clindamycin (600 mg EV every 6 h for 7 days, OR 600 mg every 8 h for 10 days)	105 (82.7)	9 (29.0)
Ceftriaxone (1 g EV every 12 h for 7 days OR 2 d EV every 12 h for 10 days)	6 (4.7)	5 (16.1)
Cefalotin (2 g EV every 6 h for up to 7 days OR 800 mg EV every 6 h for 7 days, OR 470 mg EV every 6 h for 7 days)	4 (3.2)	4 (12.9)
Amoxicillin + clavulanate (17 mL PO every 12 h for 7 days)	3 (2.3)	2 (6.5)
Ampicillin + sulbactam (1.5 g EV every 8 h for 10 days)	3 (2.3)	2 (6.5)
Cefalexin (4 ml PO every 6 h for 7 days)	2 (1.6)	2 (6.5)
Cefalotin + cefalexin (600 mg EV every 6 h for 10 days + Cefalexin 4 ml PO every 6 h for 7 days)	1 (0.8)	-
Ciprofloxacin (500 mg PO every 12 h for 5 days OR 500 mg PO every 12 h for 7 days)	1 (0.8)	2 (6.5)
Gentamicin (80 mg EV every 8 hours for 7 days, OR 95 mg IM every 24 h for 7 days)	1 (0.8)	2 (6.5)
Metronidazole (500 mg EV every 8 h for 10 days)	1 (0.8)	1 (3.2)
Penicillin G benzathine (1.200.000 IU IM every 6 h for 7 days)	-	1 (3.2)
Piperacillin + tazobactam (4 g + 0.5 g EV every 6 h for 14 days)	-	1 (3.2)

Laboratory tests	Mean (±SD)
Erythrocytes (cells ×10⁶/mm³)	5.9 (±10.5)
Hemoglobin (g/dL)	13.1 (±2.7)
Hematocrit (%)	39.8 (±5.8)
Leukocytes (cells ×10³/mm³)	12.0 (±7.0)
Platelets (mm³)	250.3 (±171.3)
Creatinine (mg/dL)	1.1 (±1.2)
Aspartate aminotransferase (IU/L)	52.1 (±52.1)
Alanine aminotransferase (IU/L)	50.3 (±71.2)
Urea (mg/dL)	34.6 (±17.8)
Clotting time (min)	4.1 (±4.1)

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[1] Corresponding author: Dr. Jacqueline de Almeida Gonçalves Sachett. e-mail:jac.sachett@gmail.com