Wound Infection of Snakebite from Venomous , and in Taiwan: Validation of BITE and Cobra BITE Scoring Systems and Their Bacteriological Differences in Wound Cultures

Overview

Journal Toxins (Basel)

Publisher MDPI

Specialty Toxicology

Date 2023 Jan 20

PMID 36668897

Authors

Heng Yeh

Shi-Ying Gao

Chih-Chuan Lin

Affiliations

Soon will be listed here.

Abstract

Patients bitten by , , and develop different degrees of wound infection. This study validated BITE and Cobra BITE scoring systems that we established previously. Bacteriological studies of patients with wound infection were conducted. The operating characteristic curves and area under the curve (AUC) and wound infection rates were compared between the derivation set (our previous study patient population) and the validation set (new patient cohorts enrolled between June 2017 and May 2021). No significant differences in the AUC for both the BITE (0.84 vs. 0.78, = 0.27) and Cobra BITE (0.88 vs. 0.75, = 0.21) scoring systems were observed between the derivation and validation sets. and were the two most commonly detected bacteria in the microbiological study. More bacterial species were cultured from -infected wounds. Antibiotics such as amoxicillin with clavulanic acid, oxacillin, and ampicillin may not be suitable for treating patients with , , and bites in Taiwan. Carbapenem, third-generation cephalosporins, and fluoroquinolone may be superior alternatives.

Citing Articles

Comparisons of the Oral Microbiota from Seven Species of Wild Venomous Snakes in Taiwan Using the High-Throughput Amplicon Sequencing of the Full-Length 16S rRNA Gene.

Lin W, Tsai T Biology (Basel). 2023; 12(9).

PMID: 37759605 PMC: 10525742. DOI: 10.3390/biology12091206.

References

Panda S, Padhi L, Sahoo G . Oral bacterial flora of Indian cobra () and their antibiotic susceptibilities. Heliyon. 2018; 4(12):e01008. PMC: 6298943. DOI: 10.1016/j.heliyon.2018.e01008. View

Brook I . Treatment of anaerobic infection. Expert Rev Anti Infect Ther. 2007; 5(6):991-1006. DOI: 10.1586/14787210.5.6.991. View

Hung D . Taiwan's venomous snakebite: epidemiological, evolution and geographic differences. Trans R Soc Trop Med Hyg. 2004; 98(2):96-101. DOI: 10.1016/s0035-9203(03)00013-0. View

Seifert S, Armitage J, Sanchez E . Snake Envenomation. N Engl J Med. 2022; 386(1):68-78. PMC: 9854269. DOI: 10.1056/NEJMra2105228. View

Resiere D, Gutierrez J, Neviere R, Cabie A, Hossein M, Kallel H . Antibiotic therapy for snakebite envenoming. J Venom Anim Toxins Incl Trop Dis. 2020; 26:e20190098. PMC: 7011479. DOI: 10.1590/1678-9199-JVATITD-2019-0098. View

Chiang L, Tsai W, Liu P, Ho C, Su H, Lai C . Envenomation by : clinical manifestations, treatment and associated factors for wound necrosis. J Venom Anim Toxins Incl Trop Dis. 2020; 26:e20200043. PMC: 7500479. DOI: 10.1590/1678-9199-JVATITD-2020-0043. View

Chuang P, Lin W, Chen Y, Chien C, Chiu I, Tsai T . Oral Bacteria and Their Antibiotic Susceptibilities in Taiwanese Venomous Snakes. Microorganisms. 2022; 10(5). PMC: 9147925. DOI: 10.3390/microorganisms10050951. View

Hung D, Liau M, Lin-Shiau S . The clinical significance of venom detection in patients of cobra snakebite. Toxicon. 2003; 41(4):409-15. DOI: 10.1016/s0041-0101(02)00336-7. View

Shek K, Tsui K, Lam K, Crow P, Ng K, Ades G . Oral bacterial flora of the Chinese cobra (Naja atra) and bamboo pit viper (Trimeresurus albolabris) in Hong Kong SAR, China. Hong Kong Med J. 2009; 15(3):183-90. View

10.

Mao Y, Liu P, Hung D, Lai W, Huang S, Hung Y . Bacteriology of Naja atra Snakebite Wound and Its Implications for Antibiotic Therapy. Am J Trop Med Hyg. 2016; 94(5):1129-35. PMC: 4856614. DOI: 10.4269/ajtmh.15-0667. View

11.

Mao Y, Liu P, Chiang L, Lai C, Lai K, Ho C . Naja atra snakebite in Taiwan. Clin Toxicol (Phila). 2017; 56(4):273-280. DOI: 10.1080/15563650.2017.1366502. View

12.

Mao Y, Chuang H, Shih C, Hsieh H, Jiang Y, Chiang L . An investigation of conventional microbial culture for the Naja atra bite wound, and the comparison between culture-based 16S Sanger sequencing and 16S metagenomics of the snake oropharyngeal bacterial microbiota. PLoS Negl Trop Dis. 2021; 15(4):e0009331. PMC: 8078740. DOI: 10.1371/journal.pntd.0009331. View

13.

Blokhuis-Arkes M, Haalboom M, van der Palen J, Heinzle A, Sigl E, Guebitz G . Rapid enzyme analysis as a diagnostic tool for wound infection: Comparison between clinical judgment, microbiological analysis, and enzyme analysis. Wound Repair Regen. 2015; 23(3):345-52. DOI: 10.1111/wrr.12282. View

14.

Lin C, Chen Y, Goh Z, Seak C, Seak J, Shi-Ying G . Wound Infections of Snakebites from the Venomous and in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics-A BITE Study. Toxins (Basel). 2020; 12(9). PMC: 7551380. DOI: 10.3390/toxins12090575. View

15.

Lam K, Crow P, Ng K, Shek K, Fung H, Ades G . A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China. Emerg Med J. 2010; 28(2):107-14. DOI: 10.1136/emj.2009.086694. View

16.

Su H, Wang M, Li Y, Tang C, Tsai M . Can surgical need in patients with (Taiwan or Chinese cobra) envenomation be predicted in the emergency department?. Hong Kong Med J. 2016; 22(5):435-44. DOI: 10.12809/hkmj154739. View

17.

Yeh H, Gao S, Lin C . Wound Infections from Taiwan Cobra () Bites: Determining Bacteriology, Antibiotic Susceptibility, and the Use of Antibiotics-A Cobra BITE Study. Toxins (Basel). 2021; 13(3). PMC: 7999477. DOI: 10.3390/toxins13030183. View

18.

Huang W, Kao C, Mao Y, Lai C, Lai K, Lai C . and Coinfection in Cobra-Bite Wounds: A Genomic Analysis. Life (Basel). 2021; 11(4). PMC: 8069671. DOI: 10.3390/life11040329. View

19.

Liu C, Chou Y, Chen C, Liu K, Huang G, Yu J . Pathogenesis of local necrosis induced by Naja atra venom: Assessment of the neutralization ability of Taiwanese freeze-dried neurotoxic antivenom in animal models. PLoS Negl Trop Dis. 2020; 14(2):e0008054. PMC: 7032728. DOI: 10.1371/journal.pntd.0008054. View

20.

Mao Y, Liu P, Chiang L, Lee C, Lai C, Lai K . Clinical manifestations and treatments of bite and associated factors for wound necrosis and subsequent debridement and finger or toe amputation surgery. Clin Toxicol (Phila). 2020; 59(1):28-37. DOI: 10.1080/15563650.2020.1762892. View