Characteristics of Snakebite-Related Infection in French Guiana
Abstract
:1. Introduction
2. Results
2.1. Clinical and Biological Manifestations at Admission
2.2. Initial Management
2.3. Wound Infection
2.4. Microbiological Analyses
2.5. Management of Wound Infection
2.6. Independent Factors Associated with Wound Infection
3. Discussion
4. Conclusions
5. Materials and Methods
5.1. Management of Snakebite Envenoming
5.2. Diagnosis and Management of Snakebite-Related Wound Infection
5.3. Ethical Statement
5.4. Definitions
5.5. Statistical Analysis
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total Population | Wound Infection | Without Wound Infection | p | ||||
---|---|---|---|---|---|---|---|
Nb | Result | Nb | Result | Nb | Result | ||
Age (years) | 172 | 41 (28–52) | 55 | 46 (31.7–54.6) | 117 | 40 (25.4–50.8) | 0.340 |
Gender, male | 172 | 119 (69.2%) | 55 | 39 (70.9%) | 117 | 80 (68.4%) | 0.737 |
BMI | 119 | 23.8 (21–26.9) | 37 | 23.5 (20.3–26.9) | 82 | 23.8 (21.3–26.9) | 0.462 |
Medical history | 172 | 42 (24.4%) | 55 | 12 (21.8%) | 117 | 30 (25.6%) | |
Arterial hypertension | 172 | 13 (8%) | 55 | 2 (3.6%) | 117 | 11 (9.4%) | 0.182 |
Alcohol abuse | 172 | 6 (3%) | 55 | 1 (1.8%) | 117 | 5 (4.3%) | 0.413 |
Snake bite (SB) | |||||||
Time from SB to hospital (hh:mm) | 171 | 9:00 (2:02–21:00) | 55 | 12:00 (3:30–22:58) | 116 | 7:07 (1:43–19:03) | 0.064 |
Identification of the snake | 172 | 78 (45.3%) | 55 | 21 (38.2%) | 117 | 57 (48.7%) | 0.195 |
Anatomic site of the bite | |||||||
Upper limb | 172 | 34 (19.8%) | 55 | 10 (18.2%) | 117 | 24 (20.5%) | 0.328 |
Lower limb | 172 | 137 (79.7%) | 55 | 44 (80%) | 117 | 93 (79.5%) | |
Head | 172 | 1 (0.6%) | 55 | - | 117 | 1 (0.8%) | - |
Grade of envenoming | |||||||
Grade 1 | 172 | 74 (43%) | 55 | 14 (25.5%) | 117 | 60 (51.3%) | Reference |
Grade 2 | 172 | 60 (34.9%) | 55 | 21 (38.2%) | 117 | 39 (33.3%) | 0.035 |
Grade 3 | 172 | 38 (22.1%) | 55 | 20 (36.4%) | 117 | 18 (15.4%) | <0.001 |
Clinical presentation at admission | |||||||
Edema | 172 | 165 (95.9%) | 55 | 55 (100%) | 117 | 110 (94%) | 0.064 |
Local hemorrhage | 172 | 22 (12.8%) | 55 | 8 (14.5%) | 117 | 14 (12%) | 0.637 |
Necrosis | 172 | 21 (12.2%) | 55 | 17 (30.9%) | 117 | 4 (3.4%) | <0.001 |
Blisters | 172 | 22 (12.8%) | 55 | 14 (25.5%) | 117 | 8 (6.8%) | 0.001 |
Pain | 171 | 165 (96.5%) | 54 | 53 (98.1%) | 117 | 112 (95.7%) | 0.424 |
Temperature (°C) | 165 | 36.9 (36.5–37.3) | 49 | 37 (36.6–37.4) | 116 | 36.9 (36.5–37.3) | 0.045 |
Shock | 172 | 2 (1.2%) | 55 | 1 (1.8%) | 117 | 1 (0.9%) | 0.583 |
Acute renal injury | 172 | 28 (16.3%) | 55 | 12 (21.8%) | 117 | 16 (13.7%) | 0.177 |
Time to normal renal function (days) | 28 | 5 (28–10) | 12 | 4 (2–23) | 16 | 6 (2–10) | 0.958 |
Systemic hemorrhage (SH) | 172 | 24 (14%) | 55 | 7 (12.7%) | 117 | 17 (14.5%) | 0.750 |
Time from SB to SH (hours) | 24 | 5 (0–24) | 7 | 4 (1–8) | 17 | 7 (0–24) | 0.125 |
Biological parameters at admission | |||||||
Fibrinolysis | 172 | 151 (87.8%) | 55 | 45 (81.8%) | 117 | 106 (90.6%) | 0.101 |
Thrombocytopenia | 172 | 49 (28.5%) | 55 | 25 (45.5%) | 117 | 24 (20.5%) | 0.001 |
Hemolysis | 172 | 38 (22.1%) | 55 | 15 (27.3%) | 117 | 23 (19.7%) | 0.262 |
Rhabdomyolysis | 172 | 54 (31.4%) | 55 | 26 (47.3%) | 117 | 28 (23.9%) | 0.002 |
White blood count (/mm3) | 167 | 10.4 (8.3–13.6) | 53 | 12 (9.4–14.6) | 114 | 10.2 (8–13.2) | 0.016 |
C-reactive protein (mg/L) | 153 | 8.7 (2.8–32.2) | 46 | 27.6 (5.6–83.2) | 107 | 6.4 (2.7–19.6) | 0.002 |
Procalcitonin (µmol/L) | 10 | 0.1 (0–0.5) | 0 | - | 10 | 0.1 (0–0.5) | - |
Nb | Result | |
---|---|---|
Abscess | 55 | 38 (69.1%) |
Necrotizing fasciitis | 55 | 9 (16.4%) |
Cellulitis | 55 | 12 (21.8%) |
Isolated microorganism | 55 | 32 (58.2%) |
Time from SB to WI (days) | 55 | 6 (3–8) |
Antibiotic duration for WI (days) | 36 | 7 (5–8) |
Total Population | Wound Infection | Without Wound Infection | p | ||||
---|---|---|---|---|---|---|---|
Nb | Result | Nb | Result | Nb | Result | ||
Renal replacement therapy | 172 | 9 (5.2%) | 55 | 4 (7.3%) | 117 | 5 (4.3%) | 0.410 |
Noradrenaline | 172 | 2 (1.2%) | 55 | 1 (1.8%) | 117 | 1 (0.9%) | 0.583 |
Mechanical ventilation | 172 | 3 (1.7%) | 55 | 2 (3.6%) | 117 | 1 (0.9%) | 0.194 |
Antibiotics at admission | 172 | 63 (36.6%) | 55 | 22 (40%) | 117 | 41 (35%) | 0.391 |
Antivenom therapy (AV) | 172 | 115 (66.9%) | 55 | 32 (58.2%) | 117 | 83 (70.9%) | 0.097 |
Time from SB to AV | 83 | 9:00 (5:22–20:40) | 22 | 10:00 (6:00–19:45) | 61 | 9:00 (5:15–21:00) | 1 |
Adverse reaction to AV | 116 | 20 (17.2%) | 33 | 7 (21.2%) | 83 | 13 (15.7%) | 0.284 |
Transfusion | 172 | 17 (9.9%) | 55 | 9 (16.4%) | 117 | 8 (6.8%) | 0.51 |
Surgery | 172 | 48 (27.9%) | 55 | 43 (78.2%) | 117 | 5 (4.3%) | <0.001 |
Necrosectomy | 48 | 23 (47.9%) | 43 | 21 (48.8%) | 5 | 2 (40%) | 0.476 |
Time from SB to surgery (days) | 48 | 7 (5–9) | 43 | 7 (5–9) | 5 | 5 (3–8) | 0.865 |
Length of stay in ICU (days) | 138 | 3 (3–5) | 43 | 4 (3–8) | 95 | 3 (3–4) | 0.370 |
Length of hospital stay (days) | 172 | 9 (6–13) | 55 | 14 (11–23) | 117 | 7 (5–11) | <0.001 |
Univariate Analysis | Multivariate Analysis | |||||
---|---|---|---|---|---|---|
Variable | Wound Infection (n = 55) | Without Wound Infection (n = 117) | p | OR | 95% CI | p |
Blisters | 14 (25.5%) | 8 (6.8%) | 0.001 | 2.812 | 0.909–8.697 | 0.073 |
Thrombocytopenia | 25 (45.5%) | 24 (20.5%) | 0.001 | 3.374 | 1.594–7.163 | 0.002 |
Necrosis | 17 (30.9%) | 4 (3.4%) | <0.001 | 13.15 | 4.042–42.841 | <0.001 |
Rhabdomyolysis | 26 (47.3%) | 28 (23.9%) | 0.002 | 2.294 | 1.015–5.187 | 0.046 |
Grade 2 | 21 (38.2%) | 39 (33.3%) | 0.035 | 1.947 | 0.822–4.615 | 0.130 |
Grade 3 | 20 (36.4%) | 18 (15.4%) | <0.001 | 0.875 | 0.263–2.916 | 0.828 |
Grade | ||||
---|---|---|---|---|
1 (Mild) | 2 (Moderate) | 3 (Severe) | ||
Coagulation disorder | present | present | present | |
Local symptoms | Pain | present | present | present |
Swelling | Not exceeding elbow or knee | Exceeding elbow or knee | Beyond the root of the limb | |
Blister | absent | present | present | |
Necrosis | absent | absent | present | |
Local or systemic bleeding | absent | present | present | |
Systemic manifestations (Hypotension, renal injury, coma, respiratory failure, …) | absent | absent | present |
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Houcke, S.; Resiere, D.; Lontsingoula, G.R.; Cook, F.; Lafouasse, P.; Pujo, J.M.; Demar, M.; Matheus, S.; Hommel, D.; Kallel, H. Characteristics of Snakebite-Related Infection in French Guiana. Toxins 2022, 14, 89. https://doi.org/10.3390/toxins14020089
Houcke S, Resiere D, Lontsingoula GR, Cook F, Lafouasse P, Pujo JM, Demar M, Matheus S, Hommel D, Kallel H. Characteristics of Snakebite-Related Infection in French Guiana. Toxins. 2022; 14(2):89. https://doi.org/10.3390/toxins14020089
Chicago/Turabian StyleHoucke, Stéphanie, Dabor Resiere, Guy Roger Lontsingoula, Fabrice Cook, Pierre Lafouasse, Jean Marc Pujo, Magalie Demar, Severine Matheus, Didier Hommel, and Hatem Kallel. 2022. "Characteristics of Snakebite-Related Infection in French Guiana" Toxins 14, no. 2: 89. https://doi.org/10.3390/toxins14020089
APA StyleHoucke, S., Resiere, D., Lontsingoula, G. R., Cook, F., Lafouasse, P., Pujo, J. M., Demar, M., Matheus, S., Hommel, D., & Kallel, H. (2022). Characteristics of Snakebite-Related Infection in French Guiana. Toxins, 14(2), 89. https://doi.org/10.3390/toxins14020089