gms | German Medical Science

Objectives/Interrogation: Domestic cat bites are common and are often minor wounds that can be treated by simple wound care and short term antibiotic therapy with good to excellent outcome. However, delayed presentation may lead to significant morbidity or even mortality. The authors report a case series of severe hand infections following cat bite resulting in significant morbidity.

Methods: 20 cases of cat bites to the hand and wrist that were referred to hand surgery unit for further treatment were retrospectively reviewed between July 2014 and August 2018. Data included patient demographics, anatomical site of injury, clinical diagnosis, radiographic features, inflammatory markers and microbiology results, method of treatment, antibiotic regimen, and functional outcome. The patients' clinical notes were reviewed.

Results and Conclusions: The subjects consisted of 18 females and 2 males aged 27-86 years (mean age of 58 years). Eighteen patients underwent surgical intervention and 2 were managed non- operatively. Of those patients treated operatively; eleven underwent single surgery (irrigation and debridement), and 7 had multiple operations secondary to septic arthritis, osteomyelitis, necrotising fasciitis and deep soft tissue infection. Mean length of hospital stay was 11.6 days in those underwent multiple surgeries. The index finger was the most common site of injury. Pasteurella species was isolated from 39% of infected wounds. Four fingers underwent amputation due to extensive soft tissue infection, tissue destruction and necrosis, particularly in those presented late and had diabetes.Delayed presentation resulted in multiple surgeries, protracted hospital stay, longer antibiotic course, and significant soft tissue complication, which resulted in significant morbidity. Risk of amputation was significantly higher in a diabetic finger with peripheral neuropathy. The results of our case series suggest that any symptomatic cat bite to the upper limb, especially hand and wrist, must be treated promptly, essentially within 48 hours of injury and no later than 72 hours. Delayed presentation conveys complicated surgery and or significant morbidity.