title: Bite wounds and antibiotic prescription among patients presenting to an Australian emergency department.
abstract: BACKGROUND
  Emergency department presentations after mammalian bites may be associated with injection of bacteria into broken skin and may require prophylactic antibiotics to prevent subsequent infection. We aim to describe the epidemiology of patients presenting with a mammalian bite injury and antibiotic choice to an Australian adult tertiary centre.
  
  
  METHODS
  A retrospective cohort study was performed capturing all presentations after mammalian bite wounds between 01 Jan 2014 and 31 Dec 2014. An explicit chart review was conducted to determine management of each case. Cases were subgrouped into high- and low-risk groups as defined by the Australian Therapeutic Guidelines for animal bites.
  
  
  RESULTS
  There were 160 cases of mammalian bite wounds included, with 143 (89.4%) patients grouped as high-risk and 17 (10.6%) patients identified as low-risk. High-risk features were delayed presentation > 8 hours (57 patients, 35.6%), bites to the head, hand or face (113 patients, 70.6%), and puncture wounds unable to be adequately debrided (74 patients, 46.3%). There was a significant association with delayed presentation of more than eight hours and clinically established infection [OR 36.2; 95% CI: 12.6-103.6; P < 0.001]. Prescriptions for antibiotics that adhered to current guidelines occurred in 99 (61.9%) cases.
  
  
  CONCLUSIONS
  This study highlights variability in antibiotic prescription practice among clinicians and the need for ongoing education on antibiotic stewardship. Intervention strategies, including ongoing education, are indicated to improve adherence to antibiotic guidelines.
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Birdsey
authors.affiliation: Pharmacy Department, The Alfred Hospital, Melbourne, Australia.
authors.forename: Gail
authors.initials: G
authors.lastname: Edwards
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Vic., Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia. Electronic address: jwabe2@student.monash.edu.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Abetz
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Jennings
authors.affiliation: Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Vic., Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000706:statistics & numerical data; D001315:Australia; D001733:Bites and Stings / Q000188:drug therapy* / Q000451:nursing; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010878:Piperacillin / Q000627:therapeutic use; D012189:Retrospective Studies; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin; D010878:Piperacillin
keywords: Adherence; Antibiotics; Bites; Emergency department; Therapeutic guidelines; Wounds