The Incidence of Infection Complicating Snakebites in Tropical Australia: Implications for Clinical Management and Antimicrobial Prophylaxis

Laura K Smith; John Vardanega; Simon Smith; Julian White; Mark Little; Josh Hanson

doi:10.1155/2023/5812766

The Incidence of Infection Complicating Snakebites in Tropical Australia: Implications for Clinical Management and Antimicrobial Prophylaxis

J Trop Med. 2023 Oct 12:2023:5812766. doi: 10.1155/2023/5812766. eCollection 2023.

Authors

Laura K Smith¹, John Vardanega^{1

2}, Simon Smith¹, Julian White³, Mark Little^{1

4}, Josh Hanson^{1

5}

Affiliations

¹ Cairns Hospital, Cairns, Queensland, Australia.
² QML Pathology, Murarrie, Queensland, Australia.
³ Women's and Children's Hospital, Adelaide, South Australia, Australia.
⁴ NSW Poisons Information Service, Sydney NSW, Australia.
⁵ The Kirby Institute, UNSW, Sydney, NSW, Australia.

Abstract

Objective: To define the incidence of infection following snakebite in tropical Australia and the resulting implications for the routine prescription of prophylactic antibiotics.

Methods: A retrospective study of all individuals presenting to Cairns Hospital, a tertiary referral hospital in tropical Australia, after a snakebite between December 2013 and October 2020.

Results: There were 732 hospitalisations, 720 (98.4%) patients presented within 8 hours of the snakebite, and 29/732 (4.0%) were envenomated. Envenomated patients were more likely to receive empirical antibiotics than nonenvenomated patients (8/29 (27.6%) versus 14/703 (2.0%), p < 0.001), although this was frequently as a bundle of care for critically ill individuals. Superficial skin infection was diagnosed by clinicians in 6/732 (0.8%) patients during their hospitalisation; infection was diagnosed more commonly in envenomated than in nonenvenomated patients (3/29 (10.3%) versus 3/703 (0.4%), p = 0.001). All 3 envenomated individuals diagnosed with infection were believed to have taipan (genus Oxyuranus) bites. Five (83%) of the six patients diagnosed with infection had received empirical antibiotics at presentation; only 1/710 (0.1%) patients who received no antibiotics developed a (superficial) infection.

Conclusion: Infection is a very uncommon complication of snakebite in tropical Australia. Individuals bitten by snakes in tropical Australia should not routinely receive antibiotic prophylaxis.