Animal Bite Skin and Soft Tissue Infection Pathway Background and Objectives Animal bites are a common reason for presentation to the Emergency Department and pediatric and surgical offices. The Infectious Diseases Society of America updated their Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections in 2014, and these guidelines include recommendations for animal and human bite wounds prevention and treatment. The Connecticut Children’s clinical pathway was developed to ensure an optimal consistent approach to the surgical and medical management of children who present with animal bites by: Recommending if vaccination and/or immune globulin prophylaxis are indicated Recommending if antibiotics are needed and if so, which antibiotics are indicated based on patient’s wound type Recommending when pediatric surgery/trauma consult is needed Algorithm Download Animal Bite Skin and Soft Tissue Infection Pathway Algorithm – Updated November 15, 2021 Attention: There is currently a shortage of intravenous (IV) clindamycin In the event of a shortage at your institution, Connecticut Children’s Infectious Diseases and Immunology and Antimicrobial Stewardship Program suggest the following alternatives: If your patient is able to effectively take oral medications, it is recommended to simply substitute with oral clindamycin at a similar dose, as oral clindamycin has very high bioavailability (i.e., > 90%). For patients allergic to penicillins: If able to tolerate cephalosporins: cefuroxime plus metronidazole If unable to tolerate cephalosporins: ciprofloxacin plus metronidazole If you have any questions on further alternatives or appropriateness of antibiotics, please call our Infectious Diseases and Immunology Department through the One Call Hotline at 1-833-PEDS-NOW to be connected with the On-Call physician. Quality Metrics Percentage of eligible patients with use of Animal Bite order set Percentage of patients who receive the recommended antibiotics per pathway Percentage of patients who were prescribed the correct duration of antibiotics based on severity Average LOS for ED (hours) and admitted patients (days) Returns to ED within 7 days from first ED visit Returns to ED within 7 days of discharge from inpatient/observation stay Educational Module Download Animal Bite Skin and Soft Tissue Infection Educational Module – Updated November 15, 2021 Key References Kimberlin, D.W., Barnett, E. D., Lynfield, R., Sawyer, M.H. (Ed.). (2021). Red Book: 2021-2024 Report of the Committee on Infectious Diseases (32nd edition). Committee on Infectious Diseases, American Academy of Pediatrics. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul;59(2):e10-52. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015. Pathway Contacts Brendan Campbell, MD, MPH Division of Pediatric Surgery and Trauma Hassan El Chebib, MD Division of Infectious Disease and Immunology Jennifer Girotto, PharmD Antimicrobial Stewardship Program Grace Hong, APRN Division of Infectious Disease and Immunology Samantha Pelow, APRN Division of Pediatric Surgery and Trauma Disclaimer The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case. View all Clinical Pathways >
