Epidemiology and etiology

Fifty percent of Americans will be bitten by an animal at least once during their lifetimes. Although most of these injuries are minor, approximately 20% will require medical treatment.1

Dogs cause approximately 80% of all bites. These bites most commonly involve the extremities, and young children are particularly at risk.48,49 Approximately 15% to 25% of dog bites become infected.49

Cat bites are the second most common animal bite, most often occurring in women and elderly individuals. Most involve the hand. Because cats have long, thin teeth that cause puncture wounds, their bites are more likely to become infected than a dog bite. Approximately 50% of cat bites become infected.48,49

Human bites are third most common and the most serious.49 Before the availability of antibiotics, up to 20% resulted in amputation. Currently, human bite-associated amputation rates remain at 5%, secondary to vascular compromise and infectious com-plications.49

There are two types of human bite injuries. Occlusal injuries are inflicted by actual biting, whereas clenched-fist injuries are sustained when a person's closed fist hits another's teeth. Of the two, clenched-fist injuries typically are more prone to infectious 48,49


© Bite wound infections generally are polymicrobial. On average, five different bacterial species can be isolated from an infected animal bite wound.1 Both the normal flora of the biter's mouth and that of the bite recipient's skin can be implicated. The bacteriology of the cat and dog mouth is quite similar. Pasteurella multocida, a gramnegative aerobe, is one of the predominant pathogens, isolated in up to 50% of dog and 75% of cat bites. Viridans streptococci are the most frequently cultured bacteria


from human bite wounds. Table 73-9 provides a comprehensive list of cat, dog, and human bite-wound pathogens.

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