In the Literature

Bonilla-Aldana and colleagues systematically reviewed the literature dealing with infections following snakebites and performed a meta-analysis.They found an overall reported incidence of infections complicating snakebite of 27.0% (95% confidence interval [CI], 22.0%-32.9%),albeit with very great heterogeneity (I 2 = 99.7%), with incidences of 32% reported from Asia, 21% from the Americas, and 29% from Africa (24.4% in South Africa and 62.8% in Ethiopia).Infection was reported to occur twice as frequently after bites by elapids (62%) than after vipers (31%); Elapidae include, among others, cobras, mambas, and coral snakes, while Viperidae include, among others, Old World vipers, and rattlesnakes.Surgical intervention was performed in 68% of cases.Gram-positive bacteria were recovered in 40.0% of infections while gram-negatives and anaerobes accounted for 63.0% and 4.0%, respectively.The most frequently isolated bacterium was Morganella morganii (32.0%), followed by Enterococcus sp (23.0%) and Staphylococcus aureus (15.0%), while each of the following accounted for <10%: Proteus spp, Shewanella spp, Escherichia coli, Citrobacter spp, Bacteroides fragilis, Serratia spp, Aeromonas hydrophila, Pseudomonas aeruginosa, and Klebsiella pneumoniae.This study provides a useful overview but leaves many questions unanswered.This, at least in part, results from the heterogeneity of the observed rates of infection, some of which may be due to variable laboratory support and clinical practices, including the criteria used for the diagnosis of infection and indications for surgery.