Managing human bite infections of the hand

Human bite injuries of the hand may become complicated and therefore demand an organized approach to management. Thirty-two patients with human bites to the hand, admitted to Toronto's Wellesley Hospital between 1981 and 1985, were analyzed. The history and etiology, delay before presentation, microbiology results versus time from injury, and treatment regimens were reviewed. Streptococci appeared to be early pathogens and staphylococci later pathogens. However, a prospective study with serial aerobic, anaerobic, and 10% CO(2) cultures is needed to confirm these findings. Lack of organization in management was the most notable finding. Inpatient therapy with intravenous antibiotics usually is required. Treatment should revolve around the mnemonic 'ODD BITES': open treatment; debridement; drugs (antibiotics); bloodwork (leukocyte count); irrigation; tetanus prophylaxis; exploration (including X-rays); and swab (for culture and sensitivity).