Cat bite: an injury not to underestimate

Domestic cat bites are common and are often treated by simple wound care with good outcome. However, delayed presentation may lead to significant morbidity or even mortality. Twenty cases of cat bites to the hand and wrist were retrospectively reviewed between 2014 and 2018. Data included patient demographics, anatomical site of injury, microbiology results, method of treatment and surgical outcome. The subjects were 18 females and two males aged 27-86 years (mean age of 58 years). Eleven patients (Group A) were presented within 48 hours of their injury. Nine patients (Group B) presented later than 48 hours. Of these, 78% (n = 7) underwent multiple operations secondary to septic arthritis, osteomyelitis, necrotising fasciitis and deep collection. Mean length of hospital stay was 3.4 days in Group A, and 9.2 days in Group B, (p < .01). Four patients underwent digital or ray amputations. The index finger was the most common site of injury (45%). Almost 40% of cases had flexor tendon sheath infection of the fingers. Pasteurella species was isolated from 35% of infected wounds. Mean duration of antibiotic treatment and length of hospital stay were significantly longer in Group B (p < .05). Delayed presentation of infected cat bites increased the likelihood of more complicated surgeries such as amputation. Diabetic fingers with established peripheral neuropathy were more likely to undergo amputation. We recommend that any symptomatic cat bites to the upper limb, especially hand and wrist, must be treated promptly, essentially within 48 hours of injury, particularly in immunocompromised population.