Epidemiology of secondary infection after snakebites in center-west Brazil.

Background: Snakebites represent a significant health problem in tropical countries, with an annual incidence of 2.7 million cases worldwide. The incidence of secondary infections after snake bites is also high and is usually caused by bacteria from the oral cavity of snakes. Morganella morganii has been identified as an important cause of infections and has been guiding antibiotic therapy in several regions of Brazil and the world. Methodology/Principal findings: We performed a retrospective cross-sectional evaluation of snakebites in hospitalized patients between January 2018 and November 2019 and selected those with secondary infection in their medical records. During the period, 326 cases of snakebites were treated, and 155 (47.5%) of them eventually had secondary infections. However, only seven patients underwent culture of soft tissue fragments, in which three cases were negative culture results, while Aeromonas hydrophila was identified in four cases. Of these, 75% were resistant to ampicillin/sulbactam, 50% had intermediate sensitivity to imipenem, and 25% had intermediate sensitivity to piperacillin/tazobactam. Trimethoprim/sulfamethoxazole (TMP-SMX) was not tested on any strain. Of the 155 cases that progressed to secondary infections, 48.4% (75) were empirically treated with amoxicillin/clavulanate, 41.9% (65) with TMP-SMX, and 32 (22%) of these 144 cases required a change to a second regimen, and 10 of these 32 patients required a third therapeutic regimen. Conclusion: Wild animals act as reservoirs of resistant bacteria because their oral cavity favors biofilm formation, which explains the finding of A. hydrophila with a reduced sensitivity profile in this study. This fact is essential for the appropriate choice of empirical antibiotic therapy. Author summary: Secondary infection is among the most common complications that may occur after an ophidian accident. The associated microorganisms are those found in the oral cavity of snakes, with the bacteria Morganella Morganii being described with the highest prevalence. In the oral cavity of snakes, bacteria are protected and can develop resistance to the most common antibiotics used in clinical practice. Our study aimed to study cases of secondary infection after snakebites in a specialized service in Midwest Brazil. The investigation of which bacteria caused the infection was carried out in some cases, and only the bacteria Aeromonas hydrophila was isolated, with resistance to the antibiotic most commonly used in the service, which was Amoxicillin with Clavulanate. This led us to discuss the best therapeutic approach for this germ and also for ophidian accidents that complicate with secondary infection in general. [ABSTRACT FROM AUTHOR]