Physicians treat 1 to 2 million animal bites per year - between 5 to 19% are inflicted by cats. Because cat teeth are long and slender, they are more likely to cause puncture wounds (as opposed to dog bites which tend to cause avulsions, lacerations, or crush wounds). Many people also suffer scratches due to cat claw injuries. Most people who present to physicians are concerned about rabies, tetanus, or wound infection. Women are 1.5 to 2x more likely to be bitten by a cat than are men. The opposite is true for dog bites.

Immunosuppression, age >50, delay in treatment of >10 hours, wound site (hand and lower ext. > head/neck and runk), wound type (puncture > lacerations/abrasions), wound depth (full thickness > partial thickness).

Varies between studies from 15% to 80% of all bites.

Microbiology:

Wounds are ususally polymicrobial. Pasteurella multicoda is a gram negative aerobe found in more than 50% of cat bite wounds. It typically causes a cellulitis which develops in less than 24 hours and may cause fever and purulent discharge. Osteomyelitis, septic arthritis (esp. in patients with joint prostheses), resp. infection, meningitis, peritonitis, and sepsis (esp. in pts. with chronic liver dz.) have been reported. Other organisms leading to wound infection include Staphylococcus sp., Streptococcus sp., Enterobacter sp., Acinetobacter sp., and Neisseria sp. Tularemia has also been rarely reported after a cat bite, usually in rural areas where cats feed off rabbits and rodents. Tularemia should be considered in patients who develop pulmonary infections or who do not respond to initial therapy with penicillin or one of its derivatives.

The rabies vaccination status of the cat should be obtained. If the patient has not had a tetanus booster within the past 5 years, this should be given. The wound should be debrided if necessary and should be cleaned with povidone-iodine solution and irrigated with normal saline under pressure (e.g., with syringe and ngiocath). If the wound is obviously infected or is high-risk the patient should be treated with oral antibiotics. The drug of choice is amoxicillin-clavulanate (Augmentin). Alternative choices are penicillin V, doxycycline, or IM ceftriaxone. If the infection is serious enough to require admission and IV treatment, the drug of choice is cefoxitin. Alternatives include ampicillin-sulbactam, ticarcillin-clavulanate, or ceftriaxone.