Table 1.
Bacteria isolated from Naja atra bite cases and diagnostic methods of its envenomation
| Diagnostic methods | ||||||||
|---|---|---|---|---|---|---|---|---|
| VGH-TC | VGH-TP | Overall | P value | Definitive case† | Clinical case‡ | Overall | P value | |
| Case numbers | N = 78 | N = 34 | N = 112 | 79 (54/25)§ | 33 (24/9)§ | 112 | 0.646* | |
| First aid | ||||||||
| Topical herbs | 2 | 6 | 8 | – | – | – | ||
| Rope binding∥ | 4 | 0 | 4 | – | – | – | ||
| Incision and suction | 2 | 1 | 3 | – | – | – | ||
| Wound infection | 52 | 34 | 86 | 61 | 25 | 86 | ||
| Any surgery | 36 | 25 | 61 | 42 | 19 | 61 | ||
| Any form of bacterial culture | 32 | 27 | 59 | 41 | 18 | 59 | ||
| Positive bacterial cultures | 29 | 21 | 50 | 34 | 16 | 50 | ||
| Aerobic gram-positive bacteria | 13 | 11 | 24 | 16 | 8 | 24 | ||
| Bacillus cereus | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Enterococcus spp. | 10 | 11 | 21 | 0.015 | 13 | 8 | 21 | 0.336 |
| Coagulase-negative Staphylococcus species | 2 | 2 | 4 | 0.584 | 3 | 1 | 4 | 1 |
| Staphylococcus aureus | 1 | 1 | 2 | 0.517 | 2 | 0 | 2 | 1 |
| Aerobic gram-negative bacteria | 27 | 22 | 49 | 33 | 16 | 49 | ||
| Acinetobacter baumannii | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Aeromonas hydrophila | 6 | 1 | 7 | 0.673 | 6 | 1 | 7 | 0.672 |
| Citrobacter freundii | 1 | 1 | 2 | 0.517 | 1 | 1 | 2 | 0.504 |
| Escherichia coli | 2 | 3 | 5 | 0.163 | 3 | 2 | 5 | 0.63 |
| Klebsiella pneumoniae | 0 | 1 | 1 | 0.304 | 0 | 1 | 1 | 0.295 |
| Morganella morganii | 17 | 15 | 32 | 0.016 | 17 | 15 | 32 | 0.011 |
| Proteus spp. | 4 | 4 | 8 | 0.242 | 6 | 2 | 8 | 1 |
| Proteus mirabilis | 1 | 2 | 3 | 0.218 | 3 | 0 | 3 | 0.554 |
| Proteus penneri | 1 | 1 | 2 | 0.517 | 2 | 0 | 2 | 1 |
| Proteus vulgaris | 3 | 2 | 5 | 0.638 | 3 | 2 | 5 | 0.63 |
| Pseudomonas aeruginosa | 2 | 4 | 6 | 0.068 | 4 | 2 | 6 | 1 |
| Providencia spp. | 4 | 2 | 6 | 1 | 3 | 3 | 6 | 0.358 |
| Providencia alcalifaciens | 1 | 1 | 2 | 0.517 | 1 | 1 | 2 | 0.504 |
| Providencia rettgeri | 3 | 1 | 4 | 1 | 2 | 2 | 4 | 0.58 |
| Serratia spp. | 1 | 2 | 3 | 0.218 | 3 | 0 | 3 | 0.554 |
| Serratia liquefaciens | 0 | 1 | 1 | 0.304 | 1 | 0 | 1 | 1 |
| Serratia marcescens | 1 | 1 | 2 | 0.517 | 2 | 0 | 2 | 1 |
| Shewanella spp. (putrefaciens) | 3 | 2 | 5 | 0.638 | 4 | 1 | 5 | 1 |
| Yokenella regensburgei | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Anaerobic bacteria | ||||||||
| Bacteroides spp. | 5 | 2 | 7 | 5 | 2 | 7 | ||
| Bacteroides fragilis | 5 | 2 | 7 | 1 | 5 | 2 | 7 | 1 |
| Bacteroides uniformis | 0 | 1 | 1 | 0.304 | 1 | 0 | 1 | 1 |
| Fungus | ||||||||
| Candida parapsilosis | 1 | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Polymicrobial (≥ 2 pathogens) | 14 | 18 | 32 | < 0.001 | 21 | 11 | 32 | 0.471 |
*
No significant variation in the diagnostic methods between the two hospitals.
†
Diagnosed by examining the snake, having the patients to identify snake through a picture, or laboratory testing of the venom.
‡
Diagnosed by physical examination, serial wound inspection, a relevant history, and clinical improvement after receiving specific antivenom for N. atra bite.
§
The bracket number represents the cases in Taichung Veterans General Hospital/Taipei Veterans General Hospital, respectively.
∥
Included any form of rope, rubber band, or towel/clothes bindings.