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The microbiology of crocodile attacks in Far North Queensland: implications for empirical antimicrobial therapy

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Wound infections are common after crocodile attacks and, therefore, prophylactic antimicrobial therapy is advised. However, there are limited data to guide recommendations for the optimal empirical regimen.

In a study from 1992,1 six of 11 survivors of crocodile attacks from Australia’s Northern Territory developed wound infection. The organisms isolated included Aeromonas hydrophila and Enterococcus species, Clostridium species, Pseudomonas aeruginosa and Proteus species, Staphylococcus epidermidis and Burkholderia pseudomallei. As a result, the authors advocated an empirical antibiotic regimen of ceftazidime, penicillin and metronidazole, with the addition of flucloxacillin to treat the patient’s skin flora.1 The Australian Therapeutic Guidelines do not discuss crocodile attacks specifically, but suggest giving oral amoxycillin–clavulanate to people with animal bite wounds at high risk of developing infection, and to patients with established mild infection. For more severe infections, intravenous piperacillin–tazobactam is recommended.2

To validate these recommendations, we reviewed the medical records of 14 of the 15 patients attacked by crocodiles who presented to Cairns Hospital in Queensland, Australia, after 1990 (one chart had been destroyed).…