To determine if the use of prophylaxis antibiotic in mammalian and human bites is effective in preventing bite wound infection.
Relevant RCTs were identified by electronic search through MEDLINE, EMBASE, LILACS and the Cochrane Controlled Trials Register databases.
Types of participants: Patients with injuries caused by mammalian or human bites.
Types of intervention: Use of antibiotics compared to the use of placebo or no intervention.
Types of studies: Randomised clinical trials or quasi-randomised controlled trials
Types of outcomes measures: Proven or presumptive bacterial infection or absence of infection at the site of bite.
Human and other mammalian bite wounds are a common problem and they account for up to 1% of all visits to hospital emergency rooms (Weiss 1998, Goldstein 1992). American statistics estimate that almost half of all children have been bitten by a dog at some point of their lives (Weiss 1998). The direct health care costs associated with the care of these wounds can be estimated to exceed $30 million (Elenbaas 1982).
A large percentage of bite wounds are superficial abrasions. Most of these wounds are inflicted by dogs and cats. In more than 70% of cases, people are bitten by their own pets or by an animal known to them. School-age children constitute 30-50% of all those sustaining mammalian bite injuries (Willey 1990).
There is a small but definite morbidity and mortality associated with infection in the more serious lacerated and puncture wounds. Human bites have long been considered as having a very high infection rate, and the usual explanation was that the normal human oral flora harbours more pathogens than that of animals. However, some authors have found data that indicate that human bites occurring anywhere else than the hand do not have any higher risk than animal bites, and they consider the high rate of complications as a bias due to their usual location and initial delay in medical attention (Callanham 1988).
Prevention of tetanus and rabies where appropriate, together with adequate cleansing of such wounds, are universally accepted measures, whereas the prophylactic use of antibiotics to reduce wound infections is controversial. That controversy can be traced primarily to the paucity of well-designed, prospective studies that examine the efficacy of treatment for bite wounds. The few currently published prospective studies of antibiotic prophylaxis suffer from small numbers of patients and low infection rates, in either the control or the treatment groups and this diminishes the statistical significance of the results. It has been estimated that three hundred and seventy patients in each group would be required to test the efficacy of antibiotic prophylaxis with a probability of type II error of 10% (Jones 1985).
Review articles have advocated the use of antibiotics in certain cases, such as patients aged over 50 years, those with puncture wounds and hand wounds, and those delaying presentation to medical attention for over 24 hours, while accepting that further information was required (Snook 1982). In order to gather a bigger number of cases to try to provide the information required, we need to make a systematic study of randomised trials considering the value of antibiotic prophylaxis in human and other mammalian bites.
To determine if the use of prophylactic antibiotics in mammalian and human bites is effective in preventing bite wound infection.
Randomised and quasi-randomised controlled trials. The randomised clinical trials may be double blind, single-blind or unblinded. The RCTs may be unpublished or published as an article, an abstract or a letter, and no language limitations were applied.
Patients with injuries caused by mammalian or human bites attending hospital or health care provider within 24 hours of injury, without clinical signs of infection.
Use of antibiotics within 24 hours of injury compared to the use of placebo or no intervention in order to prevent bite wound infection.
Proven bacterial infection: clinical signs (temperature, induration, erythema, swelling, pain, warmth, pus, odour, adenopathy, lymphangitis, cellulitis) plus positive microbiological cultures (for aerobics and anaerobics) at the site of bite.
Presumptive bacterial infection: clinical signs of infection at the site of bite with negative culture (or culture not obtained).
Absence of infection: absence of the clinical signs described above.
Relevant RCTs were identified by electronic search through MEDLINE (1966 to 2000), EMBASE (1980 to 2000), LILACS (1988 to 2000) and the Cochrane Controlled Trials Register databases.
The following strategy was used to search the eletronic databases:
1. animal [MESH] OR mammalian [TEXT WORD] OR cat [TEXT WORD] OR dog* [TEXT WORD] OR monkey* [TEXT WORD] OR donkey* [TEXT WORD] OR human [TEXT WORD] OR humans [TEXT WORD]
2. bites [TEXT WORD]
3. prophyla* [TEXT WORD]
4. #1 AND #2
5. #3 AND #4
The bibliographic references of identified RCTs, textbooks, review articles and meta-analyses were checked in order to find RCTs not identified by electronic search.
A hand search was undertaken to find RCTs presented in Brazilian Infectious Diseases Meetings (1980-1995).
The titles (and abstracts when available) in the MEDLINE, EMBASE, LILACS and handsearch of RCTs and reviews were reviewed by the two reviewers. Any article that met the inclusion criteria was retrieved. All identified trials were listed and trials excluded from the review were identified with the reasons for exclusion.
An assessment of the quality of the included studies (excluding abstracts) was performed independently by Humberto Saconato and Iara M. de Medeiros. The reviewers was not blinded to author, institution and journal of publication of results. The two assessors then reviewed together each study and by consensus develop an overall quality score. If necessary, these consensus scores were used in subsequent sensitivity analysis. The following dimensions and criteria was used in a standard way adopted from the Cochrane Collaboration Handbook (Handbook 2000) and Schulz et al. (Schulz 1995).
A. Generation of allocation sequence
Adequate sequence generation was regarded as use of computer random number generator, random number tables or shuffling.
Does not report on one of the adequate forms of generation of allocation sequence mentioned above in A , but mentions randomizations method.
Other methods of allocation that appear to be unbiased (e.g. minimization).
B. Allocation concealment
Adequate measures taken to conceal allocations such as central randomizations, serially numbered, opaque, sealed envelopes, or other description that contains elements convincing of adequate concealment.
Unclearly concealed trials, in which the authors either did not report an allocation concealment approach at all, or report an approach that did not fall into one of the categories in B.
Inadequately concealed trials, in which the method of allocation was not concealed, such as alternation methods or use of case numbers (quasi-randomisation).
C. Inclusion of all randomised participants
Trials in which an intention-to-treat analysis is possible with only a few losses to follow-up.
Trials which reported exclusions as listed in C above, but exclusions were less than 10%.
Trials which reported exclusions, or exclusions greater than 10% or wide differences in exclusions between groups.
D. Blinded assessment
Trials in which the double-blind or double-masked technique is used.
Trials trying to control information bias by other methods (e.g. single-blinded trials).
Trials in which reduction of information bias is not employed.
DATA EXTRACTION
---------------------------
The following data were extracted from the studies included: title, year of publication, design, generation of allocation concealment, number of participants, age and sex of participants, patients with underlying diseases, severity of the injury, body part of the injury, species of aggressor mammal, antibiotics used, time to antibiotic use, duration of antibiotic use, side-effects, assessment of patient compliance, infection rates in both groups of patients, assessment of the outcomes, local care (before and after the visit to emergency rooms), suture of the injury, time of follow-up, drop out, cost analysis.
ANALYSING AND PRESENTING THE RESULTS
-----------------------------------------------------------------
The studies were stratified in subgroups according to:
� Animal species (dogs, cats, human)
� Types of wounds (lacerations, punctures, abrasions, avulsions)
� Location of the wound (hands, arms, legs, neck, face, trunk
Statistical analysis:
Intention to treat analysis was performed. Heterogeneity between RCTs was tested using a chi-square test and by inspecting the graphical presentation. Odds ratio with respective confidence intervals (CI) using random effects model was reported. When appropriate, the number of patients that it was necessary to treat to prevent one case of bacterial infection was calculated.
Sensitivity Analysis
The following strategies were used for the sensitivity analyses:
1. Repeating the analysis taking account of study quality, excluding studies with poor quality.
2. Repeating the analysis using different different statistic models (fixed and random effects models).
TYPES OF PARTICIPANTS
----------------------------------
Two studies included only children, two studies analysed only adults and three studies included both children and adults. One study did not specify which age group was included.
TYPES OF INTERVENTION
-------------------------------------
The antibiotics used were: phenoxymethyl penicillin (two studies) (Boenning 1983, Skurka 1986), oxacillin (two studies) (Elenbaas 1984, Elenbaas 1982), dicloxacillin (two studies) (Dire 1992, Rosen 1985), co-trimoxazole (one study) (Jones 1985). Two studies used different antibiotics. In the study of Rosen (Rosen 1985) cephalexin or erythromycin were used and ceclor or kefzol or penicillin G was used in the study of Zubowicz et al (Zubowicz 1991).
Six studies used placebo, but only two mentioned the use of identical in appearance placebo (Elenbaas 1982, Elenbaas 1984). In two studies the control group did not have any intervention.
TYPES OF OUTCOMES
--------------------------------
All studies analysed infection incidence. Four studies analysed infection incidence according to part of the body injured (Dire 1992, Jones 1985, Skurka 1986, Zubowicz 1991), separating hands from other parts. Three studies were analysed according to the type of wounds (lacerations, puncture, abrasions or avulsions) (Dire 1992, Elenbaas 1984, Skurka 1986). Only when it was possible to define which part of the body was injured, were the data extracted, therefore only three studies were included for comparison .
Species of aggressors mammalian
--------------------------------------
In six studies (Boenning 1983, Dire 1992, Rosen 1985, Skurka 1986, Elenbaas 1982, Jones 1985), the bites were caused by dogs. In one study the aggressor animal was cat (Elenbaas 1984) and in another one humans (Zubowicz 1991).
Randomisation methods
---------------------------------
Seven studies were randomised clinical trials. Only one was quasi-randomised (Boenning 1983). The allocation concealment was adequate in one study (Rosen 1985) and the method to generate the randomisation sequence was appropriate in two studies (Dire 1992, Skurka 1986). There were no descriptions of the method of randomization in the other studies.
Double-Blind Method
-----------------------------
Six studies described double-blind methods. Two studies described a placebo of identical appearance (Elenbaas 1982, Elenbaas 1984).
Exclusions and lost of follow-up
------------------------------------------
Five studies reported looses of follow-up. Three studies reported looses of follow-up higher than 10% (Elenbaas 1982, Jones 1985, Rosen 1985). In four studies (Dire 1992, Elenbaas 1982, Jones 1985, Rosen 1985) was not possible to perform intention to treat analysis because the authors did not report how many patients was lost in each group.
There was no statiscally significant difference between to use or not prophylactic antibiotic to reduce infection rate after mammalian bites (OR 0.49, 95% CI 0.15 to 1.58). In this comparison there was statistically significant heterogeneity (test for heterogeneity chi-square 12.05, df=7, P= 0.099). Analysing by fixed model, the result favours significantly prophylatic antibiotic (OR 0.39, 95% CI 0.19 to 0.77).
Of analyses according to the type of aggressor animal, only dog bites were studied in more than one study included in the meta-analysis. There was no statistically significant reduction of infection rate after use of prophylactic antibiotic (4% (10/225)) in relation to the control group (5.5% (13/238)) after dog bites (OR 0.74, 95% CI 0.30 to 1.85). Heterogeneity was not observed in this sub-category. Only one study with a small sample size was included analysing cat bites and this study observed a higher infection rate in the control group (67% (4/6)) compared with prophylactic antibiotic (0% (0/5)). Only one study analysed human bites and the infection rate was also higher in the control group (47% (7/15)) compared with no cases of infection in the group that used prophylactic antibiotic (0/33). Excluding studies with looses of follow-up higher than 10% or excluding a quasi-randomised study (Boenning 1983) did not change significantly the results.
Wound type did not appear to influence the effect of prophylactic antibiotic on infection rate. The presence of infection in puncture lesions occurred in 7% (1/14) of the individuals receiving prophylactic antibiotic compared with 31% (5/16) in the control group (OR 0.22, 95%CI 0.01 to 8.37). In lacerations, infection occurred in 3% (2/63) of those that used prophylactic antibiotic in relation to 6% (4/66) in the control group (OR 0.80, 95%CI 0.05 to 13.67). Infections in avulsion wounds occurred in 5% (2/41) of patients in the group using prophylactic antibiotic in relation to 3% (1/30) in the control group (OR 1.07, 95% CI 0.11 to 10.63).
In relation to location of injury, only wounds of the hands, trunk and head/neck were studied in more than one study included in each comparison. Wounds of the hands had a higher infection rate in the control group (28% (12/43)) when compared to patients that received prophylactic antibiotic (2% (1/61)) (OR 0.10, 95% CI 0.01 to 0.86; NNT = 4, 95% CI 2 to 50), there is no heterogeneity between studies (test for heterogeneity chi-square 3.00, df=2, P= 0.22). In wounds of the head/neck, infection occurred in only one patient in the control group, compared with no patient in the experimental group. In wounds of the trunk, infection was observed in only one patient in the experimental group and no patient in the control group.
The studies included in this systematic review did not demonstrate a reduction in the infection rate after mammalian bites among the individuals that received prophylactic antibiotics when compared to the control group. However, these results should be interpreted with caution because significant heterogeneity was observed in the meta-analysis. The impact of prophylactic antibiotic use can be more evident in situations of higher infection risk, being therefore, important to analyse according species of animal aggressor and the type and local of the wound.
Of the analysis according to mammalian species, only dog bites had more than one included study. Cat and human bites had only one study included for each comparison. The use of prophylactic antibiotic for dog bites is not associated with statistically significant reduction of infection. Another systematic review performed by Cummings (Cummings 1994) demonstrated a reduction in the infection rate after dog bites. With exception of one RCT (Brakenbury 1980), both systematic reviews included the same studies. Then, this difference probably is related a different statistical analysis used in these two systematic reviews. Because the potential heterogeneity between the studies, we used random effects model. The exclusion of the studies with drop-out higher than 10% in sensitivity analysis did not change the results. However, when we used the fixed effect model, the global result favours antibiotic prophylaxis for mammalian bites (including dogs, cats and humans), but when only dogs bites is analysed using fixed or random effect model, there was no reduction of infection rate.
In relation to wound type, puncture wounds have been associated with a higher infection rate after animal bites, however there was no statistically significant difference between prophylactic antibiotic and control group in puncture wounds. However, a tendency was observed for a higher infection rate among the individuals with this type of wound in the control group. Prophylactic antibiotics appear to be effective when the wounds are located in the hands. Unfortunately only three randomised controlled trials analysing wounds in the hand were identified in this systematic review. It is probably important to separate the type of wound according to the species of mammal.
The possibility of publication bias appears improbably. The inspection of funnel plot apparently did not demonstrate asymmetry. We searched unpublished RCTs from Abstracts of Brazilian Infectious Diseases Meetings, but others sources of unpublished RCTs needs to be searched.
Another problem is the type of antibiotic used in the included studies. Recently, bacteriologic analysis of infected wounds of dog and cat bites have demonstrated that pasteurella species were the most common followed by streptococci, staphylococci, moraxella, corynebacterium and neisseria species (Talan 1999). Mixed infections of both aerobic and anaerobic pathogen were more frequent, and anaerobes were rarely found alone. Probably, beta-lactam antibiotic associated with beta-lactamase would have an important impact when used after mammalian bites (Talan 1999).
There is insufficient evidence that the use of prophylactic antibiotic is effective for dog bites, because most of the studies included were methodologically defficient and had small sample sizes. There is some weak evidence that the use of antibiotic prophylatic after cat and human bites reduces infection.
� INCLUSION CRITERIA: Adults and children with mammalian-bites wounds who presented to an emergency room within 24 hours of injury.
� EXCLUSION CRITERIA: superficial abrasions, clinical signs of infection, those having other medical problems requiring antibiotic treatment or allergies to antibiotic.
� TYPES OF INTERVENTION: The choice of antibiotics should be based on the flora of the oral cavity of mammalian aggressors.
� OUTCOMES MEASURES:
1. Infection Incidence, separating according according to location and the wound type. To obtain microbiologic specimens of the infected wound and to cultivate into anaerobic and aerobic mediums. Infection criteria described by Talan et al (Talan 1999) could be used. Wound should be considered infected if meets one of three major criteria - fever, abscess and lymphangitis - or four of five minor criteria: wound associated with erythema that extended more than 3 cm from the edge of the wound; tenderness at the wound site, swelling at the site, purulent drainage, and a peripheral white-cell count of more than 12,000 per cubic millimeter.
2. Incidence of adverse events
None
| Study | Methods | Participants | Interventions | Outcomes | Notes | Allocation concealment |
| Boenning 1983 | An alternate allocation was used. The groups were divided according with the date of the visit. | Fifty eight children with dog bites. Patients were included if wound occurred within the preceding 24 hours; if the wound did not require closure with sutures; if the injuries were not on the face; if the patient had no history of penicillin allergy; and no antibiotics were being administered at the time of the bite. | Twenty five patients received Phenoxymethyl penicillin 250 mg q.i.d. and local wound care for five days versus Thirty patients received local wound care only | Incidence of Infection | Specie of offending animal: Dogs. | C |
| Dire 1992 | Random allocation by a computer generation was described. Double blind. | One hundred ninety one adults and children with dog bites were included. Six patients failed to return for follow-up. The patients were excluded if had hand, foot, or puncture wounds; wounds greater more 12 hours, the presence of clinical signs of infection; or a history of immunosuppression disorders or medications or if they were less than one year old; or if there was a history of antibiotic use within the previous seven days. | Eighty nine patients received oral Dicloxacillin or Cephalexin or Erythromycin 500 mg q.i.d (50 mg/kg/day for children) by seven days and ninety six patients received placebo. | Infection incidence | Specie of offending animal: Dogs. It was not possible to perform intention to treat analysis. | B |
| Elenbaas 1982 | Random allocation was described, but method of randomisation unspecified. Double blind. | Sixty three adults patients with dog bites and full-thickness injuries were included. Patients were excluded if had clinical signs of infection, patients requiring hospitalization, having violation of the periosteum, already receiving antibiotics for other reasons, or having allergy to penicillin. Seventeen patients failed to return for follow-up | Twenty-two patients received Oxacillin 500 mg q.i.d. by five days versus Twenty patients receiving identically appearing placebo | Infection incidence according with part of body injured. | Specie of offending animal: Dogs. It was not possible to perform intention to treat analysis. | B |
| Elenbaas 1984 | Random allocation was described, but method of randomisation unspecified. Double blind. | Twelve adults patients with cat bites and full-thickness injuries were included. Patients were excluded if had clinical signs of infection, patients requiring hospitalization, having violation of the periosteum, already receiving antibiotics for other reasons, or having allergy to penicillin. One patient failed to return for follow-up | Five patients received Oxacillin 500 mg q.i.d. by five days versus six patients receiving identically appearing placebo | Infection incidence accordin with part of body injuried. | Specie of offending animal: Cats. | B |
| Jones 1985 | Random allocation was described, but method of randomisation unspecified. Double blind. | One hundred and thirteen patients were included. Exclusion criteria: superficial abrasions, those having other medical problems requiring antibiotic treatment or allergies to co-trimoxazole, and children less than 3 years of age. Thirty-five patients failed to return for follow-up. | Fifty-five patients received co-trimoxazole versus fifty-eight patients receiving placebo | Incidence of infection and incidence of infection in hand wounds | Specie of offending animal: Dogs. It was not possible to perform intention to treat analysis. | B |
| Rosen 1985 | Random allocation was described. Allocation concealment by serially numbered sealed opaque envelopes Double blind. | One hundred fifty adults and children with dog bites were included. Patients were included if they had wounds that unequivocally penetrated the dermis, were presented to emergency department for treatment within 8 hours of the injury. Exclusion criteria: Wounds involving bone, tendon, tendon sheath, or major neurovascular structures. Eighteen patients failed to return for follow-up. | Seventy patients received Cloxacillin or Dicloxacillin 250 mg q.i.d. versus sixty-two patients receiving placebo | Infection incidence according with the part of the body injuried (hand or not) | Specie of offending animal: Dogs. It was not possible to perform intention to treat analysis. | A |
| Skurka 1986 | Patients were assigned by a table of random numbers. Double blind method. | Thirty nine children (one to 16 years of age) with history of dog bites penetrating the skin within 24 hours were included. Exclusion criteria criteria: patients with infected wounds, allergy to penicillin, antibiotics administration within three days prior to the bites, and indications for hospitalization. | Nineteen patients received oral phenoxymethyl penicillin 100,000 U/Kg/ day given every 6 hours for two days and twenty patients received placebo | Infection incidence | Specie of offending animal: Dogs. | B |
| Zubowicz 1991 | Random allocation was described, but method of randomisation unspecified. Double blind method not mentioned. | Forty-eight adults patients with human bites to the hand were included. The inclusion criteria: the bite was less than 24 hours old, the bite was not infected and no other infection was present on the body, the bite did not penetrate a joint capsule and the bite injured no tendon. | Thirty-eight patients received Ceclor 250 mg t.i.d. via oral or Kefzol 1 g q.i.d. intravenous or Penicillin G 1.2 million U intravenous q.i.d. versus fifteen patients receiving Placebo oral | Infection incidence | Specie of offending animal: Human. | B |
| Study | Reason for exclusion |
| Callaham 1980 | It is not a randomised controlled trial |
| Malinowski 1979 | It is not a randomised controlled trial |
Boenning DA, Fleisher GR, Campos JM. Dog bites in children: Epidemiology, microbiology and penicillin prophylatic therapy. Am J Emerg Med 1983;1:17-21.
Dire 1992 {published data only}
Dire DJ, Hogan DE, Walker JS. Prophylatic oral antibiotics for low-risk dog bite wounds. Pediatr Emerg Care 1992;8:194-199.
Elenbaas 1982 {published data only}
Elenbaas RM, McNabney WK, Robinson WA. Prophylatic oxacillin in dog bite wounds. Ann Emerg Med 1982;11:248-251.
Elenbaas 1984 {published data only}
Elenbaas RM, McNabney WK, Robinson WA. Evaluation of prophylactic oxacillin in cat bite wounds. Ann Emerg Med 1984;13:155-157.
Jones 1985 {published data only}
Jones DA, Stanbridge TN. A clinical trial using co-trimoxazole in an attempt to reduce wound infection rates in dog bite wounds. Posgrad Med J 1985;61:593-594.
Rosen 1985 {published data only}
Rosen RA. The use of antibiotics in the initial management of recent dog-bite wounds. Am J Emerg Med 1985;3:19-23.
Skurka 1986 {published data only}
Skurka J, Willert C, Yogev R. Wound infection following dog bite despite prophylatic penicillin. Infection 1986;14:134-135.
Zubowicz 1991 {published data only}
Zubowicz VN, Gravier M. Management of early human bites of the hand: a prospective randomized study. Plastic Reconstr Surg 1991;88:111-114.
Callaham M. Prophylatic antibiotics in common dog bites wounds: A controlled study. Ann Emerg Med 1980;9:410-414.
Malinowski 1979 {published data only}
Malinowski RW, Strate RG, Perry JF, Fischer RP. The management of human bite injuries of the hand. J. Trauma 1979;19:655-659.
Brakenbury PH, Muwanga C. A comparison double blind study of amoxycillin/clavulanate vs placebo in the prevention of infection after animal bites. Arch Emerg Med 1989;6:251-256.
* indicates the primary reference for the study
Callanham M. Controversies in antibiotic choices for bite wounds. Annals of Emergency Medicine 1988;17:1321-1330.
Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med 1994;23:535-540.
Goldstein E J C. Bite Wounds and Infection. Clinical Infectious Diseases 1992;14:633-640.
Clarke M, Oxman AD, editors.. Assessment of study quality. Cochrane Reviewers� Handbook 4.1 [updated June 2000]; Section 4. In: Review Manager (RevMan) [Computer program]. Version 4.1. Oxford, England: The Cochrane Collaboration, 2000. 2000.
Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408-412.
Snook R. Dog bites man. British Medical Journal 1982;284(6312):293-294.
Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ : Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group. N Engl J Med 1999;340:85-92.
Weiss H B, Friedman D I, Coben J H. Incidence of dog bite injuries treated in emergency departments. JAMA 1998;279(1):51-53.
Willey JF. Mammalian bites. Review of evaluation and management.. Clinical Pediatrics 1990;29:283-7.
01.01 Incidence of infection grouped according to type of animal
01.01.01 Dogs
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Boenning 1983 | 1 | 25 | 1 | 30 |
| Dire 1992 | 1 | 89 | 1 | 96 |
| Elenbaas 1982 | 2 | 22 | 0 | 24 |
| Jones 1985 | 3 | 55 | 8 | 50 |
| Rosen 1985 | 1 | 15 | 2 | 18 |
| Skurka 1986 | 2 | 19 | 1 | 20 |
01.01.02 Cats
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Elenbaas 1984 | 0 | 5 | 4 | 6 |
01.01.03 Human
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Zubowicz 1991 | 0 | 33 | 7 | 15 |
01.02 Incidence of infection grouped according to type of wound
01.02.01 Puncture
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Elenbaas 1984 | 0 | 5 | 4 | 5 |
| Skurka 1986 | 1 | 9 | 1 | 11 |
01.02.03 Lacerations
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Dire 1992 | 1 | 57 | 4 | 58 |
| Skurka 1986 | 1 | 6 | 0 | 8 |
01.02.04 Avulsions
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Dire 1992 | 0 | 14 | 1 | 14 |
| Elenbaas 1982 | 2 | 27 | 0 | 16 |
01.03 Incidence of infection grouped according to site of the wound
01.03.01 Trunk
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Dire 1992 | 0 | 12 | 0 | 16 |
| Skurka 1986 | 1 | 3 | 0 | 1 |
01.03.02 Head/neck
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Dire 1992 | 0 | 36 | 1 | 34 |
| Skurka 1986 | 0 | 5 | 0 | 7 |
01.03.03 Hands
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Jones 1985 | 0 | 23 | 4 | 24 |
| Skurka 1986 | 1 | 5 | 1 | 4 |
| Zubowicz 1991 | 0 | 33 | 7 | 15 |
01.03.04 Arms
| Study ID | Treatment n | Treatment N | Control n | Control N |
| Skurka 1986 | 0 | 2 | 0 | 3 |