Delayed healthcare and secondary infections following freshwater stingray injuries: risk factors for a poorly understood health issue in the Amazon

Abstract INTRODUCTION This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections. METHODS This cross-sectional study used surveillance data from 2007 to 2014 to identify factors associated with secondary infections from stingray injuries. RESULTS A total of 476 freshwater stingray injuries were recorded, with an incidence rate of 1.7 cases/100,000 person/year. The majority of injuries were reported from rural areas (73.8%) and 26.1% were related to work activities. A total of 74.5% of patients received medical assistance within the first 3 hours of injury. Secondary infections and necrosis were observed in 8.9% and 3.8%, respectively. Work-related injuries [odds ratio (OR) 4.1, confidence interval (CI); 1.87-9.13] and >24 hours from a sting until receiving medical care (OR; 15.5, CI; 6.77-35.40) were independently associated with the risk of secondary bacterial infection. CONCLUSIONS: In this study, work-related injuries and >24 hours from being stung until receiving medical care were independently and significantly associated with the risk of secondary infection. The frequency of infection following sting injuries was 9%. The major factor associated with the risk of secondary bacterial infection was a time period of >24 hours from being stung until receiving medical care.

**摘要**
本研究旨在描述巴西亚马孙州境内淡水魟（freshwater stingray）蜇伤的临床特征，并明确继发感染的相关危险因素。
**方法**：本研究为横断面研究（cross-sectional study），采用2007年至2014年的监测数据，分析淡水魟蜇伤后继发感染的相关影响因素。
**结果**：本研究共纳入476例淡水魟蜇伤病例，发病率为1.7例/10万人·年。其中73.8%的病例来自农村地区，26.1%的蜇伤事件与劳作活动相关。74.5%的患者在蜇伤后3小时内接受了医疗救治。继发感染与坏死的发生率分别为8.9%和3.8%。多因素回归分析显示，劳作相关蜇伤（比值比（odds ratio, OR）=4.1，95%置信区间（confidence interval, CI）：1.87~9.13）以及蜇伤后超过24小时才接受医疗救助（OR=15.5，CI：6.77~35.40）是继发细菌感染的独立危险因素。
**结论**：本研究结果表明，劳作相关蜇伤及蜇伤后超过24小时才接受医疗救助，均为淡水魟蜇伤后继发感染的独立显著危险因素。本次研究中蜇伤后感染的总体发生率为9%，其中继发细菌感染的最主要危险因素为蜇伤后超过24小时才接受医疗救助。