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 引言：本研究旨在描述巴西亚马孙州亚马孙地区淡水魟（freshwater stingray）蛰伤的临床特征，并明确继发感染的相关危险因素。 方法：本横断面研究采用2007年至2014年的监测数据，识别淡水魟蛰伤继发感染的相关影响因素。 结果：本研究共记录476例淡水魟蛰伤病例，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%的蛰伤与职业活动相关。74.5%的患者于蛰伤后3小时内接受了医疗救助。继发感染与坏死的发生率分别为8.9%和3.8%。职业相关蛰伤[比值比（odds ratio, OR）4.1，置信区间（confidence interval, CI）1.87~9.13]以及从蛰伤到接受医疗救助的时间超过24小时（OR=15.5，CI=6.77~35.40）均与继发细菌感染的风险独立相关。 结论：本研究显示，职业相关蛰伤与从蛰伤到接受医疗救助的时间超过24小时，均与继发感染风险存在独立且显著的关联。淡水魟蛰伤后的感染发生率为9%。与继发细菌感染风险关联最为显著的危险因素为从蛰伤到接受医疗救助的时间超过24小时。