Are cat bites more severe than cat scratches?

Cat Bites Are More Severe Than Cat Scratches

Cat bites are significantly more dangerous than cat scratches due to their higher infection rates (20-80% for bites versus much lower for scratches) and greater risk of serious complications. 1, 2

Why Cat Bites Are Worse Than Scratches

Infection Risk

• Cat bites have a 20-80% infection rate, compared to only 3-18% for dog bites and even lower rates for scratches 3, 2
• Cat bites create deep puncture wounds that:
  • Inject bacteria directly into tissues
  • Create small entry wounds that seal quickly, trapping bacteria inside
  • Are difficult to clean properly due to their depth and small surface opening

Bacterial Contamination

• Approximately 90% of domestic cats carry Pasteurella multocida in their oral cavity 3
• Cat bites introduce this and other bacteria deep into tissues, while scratches typically cause more superficial contamination
• Other common pathogens in cat bite infections include:
  • Staphylococcus aureus
  • Streptococci species
  • Anaerobic bacteria (present in approximately one-third of bite wounds) 4

Anatomical Considerations

• Cat bites to the hand are particularly dangerous due to:
  • Proximity to joints, tendons, and bones
  • Limited soft tissue protection
  • Potential for rapid spread of infection through tendon sheaths
  • Higher risk of treatment failure requiring more aggressive intervention 1

Management Differences

Cat Bite Management

• Requires immediate medical evaluation 1
• Thorough wound irrigation until no obvious debris remains
• Prophylactic antibiotics are typically recommended for all cat bites
• Amoxicillin-clavulanate is the first-line antibiotic choice (provides excellent coverage against Pasteurella multocida) 1, 3
• For penicillin-allergic patients: fluoroquinolones plus metronidazole 1
• Suturing generally avoided to prevent trapping bacteria in the wound 1
• Close follow-up within 24-48 hours to assess for infection 1

Cat Scratch Management

• Less aggressive approach typically needed
• Thorough cleaning with soap and water is usually sufficient
• Prophylactic antibiotics generally not required unless:
  • Patient is immunocompromised
  • Scratch is deep or extensive
  • Scratch is near a joint or on the hand
  • Signs of infection develop

Prevention Strategies

• Avoid activities that might result in cat scratches or bites 5, 1
• Wash hands thoroughly after handling cats 5
• Implement flea control for cats to reduce risk of Bartonella infection 5, 1
• Consider adopting cats >1 year old and in good health 5
• Never allow cats to lick open cuts or wounds 5
• Promptly wash sites of cat scratches or bites 5

Warning Signs of Infection

Seek immediate medical attention if any of these develop after a cat bite or severe scratch:

• Increasing redness or swelling
• Increased pain
• Warmth around the wound
• Purulent drainage
• Fever or systemic symptoms 1

Special Considerations

• Immunocompromised patients are at higher risk for severe infections from both bites and scratches 1
• Hand injuries from cats (both bites and deep scratches) warrant special attention due to risk of deep structure involvement 1
• Cat bites in elderly patients or those with comorbidities like diabetes may require more aggressive management 1