What is the wound category of a single superficial cat bite in an otherwise healthy individual with no prior medical conditions?

Cat Bite Wound Classification

A single superficial cat bite in an otherwise healthy individual is classified as a high-risk wound requiring prophylactic antibiotic therapy, regardless of its superficial appearance. 1

Wound Category Classification

Cat bites fall into a high-risk infection category with infection rates of 30-50%, significantly higher than dog bites (which have infection rates of approximately 5-15%). 1, 2 This elevated risk persists even when the wound appears minor or superficial. 1

Key Risk Factors Present in This Scenario

Even a single superficial cat bite carries inherent high-risk characteristics:

• Puncture wound nature: Cat bites typically create deep puncture wounds with narrow entry points that appear deceptively minor but inoculate bacteria deep into tissues 3
• High bacterial load: 75% of cat bite wounds contain Pasteurella multocida, and 65% harbor anaerobic bacteria from the cat's oral flora 1, 4
• Deceptive presentation: The absence of immediate redness or swelling does not indicate low infection risk 1

Clinical Management Algorithm

Immediate Assessment Required

All cat bites warrant:

• Thorough irrigation with copious sterile normal saline 1
• Assessment of wound depth (superficial appearance can be misleading) 3
• Evaluation of anatomical location, particularly if near hands, face, feet, or joints 1
• Tetanus immunization status verification 1
• Rabies risk assessment based on cat's vaccination history and behavior 1

Antibiotic Prophylaxis Decision

Prophylactic antibiotics are strongly recommended for:

• All hand wounds (highest risk for osteomyelitis and septic arthritis) 1
• Deep puncture wounds 1
• Wounds near bones or joints 1
• Face or feet wounds 1
• Immunocompromised patients 1

For a superficial wound on other body locations in healthy individuals, the evidence suggests prophylactic antibiotics should still be considered given the 30-50% baseline infection rate. 1, 3

First-line antibiotic: Amoxicillin-clavulanate 875/125 mg twice daily 1

Penicillin-allergic patients: Doxycycline 100 mg twice daily 1

Critical Pitfalls to Avoid

• Never dismiss superficial-appearing cat bites as low-risk: The external wound size does not correlate with infection risk or depth of bacterial inoculation 1, 5
• Wound type and depth are the most important infection predictors, not initial appearance 3
• Puncture wounds have higher infection rates than lacerations or abrasions, even when prophylactic antibiotics are given 3
• Delayed presentation (>8-12 hours) significantly increases infection risk 6, 3

Special Considerations

Imaging indications (even for superficial wounds):

• Wounds near bones or joints require plain radiographs to evaluate for periosteal penetration or foreign bodies 2
• Hand wounds may require imaging to assess for deep complications 2

Follow-up: Close observation is mandatory even with prophylactic antibiotics, as infections can develop despite appropriate initial management and may progress to osteomyelitis, septic arthritis, or sepsis. 5, 7