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A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China
  1. Ka Keung Lam1,2,
  2. Paul Crow3,
  3. Kenneth Ho Leung Ng4,
  4. Kam Chuen Shek1,
  5. Hin Tat Fung1,
  6. Gary Ades3,
  7. Alessandro Grioni3,
  8. Kit Sun Tan3,
  9. Kam Tong Yip4,
  10. David Christopher Lung4,
  11. Tak Lun Que4,
  12. Tommy Shing Kit Lam1,
  13. Ian D Simpson5,6,
  14. Kwok Leung Tsui1,
  15. Chak Wah Kam1
  1. 1Department of Accident and Emergency, Tuen Mun Hospital, New Territories, Hong Kong SAR, People's Republic of China
  2. 2Department of Accident and Emergency, Pok Oi Hospital, New Territories, Hong Kong SAR, People's Republic of China
  3. 3Fauna Conservation Department, Kadoorie Farm and Botanic Garden, New Territories, Hong Kong SAR, People's Republic of China
  4. 4Department of Pathology, Tuen Mun Hospital, New Territories, Hong Kong SAR, People's Republic of China
  5. 5Snakebite Adviser: KFBG China Programme
  6. 6Snakebite Adviser: Pakistan Medical Research Council
  1. Correspondence to Lam Ka Keung, Department of Accident and Emergency, Pok Oi Hospital, Au Tau, New Territories, Hong Kong SAR, People's Republic of China; lamkk01{at}


Objective To determine the pattern of oral bacterial flora and their sensitivity to antibiotics in freshly captured native snakes in Hong Kong SAR, People's Republic of China.

Methods Healthy native snakes were captured and kept in a designated centre. Snake species were identified by experienced herpetologists. Mouth swabs were taken by the veterinarian using strict aseptic techniques. The snakes were released back to the wild immediately after the above procedure. Swabs were sent for microbiological studies of bacterial culture and antibiotic sensitivity.

Results 47 venomous snakes of the families Colubridae, Elapidae and Viperidae and 53 non-medically important snakes were captured. 406 bacterial isolates of 72 different species were cultured: these included Gram negative and positive bacterial species and also anaerobic bacterial species. With the exception of the white-lipped pit viper (Cryptelytrops albolabris), venomous snakes harboured more pathogenic bacteria and total bacteria species compared to the non-medically important species. Of the venomous snakes, the Chinese cobra (Naja atra) harboured the largest number of bacterial species. In the present study, all Gram negative bacteria associated with wound infection were sensitive to levofloxacin, netilmicin and piperacillin/tazobactam. Many Gram negative bacteria in the study were not sensitive to cefuroxime axetil. Amoxicillin/clavulanic acid was an appropriate choice to cover Enterococcus faecalis and anaerobes.

Conclusion In the presence of wound infection from snakebite injury in Hong Kong, first line empirical antibiotics include amoxicillin/clavulanic acid plus levofloxacin. Prophylactic antibiotics may be considered in selected cases of Chinese cobra (N atra) bite, otherwise prophylactic antibiotics are not recommended in snakebite unless tissue necrosis is present.

  • Snake bites
  • wound infection
  • antibiotic prophylaxis
  • bacterial infections
  • Hong Kong
  • environmental medicine
  • envenomation
  • infectious diseases
  • bacterial
  • musculo-skeletal
  • soft tissue infection
  • toxicology
  • wounds
  • infections

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  • Competing interests None.

  • Ethics approval The New Territories West Cluster Clinical and Research Ethics Committee of the Hospital Authority and the Animal Ethics Committee of the KFBG approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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