Epidemiology of adult acute hand infections at an urban medical center.

J Hand Surg Am

Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA; and the Rothman Institute; Philadelphia, PA 15213, USA.

Published: June 2013

AI Article Synopsis

  • This study examines the prevalence and characteristics of adult acute hand infections in an urban hospital, emphasizing the need for improved treatment guidelines due to the risks of complications like stiffness and amputation.
  • Over a six-year period, the research analyzed data from 2,287 patients with hand infections, revealing that 30% had culture-positive infections, mainly caused by methicillin-resistant Staphylococcus aureus (MRSA).
  • Findings suggest that empirical treatment should regularly account for MRSA and highlight that certain factors, such as intravenous drug use and diabetes, are linked to a higher occurrence of polymicrobial infections.

Article Abstract

Purpose: To define the current epidemiology of adult acute hand infections in an urban setting, with the aim of helping to improve empiric treatment, as hand infections represent a major source of morbidity and can result in stiffness and, possibly, amputation.

Methods: We performed an electronic medical record search to identify all patients admitted to our urban academic medical center with diagnoses related to open wounds and infections in the hand and fingers over a 6-year period (2005-2010). We recorded demographic data, location of infection, medical comorbidities, and culture data.

Results: Of the 2,287 patients admitted with diagnoses related to open wounds and infections in the hand and fingers, 1,507 incision and drainage procedures were performed, which resulted in 458 patients (30%) with culture-positive infections. Wound cultures identified 39 different species of bacteria. Most of these were methicillin-resistant Staphylococcus aureus, which compromised 53% of positive cultures, followed by methicillin-sensitive S aureus in 23% of positive cultures. The cultures were polymicrobial in 19%. History of intravenous drug use or diabetes mellitus was a strong predictor of polymicrobial infection.

Conclusions: Methicillin-resistant Staphylococcus aureus was the most common bacteria cultured from these infections. Empiric antibiotic coverage should routinely cover methicillin-resistant S aureus. We noted a higher incidence of polymicrobial infections than previously reported, particularly with intravenous drug use, diabetes, and human bites. Volar hand infections had the highest percentage of positive cultures, whereas paronychia had the lowest percentage.

Type Of Study/level Of Evidence: Prognostic IV.

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Source
http://dx.doi.org/10.1016/j.jhsa.2013.03.013DOI Listing

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