Bone and joint infections of the hand

Abstract

Background: Little guidance is currently available for standardized diagnostic protocols and therapeutic recommendations for bone and joint infections (BJIs) of the hand. Objectives: To summarize the available data in the scientific English-language literature on the diagnosis and treatment of native BJIs of the hand. To illustrate these concepts from a narrative point of view in areas where there is lack of evidence. Sources: We performed a systematic PubMed and Internet search of studies that investigated hand BJIs in adult patients. Content: Few studies have systematically investigated and validated diagnostic concepts, classifications or surgical treatment protocols. Most concepts derive from traditional intra-institutional experience, expert opinions and extrapolations from infections in large joints and long bones. Similarly, there is no uniformly accepted infection definition of BJIs of the hand. The best-documented literature is available for microbiological findings and antibiotic treatment duration in uncomplicated native joint arthritis of the fingers. Retrospective studies and one prospective randomized trial suggest that post-surgical targeted antibiotic therapy of 2 weeks results in a microbiological cure rate of 88%. Implications: Studies on diagnostic workup and infection definition and classification are urgently needed to compare inter-institutional outcome results and generate guidelines for the best patient care. For uncomplicated pyogenic arthritis of native joints, current evidence suggests that a 2-week course of antibiotic therapy following surgery cures the infection.

Osteitis/Osteomyelitis an Hand und Handgelenk

“…Die Gründe dafür können nur vermutet werden. Eine gute Perfusion und sensible Versorgung der Strukturen, die aufgrund der gleichzeitigen optischen Exposition ein frühzeitiges Erkennen und Entwickeln klinischer Symptomatik ermöglichen, könnten Ursachen sein [2,3,[9][10][11].…”

“…Viele weitere wichtige Kriterien (z. B. Verlauf) werden aber durch die Klassifikation nicht abgebildet [2,7,9,11].…”

“…Jugendlichen und nur selten bei immunkompetenten Erwachsenen auf. Manifestationen im Bereich der Hand sind insgesamt rar [4,9]. Bei einer geschwächten Immunabwehrlage ist das Risiko aber er-▶Tab.…”

Multitasking by the OC Lineage during Bone Infection: Bone Resorption, Immune Modulation, and Microbial Niche

“…Staphylococcus (S.) aureus is the leading causative agent of infectious osteomyelitis (iOM) for most of the skeleton, except for iOM of the jaw related to periodontal diseases, where Porphyromonas (P.) gingivalis predominates [ 1 , 2 ]. A variety of other pathogens, however, are also capable of infecting bone [ 3 , 4 , 5 ]. The combined actions of the pathogens and host cells lead to high levels of many inflammatory cytokines, which expand the pool of osteoclast (OC) precursors and mature bone-resorbing cells.…”

Response to: ‘Short duration antibiotic therapy for native joint arthritis cause byNeisseriainfection?’ by Durcourset al

“…3 Indeed, native joint septic arthritis is a very heterogeneous group of clinical entities 4 with different epidemiological, microbiological and therapeutic aspects in humans. 5 Already in 2005, clinicians recommended a maximum therapy duration of 1 week with targeted antibiotics for disseminated gonococcal infection, including for arthritis. 6 The later US 2015 Sexually Transmitted Diseases guidelines reconfirmed this duration indicating the duration as 'for 7 days'.…”