Epidemiology of Hand Infection — A Comparative Study Between Year 2000 and 2009

Abstract

This study aims to analyze the bacteriology and antibiotic resistance in hand infection between 2000 and 2009 at a local hospital in Asia. It is a retrospective study involving all adult patients with hand infections that were treated surgically, with tissue or wound culture sent. A total of 100 cases in 2000 and 98 cases in 2009 were included in this study. Standard epidemiology information, bacteriology, antibiotic sensitivity and treatment outcome were analyzed. Particular interest was given to diabetic hand infection. There was no significant difference of outcome in hand infection between the two years. The outcome of diabetics was not statistically worse than the non-diabetics. Comparing the patients in 2000 and 2009, more younger patients were affected with hand infection in 2009. While length of stay is shorter in 2009. Mixed infection was more common in diabetics in 2009. There was trend of clindamycin resistance in methicillin-sensitive staphylococcus aureus in 2009.

Twenty-Year Trends in Upper-Extremity Infections at a Single Urban Institution

“…It has been widely reported that Streptococcus is the second most common species behind Staphylococcus in hand infections. 1,5,7 Though this was a statistically significant shift in the distribution of organisms over the study period, the clinical significance may be minimal as both Staphylococcus and Streptococcus often have similar antibiotic sensitivities. 15e17 In contrast, the rate of Enterobacter-related infections, which are a result of aerobic gramnegative bacilli that have established resistance to traditional empiric therapy with early generation cephalosporins, increased from 0% to 13%.…”

“…17,18 The rate of polymicrobial infections also increased significantly in this study, consistent with the 10-year trend demonstrated by Kistler et al 6 Polymicrobial infections occur more often in individuals with diabetes and intravenous drug users and are associated with higher complication rates. 5,7,19 At our institution, the most common organisms isolated from polymicrobial infections were MRSA, methicillin-sensitive S aureus, and Streptococcal spp. These were commonly covered by broad spectrum empiric antibiotics such as vancomycin and cefepime used at our institution.…”

Characterizing Hand Infections in an Underserved Population: The Role of Diabetic Status in Antibiotic Choice and Infection Location

“…16,32 In 2006, vancomycin and/or clindamycin were considered first-line treatment for all nonabscess infections of the hand, but clindamycin resistance has been increasing since 2013. 11,33 Tosti et al 32 found that 20% of MRSA isolates in an urban hospital were clindamycin-resistant in 2014. Though their study found 100% sensitivity to vancomycin in their patient population, other studies have observed development of vancomycin resistance in MRSA cultures.…”

“…Whereas community-acquired hand infections in the nondiabetic patient are more likely monomicrobial and gram-positive in nature, it is well established that such hand infections in diabetic patients are more likely to be polymicrobial in nature, with variable combinations of gram-staining, drug resistance, and metabolic properties and/or fungal origin. 11,12 Diabetes is also a risk factor for infection with methicillin-resistant Staphylococcus aureus (MRSA). 12,13 Early and objective risk stratification of the diabetic with a polymicrobial/severe hand infection, as in the case of skin and soft tissue infections in adults, 14 may improve morbidity while avoiding the negative effects of overtreatment, including antibiotic side effects or promotion of development of drug-resistant organisms.…”

A Nationwide Epidemiological Analysis of Finger Infections Presenting to Emergency Departments in the United States From 2012 to 2016

“…[12][13][14] Our data demonstrate that middle-aged men were the most at-risk demographic for finger infections, which is consistent with the current literature. 2,[11][12][13][14]16,17 In a retrospective analysis of 94 hand infections (54 of whom had finger infections) undergoing surgical drainage, Turker et al 18 found that sex distribution was in a 2:1 ratio of male to female, with a mean age of 42 years. Chong et al 2 noted that men comprised approximately 70% of patients with hand infection who underwent surgical intervention in a single-center study in Singapore.…”