The risk of early complications in patients with hand infections
Background: The aim of this study was to identify the risk factors associated with the development of early complications in patients with hand infections. A secondary objective was to describe the bacteriology and resistance profile in our study population.
Methods: This retrospective observational descriptive study was performed at a regional referral centre in South Africa. All primary hand infection cases treated over a period of one year were reviewed. Children under 18 years, cases with incomplete primary outcome data and post-operative infections were excluded. Clinical and demographic data was extracted from clinical records. Amputation, re-debridement and tissue loss requiring skin grafting were regarded as early complications. Bacteriological analysis comprised identification of causative organisms as well as evaluation of their resistance profiles. Risk factors that were found to be significant for development of early complications were entered into a multivariate regression analysis.
Results: After inclusion and exclusion criteria were applied, 78 patients were deemed eligible for inclusion to the study. The patientassociated risk factors that were found to be associated with the development of early complications after univariate analysis were increasing age and poorly controlled diabetes mellitus. Human bites and polymicrobial infections were the only aetiological factors that were identified to be significant on a univariate level. Initial presentation to a private sector general practitioner (GP) was the only management factor to reach significance on univariate analysis. Human immunodeficiency virus (HIV) infection, CD4 count, viral load and duration of ARV treatment were not found to be significantly associated with the development of early infections. On multivariate logistic regression analysis, poorly controlled diabetes mellitus, human bites and first presentation to a private GP were the only risk factors that remained significant for the development of early complications. The culture yield was 68%. Staphylococcus aureus (S. aureus) was the most frequently isolated organism (37%), followed by polymicrobial infections (10%). S. aureus encountered in our study population remained mostly sensitive to cloxacillin; however, high levels of resistance (50%) to ampicillin were observed. Klebsiella sp. and Acinetobacter sp. were the most frequently observed Gram-negative organisms.
Conclusion: After multivariate regression analysis, hand infections in poorly controlled diabetic patients, infections occurring after human bites as well as those affected by polymicrobial infections were identified as independent risk factors for development of early complications in patients with hand infections. HIV infection was not found to be a significant risk factor. Our bacteriological profile is in keeping with trends demonstrated in the literature where S. aureus infections seem to be declining in frequency while polymicrobial infections seem to be encountered more frequently.
Level of evidence: Level 4