Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure

Xu, G.G.; Yam, Andrew; Teoh, Lam-Chuan; Yong, F. C.; Tay, Shian Chao

doi:10.47102/annals-acadmedsg.v39n9p670

Cited by 11 publications

(1 citation statement)

References 11 publications

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“…Diabetes is often seen as a comorbidity along with renal disease. Xu et al found it was the cause of renal failure in 88% of ESRD patients who underwent upper extremity infection surgical debridement [ 15 ]. Patients with renal disease and diabetes demand extra consideration, and prospective studies are needed to determine the safest course of treatment for this complex group.…”

Section: Discussionmentioning

confidence: 99%

Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study

2023

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Background Hand infections are heterogeneous, and some may undergo successful outpatient management. There are no strict guidelines for determining which patients will likely require inpatient admission for successful treatment, and many patients succeed with outpatient therapy. We sought to determine risk factors for failed outpatient management of cellulitic hand infections. Methods We performed a retrospective review of patients who presented to the Emergency Department (ED) for hand cellulitic infections over five years, from 2014 to 2019. Vital signs, lab markers, Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Measure (ECM), and antibiotic use were investigated. Discharge from the ED without subsequent admission was considered an outpatient success, while admission within 30 days of the prior visit was considered a failure. Continuous variables were compared with Welch's t test, and categorical data with Fisher's exact tests. Multivariable logistic regression was performed on comorbidities. Multiple testing adjustment was performed on p-values to generate q-values. Results Outpatient management was attempted for 1,193 patients. 31 (2.6%) infections failed treatment, and 1,162 (97.4%) infections succeeded. Attempted outpatient treatment was 97.4% successful. Multivariable analysis demonstrated higher odds of failure with renal failure according to both CCI (OR 10.2, p < 0.001, q = 0.002) and ECM (OR 12.63, p = 0.003, q = 0.01) and with diabetes with complications according to the CCI (OR 18.29, p = 0.021, q = 0.032). Conclusions Outpatient treatment failure was higher in patients with renal failure and complicated diabetes. These patients require a high index of suspicion for outpatient failure. These comorbidities should influence consideration for inpatient therapy though most patients can undergo successful treatment as outpatients. Level of evidence Level III.

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Section: Discussionmentioning

confidence: 99%

Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study

2023

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Infections and diabetes

Singh¹,

Sridhar²

2015

Int J Diabetes Dev Ctries

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Infections and diabetes illustrate the health problems facing India, and more. The two often coexist, making each other the worse for it. Subjects with diabetes have a greater frequency and severity of many common infections (urinary, pulmonary, soft tissue) whereas some rare infections are seen almost exclusively in the diabetic population viz. rhino-cerebral mucormycosis, malignant otitis-externa and emphysematous cholecystitis, cystitis, and pyelonephritis.These infections should be sought in patients presenting with DKA and hyperglycemic hyperosmolar syndrome. Fournier's gangrene and infections of the foot occur predominantly in diabetics.The increased susceptibility to infections and impaired wound healing is due to diminished vascularity, autonomic dysfunction, and abnormalities in cell-mediated immunity and phagocytic function. The common pathogens are Escherichia coli, Klebsiella, Campylobacter, and Salmonella enteritidis.Infections may worsen glycemic control. Periodontal infection is linked with dysglycemia and cardiorenal complications.Prevention from infection requires good glycemic control, good hygiene, and preventive vaccination.Beside the well-recognized association of infection and diabetes, a recent study from India reported that the prevalence of hepatitis C in these subjects is higher; it was positive in 11 out of 192 (5.7 %) with a higher prevalence in men and in those with poorer glycemic control [1]. Similarly in an earlier study also from India, hepatitis B virus was more common in subjects with acute viral hepatitis having diabetes (58.33 vs. 25.3 % in controls) [2]. In a multiple variable logistic regression analysis, acute hepatitis B and diabetes were shown to be related to severe hepatitis.Interestingly, Helicobacter pylori infection was higher in subjects with diabetes (n 62; 77.5 %) compared to controls (n 62; 77.5 %). It was correlated with poorer glycemic control, suggesting that chronic inflammation with the infection may be associated with subsequent development of insulin resistance [3].Urinary tract infection is commonly observed in diabetes. Among Indian subjects with culture-positive urinary infection, nearly 30 % were asymptomatic. Diabetes was associated with a higher prevalence of pyelonephritis and with poorer glycemic control. In descending order, cultured pathogenic bacteria were E. coli (64.6 %), Klebsiella (12.1 %), and Enterococcus (9.9 %). Extended-spectrum beta-lactamaseproducing E. coli was more common in diabetes [4]. With clinical introduction of antidiabetic agents acting through inducing glycosuria (SGLT2 inhibitors), counseling about genital hygiene must be integrated to reduce the risk of genital and urinary infections.The enormous physical and financial burden of diabetic foot infection has been highlighted in a recent journal editorial [5]. The current issue describes diabetic foot involvement from Saudi Arabia [6] and China [7] and an uncommon bacteriological infection [8]. In India, smoking and barefoot walking are common underlying factors in foot com...

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Bone and joint infections of the hand

Sendi

Kaempfen

Uçkay

et al. 2020

Clinical Microbiology and Infection

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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.

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Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure

Cited by 11 publications

References 11 publications

Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study

Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study

Infections and diabetes

Bone and joint infections of the hand

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