The clinical and microbiological profile of the diabetic hand: A retrospective study from South India

Abstract

Background:Pyogenic Infections of the hand in diabetes are largely a tropical entity and published material in the area are rather meagre.Patients and Methods:This is a retrospective study on the pattern of hand infections and involves the microbiological profile of 39 cases of diabetes hand-related infections admitted to the hospital between the years 2004 and 2010.Results:This study included 39 patients, among whom 23 (59%) had necrotizing fasciitis (NF), and 16 (9-abscess and 7-tenosynovitis) had nonnecrotizing infection. Among 25 culture positive patients, polymicrobial infections were isolated in 13 (52%) patients, a single organism was isolated in 9 (36%) and 3 (12%) had sterile cultures. Out of the 41 different bacterial isolates, 51.12% were Gram-negative and 48.78% were Gram-positive. Patients with NF had a higher mean glycated hemoglobin (10.83 ± 2.59 vs. 8.64 ± 1.8%, P = 0.020), when compared to the nonnecrotizing group. Patients with NF also had more polymicrobial infections (P = 0.017), and a longer duration of hospitalization when compared to patients without NF (21.8 ± 9.96 vs. 12.7 ± 14.5 days, P = 0.021). Seven (17.94%) patients required amputation of the affected digits of which six (15.38%) had NF.Conclusion:Patients with poor glycemic control, polymicrobial infection, delay in presentation, and a prior surgical intervention at another medical center was associated with more severe necrotizing infections. The duration of hospitalization and amputation rates was greater among patients with NF.

Optimizing Treatment of Hand Infections: Is MRSA Coverage Always Necessary?

“…This led to an amputation rate of 18% in the study cohort, with significant factors contributing to the worse prognosis in patients with DM being evidence of poor glycemic control, delayed presentation, and prior intervention for hand infection. 23 In our study, patients with DM were found to have a slightly increased likelihood to need more than one I&D and an increased LOS on multivariate linear regression.…”

Surgical outcomes of diabetic hand infections in Lagos, Nigeria

“…Conversely, several previous reports from Asian countries have reported male dominance11. These observations are believed to be due to the fact that in many African communities, women make up the majority of the manual labour work force as opposed to men in Southwest China and India11,12. Consequently, African females are more likely to suffer minor hand trauma that could predispose these individuals to infections.…”

Diabetic Hand Infections: Factors at Presentation Influencing Amputation and Number of Surgical Procedures

“…We looked up the Indian studies on diabetic hand infections and found that in the study by Raveendran et al 5 the study population consisted of 39 cases admitted in their center over 6 years. The profile showed a male preponderance: 24/39 patients (61.5%).…”

“… 2 3 4 A PubMed search for articles on diabetic hand infection from India provided three retrievable original articles; one each from the northern, eastern and southern parts of India. 5 6 7 One of the main concerns among patients with diabetic hand infections is the risk of amputation and multiple surgical procedures which, in turn, influence the length of inpatient stay and the cost of care, which are the second common concern of the patients. This study was intended to find out the factors present at the time of arrival, which have a significant relationship with the risk of amputation and multiple surgical procedures.…”