Susceptibility of microorganisms causing acute hand infections.

Nina Fuchsjäger,Gebhard Feierl,Robert Krause,Herwig Winterleitner,Horst Koch,Taeok Bae

doi:10.1371/journal.pone.0220555

Abstract

Hand infections are a common presentation at the emergency departments. Without knowing the source of infection clinicians are dependent on systematic reports on the bacterial spectrum and susceptibility tests of the specific infection in their patient community. This study was based on a retrospective chart review of patients presenting to our outpatient clinic with acute hand infections. We documented patient demographics, the etiology, location, culture tests of the infection and analyzed if certain bacteria could be cultured significantly more often in certain etiologies or in specific sites of the hand infection. Susceptibility tests were added. Bacterial swabs of 204 patients were analyzed. Overall S. aureus was found in 53% of all cases, in only one case revealed methicillin-resistant S. aureus (MRSA). There was no significant difference in the bacterial spectrum according to the etiology of the hand infections, except for animal bites where Pasteurella multocida was the dominating bacteria in 63% of all cases. Amoxicillin-clavulanic acid, fluoroquinolones, and piperacillin were effective against the main bacteria. Our study confirms the previously published antibiotic resistance reports and reinforces the current antibiotic treatment guidelines also in this western European population.

Highlights

Hand infections form a major entity among clinical presentations at emergency departments, the plastic, surgical, or orthopedic outpatient clinics
There was no significant difference in the bacterial spectrum according to the etiology of the hand infections, except for animal bites where Pasteurella multocida was the dominating bacteria in 63% of all cases
After the analysis of 204 specimens we conclude the following: 1) in our capture area, S. aureus is the dominating bacterium in most of acute non-bite hand infections and there is very low incidence of methicillin-resistant S. aureus (MRSA). 2) The dominating bacterium found in cultures from animal bites is Pasteurella multocida

Summary

Introduction

Hand infections form a major entity among clinical presentations at emergency departments, the plastic, surgical, or orthopedic outpatient clinics. The primary cause of the infection may seem trivial. Due to the unique anatomical features of the hand, the condition can spread which may result in severe functional impairment. Potential sequels include tissue necrosis, amputations, functional impairment and severe infections causing even death [1]. The clinical course and severity of acute hand infections depend on several factors: portal of entry of the pathogen, the site and depth of the infection, the etiology and the involved bacterial spectrum, the timing, and choice of treatment, as well as patient related factors such as age and comorbidities like diabetes mellitus or immunodeficiencies [2].

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