Diabetic Hand Infections Research Articles

Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions.

Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Both mixed bacteria (31.2% vs. 16.6%, p = 0.014) and fungi (7.5% vs. 0.8%, p = 0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p = 0.001). Although the overall mortality was not significantly different, there was atendencytobeincreased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p = 0.762) and disability (6.3% vs. 12.2%, p = 0.138) were not significantly different between the two regions. Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.

Cost-based Comparative Analysis of Diabetic Hand Ulcers and Diabetic Foot Ulcers

Background:The Social Insurance Institution of Turkey reported that in 2021, there were approximately 12 million patients with diabetes under universal health insurance. and the expenditure was incurred for the treatment of complications was TL 2.6 billion.Although previous studies have analyzed the cost of diabetic foot ulcers, no study from Turkey has yet compared the costs of diabetic hand ulcers and foot ulcers and analyzed the relationship between the cost and demographic characteristics of patients. 
 Methods:From January 2022 to June 2022, the data of 49 patients with diabetic hand ulcers and 44 patients with diabetic foot ulcers were analyzed retrospectively according to demographic datas and costs.Correlations were analyzed using cross tables, chi-square statistics, and partial correlation analysis, and groups were compared using t-test for independent groups and covariance analysis. 
 Results:The calculated average cost of patients who were followed up and treated for diabetic hand and foot ulcers was 257.01 USD and 462.54 USD, respectively. There was no statistically significant difference between the patients with diabetic hand and diabetic foot ulcers in terms of mean age, length of hospital stay, or HBA1C and CRP levels at admission. The mean cost of the diabetic hand was lower than that of the diabetic foot, and this difference was statistically significant.
 Conclusion:Although diabetic hand infections are less costly and cause fewer major amputations, it is a clinical condition that should be given at least as much attention as diabetic foot ulcer due to its atypical localized onset and the reproductive potential of different microorganisms.

The incidence and severity of diabetic hand infection presentations during the COVID-19 pandemic.

Level of evidence: IV.

LBSUN293 Diabetic Hand Infection: A Case Report

Abstract Background Diabetes Mellitus is related to musculoskeletal and soft tissues complications in a very diverse way, and with no doubt, hands are also affected. Almost 40% of people living with Diabetes have significant problems in the hands that require medical attention. (1) Clinical Case: A 59-year-old women with history of Diabetes Mellitus diagnosed 20 years ago without control, treated with NPH and Lispro insulin (basal bolus regimen). She was admitted to the emergency room due to a third-degree boiling water burn in her right index finger. Before she came to the hospital, she was previously evaluated by a physician who prescribed antibiotics (clindamycin) for 5 days without response. At physical examination, erythema, edema, purulent secretion was found in the finger. In addition, fever and high glucose levels were also noted. During hospitalization, intravenous antibiotics such as tigecycline and oxacillin were used with no improvement. Blood samples demonstrated leukocytosis and C-reactive protein (CPR) elevated levels. Secretion culture was positive to Methicillin-sensible Staphylococcus Aureus. Electromyography revealed severe lesions at sensory-motor peripheral nerves with chronic denervation in upper limbs. Due to the poor evolution of the injury, traumatologists indicated surgical cleaning. After 2 days, leukocytosis and CPR elevated levels persisted and despite all the efforts done to save the finger, traumatologists decided to perform an amputation. After 2 weeks of antibiotic treatment, the patient was discharged with normalized hemogram and CPR levels. Conclusion Diabetic hand infection is less recognized in the literature that the diabetic foot, main reason why it is easily ignored and underestimated; resulting in increased morbidity among diabetic patients. The combination of neuropathy, peripheral artery disease and impaired glucose levels made this patient had a poor outcome, resulting in the loss of a finger. It is very important to evaluate the hands during routine controls to avoid these sad events.

Collar-button abscess as a complication of infected hematoma in the setting of uncontrolled type 2 diabetes.

IntroductionCollar-button abscesses are deep space infections of the hand.Case presentationWe present a case of a 66-year-old man who developed an acute collar-button abscess of the hand after a concrete bench fell onto the dorsal aspect of his hand. The hand abscess was managed successfully with intravenous antibiotics and operative intervention.DiscussionWhile such infections comprise a small percentage of hand infections, insufficient or delayed treatment results in permanent hand disfiguration and dysfunction. This case highlights an uncommon dorsal-to-volar pattern of hand abscess extension.ConclusionKnowledge of the anatomy of the hand is essential to diagnosis and appropriate surgical management.

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

Background Diabetic hand infections are associated with significant morbidity and disability. Amputations cause permanent disability, and multiple surgical procedures lead to morbidity. Diabetic foot infections have been well-studied but literature on hand infections is limited. We undertook a retrospective study of patients with diabetic hand infections operated at our center to study the factors at presentation with significant association with amputation and number of surgical procedures. Patients and Methods Demographic data of 51 patients was collected. The six parameters, namely, duration of diabetes, “onset of symptoms to presentation” interval, presence of comorbidities, HbA1c level, random blood sugar (RBS) levels at admission, and culture characteristics were selected for statistical analysis to find a relationship with the two outcome variables: number of procedures done and need for amputation. Results On bivariate analysis, Gram-negative infection was found to have a significant relationship with the need for multiple of procedures ( p = 0 . 014). The mean difference between the “onset of symptoms to presentation” interval between the amputation/non-amputation groups (2.9 days, p = 0 . 04) and the multiple procedures/non-multiple procedure groups (4.4 days, p = 0 . 02) was found to be statistically significant. Presence of comorbidities, long duration of diabetes, HbA1c, and RBS levels at admission did not show any statistically significant association with the two outcome variables studied. Conclusion In the present study, we found that infection with Gram-negative organisms is significantly related to the need for multiple surgical procedures. A delay in presentation can influence the risk of amputation as well as multiple procedures. Institution of early appropriate care is important to get a good outcome.

Clinical outcome of Maggot Debridement Therapy followed by Negative Pressure Wound Therapy for chronic hand wound with Multi-Drug Resistant Organism infection: Two cases and review of the literature.

The advancement in science and research has led to development of medical maggots which feed exclusively on dead tissue. Medical maggots have three important functions namely debridement, disinfection, and stimulation of wound healing. The modern use of medical maggots now goes by the term "Maggot Debridement Therapy" (MDT) for use in wound management. MDT is still used infrequently due to the effectiveness of surgical debridement and antibiotics for treatment of wound infection. Lately, there was emergence of Multi-Drug Resistant Organism (MDRO) likely due to inappropriate antibiotics usage. Maggot secretions have been shown to be effective in inhibiting some MDRO, for example, Methicillin-resistant Staphylococcus aureus, thus making MDT an attractive option for wounds with MDRO. We report two patients with multiple medical comorbidities, diagnosed with serious MDRO Diabetic Hand Infections treated with three cycles of MDT followed by Negative Pressure Wound Therapy.

Outpatient Management of Diabetic Hand Infections.

PurposeFor many providers, hand infections among diabetic patients is a condition that necessitates focused inpatient care. These patients are believed to have decreased innate immunity to fight infection, a more virulent course, and difficulty with recovery. Diabetes is considered by some to represent an additional risk factor that can result in an unfavorable outcome if not managed in an aggressive manner. Our own experience suggests that many of these patients can be safely managed in the outpatient setting. The purpose of this project was to better define the clinical outcomes for this population.MethodsEvidence-based criteria were utilized to direct inpatient versus outpatient treatment pathways. A database was developed to track hand infections treated by the specialty service. The primary outcome was the resolution of hand infection. Secondary outcomes included specific treatment responses as well as patient characteristic comparisons of the different treatment groups. Independent variables included (parenteral and enteral) antibiotic use and bedside interventions performed. Patients were followed to complete the resolution of infection.ResultsFor all patients managed as outpatients, diabetic patients had statistically significantly decreased improvement rates at two weeks as compared to non-diabetic patients (62% vs 75%, p =0.024). This difference disappeared at two months. Among diabetic patients, those with the highest rate of recovery at two weeks (90%) received intravenous antibiotics, bedside procedures, and oral antibiotics. Patients who did not receive antibiotics or undergo bedside procedures had the lowest percent of improvement (37%). Across all treatment subgroups, bedside procedure was the most impactful intervention. Less than 10% of patients were converted from outpatient to inpatient care, both diabetic and non-diabetic.ConclusionsWe reviewed our experience managing diabetes mellitus hand infections treated in the outpatient setting. Appropriate and effective treatment is possible, and the results are equivalent to those of patients without diabetes mellitus.

Is the Preoperative Glycated Hemoglobin (HbA1c) Level Predictive of the Severity of Diabetic Hand Infection According to Surgical and Clinical Outcomes?

We purposed to investigate whether preoperative HbA1c level is associated with the severity of surgical treatment in diabetic hand infection cases. Between December 2015 and October 2018, 102 patients were surgically treated due to diabetic hand infection. Of the patients, 75 who met the criteria for diabetic hand infection were included in the study. The patients were divided into two groups: Group 1, < 8.5% HbA1c level (poorly controlled); and Group 2, 8.5% or higher HbA1c level (uncontrolled). Preoperative, intraoperative, and postoperative data were recorded. Drainage, VAC, ray/open amputation, and microsurgical reconstruction were performed according to the examination and clinical findings. p<0.05 was considered statistically significant. The study groups consisted of 41 patients (5 female/36 male; median age 59 years, range 32-68) in Group 1 and 34 patients (6 female/28 male; median age 62 years, range 28-67) in Group 2. The mean follow-up period was 21.14±10.42 months in Group 1 and 16.70±10.19 months in Group 2, which were not significantly different (p>0.05). The most common microbiological pathogen was polymicrobial in both study groups (39% in Group 1 and 41.2% in Group 2). Drainage was the most common surgical procedure in both groups and there was no significant difference between the groups in terms of the surgical techniques that were used (p>0.05). Although HbA1c level is an important biomarker for monitoring glycemia in diabetic patients, it is not associated with the severity of surgical treatment in diabetic hand infections.

Surgical outcomes of diabetic hand infections in Lagos, Nigeria.

Hand infections in diabetics can be a major cause of functional impairment. In patients with Tropical Diabetic hand syndrome prompt surgical intervention may salvage the hand, but return to premorbid function remain a challenge. A retrospective study of consecutive diabetic patients with hand infections was done in 2 tertiary institutions in Lagos, Nigeria to identify the epidemiology, modes of presentation, types of surgical intervention and outcomes of treatment. Twenty one patients were studied over a 5 year period. ten males, eleven females. All were type 2 Diabetes. 52.4%(11) were diagnosed less than a year prior to presentation. 61.9%(13) had digit/hand gangrene on presentation. All operated patients (20) had wound debridements. 52.5% (11) digit/hand amputations and this was the commonest surgical procedures done. Other surgeries done include skin grafts and `flap reconstructions. There was a 19% mortality rate. Less than a fifth were able return to their premorbid occupation after 3 months. But all had reduced range of motion in the interphalangeal joints in the adjacent digits. There is a high morbidity rate for hand infections in the diabetic, even though majority of the hands were salvaged, most patients were unable to return to their premorbid occupation at 3 months.

Diabetic Hand Infection: An Emerging Challenge.

Background: Hand infection in diabetics is an often ignored but challenging condition. If not addressed effectively, it may result in long term disability, contracture, amputation and even death. Methods: From August 2014 to December 2015, a study was done in our centre, where 49 diabetic hand infection cases were analyzed in two groups, superficial and deep hand infection. Results: Mean age of the patients was 51.63 years. There were 21 superficial infections and 28 deep infections. Cause of infection was unknown or spontaneous in 16 cases, traumatic laceration or crush in 14 patients, following minor prick in 10 cases. Most of the cases were the results of neglected minor wound. Forty-one patients were insulin dependent. Five cases were diagnosed as diabetic at the time of treatment. Four patients were treated conservatively and 45 (92%) cases required operation in the form of incision, drainage and debridement. In 16 (35%) cases, wound was left open and was healed by secondary intention following regular dressing. In five patients, wound was closed secondarily. Partial thickness skin graft was applied in 15 cases. Seven patients were treated with flap coverage. Partial digital or ray amputation were done in 16 cases. All fingers except thumb were amputated in one case and amputation from wrist was done in another patient. Wound swabs were taken, and antibiotics were changed or continued accordingly. But reports of 26 cases were available. No growth was found in four cases, monomicrobial infection was found in 15 patients and polymicrobial in seven cases. Infection resolved with healing in 47 cases. Two patients died during treatment from sepsis, both were insulin dependent, had associated renal failure and from deep infection group. One patient developed severe mental disorder. Conclusions: For diabetic hand infection, early diagnosis and prompt treatment with appropriate antibiotics and emergency surgery with extensile incision is crucial. Primary amputation of the part could be life and limb saving.

Inguinal Flap Implementation In Diabetic Hand Infection With Complicated Invasive Candidiasis

Inguinal Flap Implementation In Diabetic Hand Infection With Complicated Invasive Candidiasis

Hand infection in patients with diabetes: a series of 17 cases and a pooled analysis of the literature

Background/aim: The aim of this study was to report the clinical characteristics and the treatment outcomes of hand infections in diabetic patients and to review the literature. Materials and methods: The medical records of 17 patients with diabetic hand infections admitted to the Diabetic Foot Care Center of two different clinics from January 2012 to October 2017 were reviewed. To perform the pooled analysis, published series (32 studies) were searched in two international databases (www.scopus.com and www.pubmed.com). Results: Of the 17 patients (mean age 61.7 ± 8.5 years), 8 (47.1%) were female. All cases were type 2 diabetes mellitus. The mean duration of diabetes was 9.0 ± 5.96 years and the mean HbA1c was 7.86 ± 1.88%. There was necrosis in 8 patients (47.1%). The most common causes were injury during saw and hammer use in 5 patients (29.4%) and injury due to inappropriate nail cutting in 3 patients (17.6 %). Nine (52.9%) patients were operated on. No patients underwent any major amputations or died. In 32 publications, 704 patients with diabetic hand infections were found. The average age was 53.43 years (n = 591) and 84.29% of patients (322/382) were found to have type 2 DM. The mean duration of diabetes was 4.12 years (n = 317) and the mean HbA1c was 10.58% (n = 140). The rate of surgical operation was 74.59% (323/433). Conclusion: Diabetic hand injuries often occur when using hand tools such as hammers, saws, and knives, and when cutting nails. It is necessary to use conservative treatment rather than amputation. These patients should consult experienced health care professionals.

EPIDEMIOLOGY OF HAND INFECTION — A COMPARATIVE STUDY BETWEEN YEAR 2000 AND 2009

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.

HAND INFECTION IN DIABETIC PATIENTS

The diabetic hand infection is less reported in the literature. Therefore, it is easily ignored and underestimated resulting in increased morbidity among the diabetic population. Diabetic hand is a rapid in progression, extensive and severe tissue destruction. We analyze the clinical course and outcome of hand infection in diabetic patients. We reviewed all the admissions with hand infection from January 2006-April 2010. Thirty-seven patients were found with associated diabetes mellitus. The demographic data, culture report, number of operations and management, hospital stay and outcome-like amputation were recorded. The average age was 62 years. Pain and swelling were the chief complaints. The cause of infection was varied. The infection was superficial in 13 and deep in 24 patients. Forty-one percent of culture report revealed polymicrobial organism. The increased length of hospital stay, reoperations and amputation were associated with deep infection and polymicrobial organism. Prompt medical and surgical attentions are the most important factors. A proper glycemic control, elevation of the affected extremity, thorough and adequate surgical debridement and appropriate antibiotics are the important considerations when dealing with diabetic hand infection.

Diabetic hand infection in the tropics

We were interested to read the Case report by Dr Richard Paisey and colleagues (Pract Diabetes Int 2003; 20: 56–57) concerning a British type 1 diabetic patient who developed severe deep hand infection following acupuncture trauma. Severe hand infection is now an uncommon complication of diabetes in developed countries, though there have been reports of its occurrence 20 to 30 years ago.1 In tropical countries, however, the condition persists today. First reported in 1984 by Akintewe and colleagues in Nigeria,2 it has been widely reported in Africa,3, 4 and recently in India.5 The clinical presentation is very stereotyped. Diabetes is usually poorly controlled and (as in the UK case) there is often a history of preceding trauma, which is frequently trivial. Presentation to hospital may be delayed by the patient seeking initial help from traditional healers or herbalists. There is usually severe deep palmar hand sepsis, and despite treatment, amputation or even death may occur. The longest reported series is from Tanzania, where 31 cases were investigated, and compared with non-infected case controls.6 Factors significantly associated with hand sepsis were neuropathy, insulin treatment and a low body mass index (BMI). The latter two factors may simply reflect poor glycaemic control. Hand sepsis in the tropics can have serious implications – the Tanzanian researchers for example have reported four cases, all of whom died.7 In the larger Tanzanian series, there was a 13% mortality rate, with a further 13% requiring major upper limb amputation.6 The treatment of tropical diabetic hand sepsis includes IV broad-spectrum antibiotics in high dose, and early and adequate surgery to release pus and debride dead tissue.7 Despite this, survival is not always guaranteed, and there may be a long-term burden of residual disability. Figure 1 shows a Gambian man with type 2 diabetes and severe deep sepsis of the left hand. The patient's diabetes was poorly controlled as he could not afford medication. Following minor trauma, sever cellulitis occurred. Presentation to hospital was delayed by his attending a herbalist (some remnants of green leaves can be seen on the periphery of the ulcer). Despite surgical debridement and iv antibiotics, amputation of the hand was needed. Severe deep sepsis of the left hand in a Gambian man with type 2 diabetes. (Reproduced with permission of FSG Communications Ltd) Geoff Gill*, Lennox Archibald , Zulfiqarali G Abbas , * Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA,IJK, Regeneration Technologies Inc, Alachua, Florida 32616, USA, Muhimbili University College of Health Science/Abbas Medical Centre, PG Box 21361, Dar es Salaam, Tanzania

DIABETIC HAND INFECTIONS

Compared with the limited experience reported in the literature to date, analysis of the authors' clinical series of hand infections demonstrates that more than one third of the patients are diabetic. This can be attributed to the population of African-Americans in Washington, DC, the high incidence of diabetes in this particular race, and the inherent susceptibility of diabetics to develop an infection of the hand. The most severe infections occur in insulin-dependent diabetic patients or those with chronic renal failure because of protein depletion, poor wound healing, neuropathy, and ischemia. Although a similar spectrum of infections is encountered in diabetic and nondiabetic patients, some characteristic presentations are somewhat unique to the diabetic population. Gram-negative and mixed organism infections are particularly common in diabetic patients. Despite the poor prognosis of diabetic hand infections in general and the unsatisfactory outcome in patients on renal dialysis, most diabetic patients successfully heal following early and appropriate intervention. Early diagnosis and aggressive and adequate surgical drainage and tissue excision or amputation (if indicated) are key principles. The authors have learned that the surgical incision must extend along the entire area of erythema and induration because the infection often is more extensive than suspected both before and during the initial surgery. Observation, local wound care, and the administration of antibiotic agents are not acceptable substitutes for surgical decompression in the diabetic patient with a hand infection. In the subgroup of diabetic patients most prone to develop hand infections (i.e., associated renal dialysis), the surgeon must recognize that ongoing tissue loss is commonplace, repeat wound debridements are required, and an eventual amputation is highly likely.

Hand infections in the diabetic patient

Between 1984 and 1994, 23 diabetic patients were admitted to a university hospital/Department of Veterans Affairs (DVA) Medical Centre with a primary or secondary diagnosis of hand infection. We also identified 726 patients admitted to all DVA Medical Centres during the years 1989 through 1994 with co-diagnoses of diabetes mellitus and hand infection. Contrary to previously published literature, most diabetic hand infections are non-specific, confined to the soft tissues, and respond to broad spectrum parenteral antibiotic therapy. When surgery is necessary, most patients do not require amputation.

Hand Infections in the Diabetic and the Diabetic Renal Transplant Recipient

We present a series of 41 diabetic patients with severe tissue destruction and deformity secondary to hand infections. Thirty (73%) of the patients showed propagation of the infection to bone, tendons, or deep palmar spaces, and 26 of 41 (63%) required amputations. Sixty-three percent of the cultures were mixed; pure Staphylococcus aureus accounted for only 12%. Diabetics who were renal transplant recipients were at increased risk, with a 100% amputation rate and an average hospitalization of 41 days. Recommendations for management of diabetic hand infections are given to reduce the mortality and morbidity in these patients.

Factors determining poor prognostic outcomes following diabetic hand infections.

Background and Objective:Hand ulcers are seen in a small percentage of patients with diabetes. The predisposing factors of diabetic hand varies between different countries. However, the effects of predisposing factors on prognosis are not clear in diabetic hand infections. In this study, our aim was to determine the effects of predisposing factors on poor prognostic outcomes in patients with diabetes mellitus.Methods:Thirty-four patients with diabetes mellitus who were treated and followed up for a hand infection in between 2008 and 2014 were investigated retrospectively. Patients were evaluated according to predisposing factors defined in the literature that included disease period, age, gender, admission time, presence of neuropathy, smoking habits, HbA1c levels at admission time, peripheral vascular disease, end-stage renal disease (ESRD), and trauma. Death and minor/major amputation cases during treatment were defined as poor prognosis.Results:Patients who had ESRD, peripheral neuropathy, or an HbA1c level greater than 10% had significantly higher amputation rates.Conclusions:Peripheral neuropathy, ESRD, and HbA1c levels greater than 10% at the time of admission were determined as poor prognosis criteria for diabetic hand treatment.