gms | German Medical Science

Objectives/Interrogation: Diabetics (DM) in underserved communities are at greater risk for hand infections compared to the general population. Such infections in the setting of DM can yield devastating consequences without prompt and aggressive treatment. Moreover, vancomycin resistance constitutes a growing challenge for the treatment of infections in both diabetics and non-diabetics. We aimed to determine which features of were suggestive of infection severity by comparing hand infections by diabetic status, presenting to an urban hospital with respect to: (1) inflammatory markers, (2) infection site, (3) microbiology, and (4) antibiotic choice.

Methods: A prospectively collected, single-center database of 53 patients who presented from 2014-2016 with any hand infection was retrospectively reviewed; patients were stratified by presence (n=24) or absence (n=24) of DM and location of infection (Proximal [proximal to digit] vs. Distal [within the digit]). Univariate analyses compared laboratory/culture results. Analysis of variance compared antibiotic regimens within and between disease groups. Multivariate analyses were employed to identify significant predictors of labs or infection location.

Results and Conclusions: Mean ESR was significantly higher in DM (76.2 vs. 51.3 mm/hr); mean WBC, CRP were comparable. Regression analysis showed that diabetics had higher odds of having increased ESR than non-diabetics (OR=1.03) (all p<0.02). Proximal infections had higher mean CRP (136.9 vs. 50.5 mg/L, p=0.001) and WBC (5.2 vs. 3.9 103/µL, p=0.02). Regression analysis showed that proximal infections were associated with increased odds of resulting in higher CRP (OR 1.02, p=0.003). Rates of Staphylococcus aureus, MRSA, and gram-negative organisms were comparable between DM groups. Diabetics received vancomycin/piperacillin/tazobactam (VAN-PTZ) more often (52% vs. 8%). Providers treated DM with VAN-PTZ or any VAN-containing regimen more often than with any other regimen (all p<0.05). In conclusion, this study underlies the need for systematic criteria to aid in risk-stratifying patients for appropriate antibiotic use. The microbiology of hand infections in diabetics may not differ compared to non-diabetics as much as was previously thought. It may not be appropriate to treat both groups differently in urban populations similar to our own; antibiotic selection in this population may be overly-aggressive and contribute to drug-resistance.