gms | German Medical Science

Objectives/Interrogation: Infections of the upper limb constitute a common presentation with significant morbidity and in rare cases mortality. In a majority of cases, upper limb infections are caused by Staphylococcus and Streptococcus species however patients with a higher risk of infection such as diabetics and immunocompromised patients often have cultures positive for polymicrobial growth, fungi and even mycobacteria. Recurrent and 'difficult to treat' infection in the upper limb pose a challenge for the hand surgeon and our aim was to review the incidence of upper limb infection, the microbiological implications and management in our unit.

Methods: We performed a retrospective study of 1000 consecutive patients presenting to our unit with upper limb infections during 2016-2018. From our digital databases we recorded demographic data, co-morbidities, length of hospital stay, antibiotics used, organisms grown, number of surgical debridements required, amputations and number of recurrent admissions. Statistical tests were performed with SPSS.

Results and Conclusions: Out of 1000 patients, a majority of infections were caused by animal bites, most predominantly dog bites. In our cohort, the patients were treated with intravenous antibiotics and the majority had surgical debridement and washout. The recurrent and persistent infections were more commonly seen in patients with impaired vascular perfusion, diabetes and other immunocompromising conditions. We have reviewed current and future technologies in reducing microbiological load in the treatment of complicated hand infections.

Prompt treatment of upper limb infections with tailored antibiotics and surgical debridement if required is essential. Special notice is also given to the difficult to treat upper limb infections and we suggest a treatment protocol of upper limb infections based on the results in our unit.