Profiling of hand infections requiring admission to hospital universiti sains malaysia between 2005-2010
Hand infection poses a diagnostic and treatment challenge to the medical fraternity. The complex nature of the anatomy involved and the vast microbiological spectrum demands a detailed understanding of the disease. Global literature regarding hand infection is relatively limited, more so within the...
Saved in:
| Main Author: | |
|---|---|
| Format: | Thesis |
| Language: | English |
| Published: |
2012
|
| Subjects: | |
| Online Access: | http://eprints.usm.my/60985/1/DR%20GOPINATH%20MATHAVAN%20-%20e.pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Hand infection poses a diagnostic and treatment challenge to the medical fraternity. The complex nature of the anatomy involved and the vast microbiological spectrum demands a detailed understanding of the disease. Global literature regarding hand infection is relatively limited, more so within the Asian continent. The rapid change in patterns of pyogenic hand infection requires a local perspective to aid an accurate diagnosis and a guided treatment based on the regional bacteriological spectrum. To study the pattern of hand infection among the Kelantanese population. It is aimed to delineate and update the bacteriological spectrum, characterize patterns and sites of injury, evaluate clinical and biochemical markers and possible causes and complications in patients with bacterial hand infection. Between January 2005 to December 2010, all patients with hand infection requiring admission to the Orthopedic department of Hospital Universiti Sains Malaysia were reviewed retrospectively. A standard protocol was used to collect data and record the relevant details based on the case records that were traced via the records unit of the hospital. We identified the aetiology, predisposing factors, associated co morbidities, extent of involvement, nature, clinical presentation, biochemical markers, bacteriological pattern of involvement and complications. 203 patients were studied for 5 years period ranging from January 2005 till December 2010. The age of patient treated for hand infections ranged from 1 year of age till 92 years of age. The sex distribution comprised of 63.5% males and 36.5 % females. Majority of patients consists of Malay ethnicity (97.5%). Trauma and animal bites is the most common cause of hand infections making approximately 61.1% and 14.8% respectively. The site of infection was subcutaneous in 53.7% followed by skin, sub fascial and tendon in 23.6%, 8.4% and 4.4% respectively. Zone II was most commonly involved in 30% of cases and approximately 48.3% had 2 or more zones involved. The mean duration of hospital stay was 9.2days and the mean duration from presentation to the hospital till surgery was 2.5 days. The most common diagnosis was abscess in 50.2 % of patients followed by cellulitis, tenosynovitis and necrotizing fasciitis. Clinical parameters of presenting temperature, blood pressure, pulse rate and biochemical investigations including Total white cell count, ESR, CRP and Serum Albumin levels neither indicated the severity of the infection nor related to the etiology of the infection. 119 culture samples were analyzed, 54.6% were pure Staphylococcus Aureus followed by 26.1 % of culture being mixed growth in origin. 48.8% of the patients in the study population were diabetics and comprised the majority of population with complications. Diabetics above the age group of 40 years revealed significant post operative stiffness (p <0.021), post operative functional limitation (p<0.021), requirement of multiple surgeries (p<0.027) and increased duration of hospital stay (p<0.001) as compared to non diabetics. The mean hospital stays among diabetics were 12.6 days. This study confirms that Staphylococcus Aureus is responsible for most hand infection followed by mixed organism that was common among diabetics and those presenting following animal bites. Trauma and animal bites is the most common aetiology in the population studied. Staphylococcus Aureus is the commonest organism following trauma however similar conclusion cannot be made based on other aetiologies. Zone 2 is the commonest location and subcutaneous infections are frequently encountered. Clinical parameters of presenting temperature, blood pressure, pulse rate and biochemical markers such as total white cell, erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) is not an indicator of severity or potential aetiology. Outcome measures such as stiffness, functional limitation, requirement of multiple surgeries and increased duration of hospital stay is more significant in the diabetic population that presented with hand infection. Therefore choice of empirical antibiotics should be directed based on the presenting etiology and possible comorbidities. |
|---|