Outpatient Management of Diabetic Hand Infections

Purpose For 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. Methods Evidence-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. Results For 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. Conclusions We 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.