Retreatment of previously treated hand infections

Presenting patient profiles and bacteriologic culture and sensitivity data from 132 patients representing a 5-year experience with hand infections were examined. Patients were subdivided into those having no prior treatment and those having previously been treated with antibiotics. Presenting patient profiles showed the majority of patients to be young to middle-aged males. Temperature, pulse, and white blood cell counts, while usually mildly elevated, were usually not diagnostic. In comparison with patients not having been previously treated, patients having already received antibiotics with persistent or recurrent infections showed more of a tendency toward mixed infections. Anaerobic, mycobacterial, and fungal infections were also increased. Antibiotic susceptibility studies showed the cephalosporins and clindamycin maintain a reasonably good coverage (78% and 72%, respectively). Penicillinase-resistant antibiotics also provided some coverage in two thirds of patients. Proper antibiotic therapy may depend on several factors including previous treatment. Other measures of surgical drainage when appropriate, elevation, compresses, and splinting remain important.