Epidemiology and management of purulent paronychia: A bicentric study

Paronychia is a common condition, but there are no specific guidelines for its management, which lacks standardization. The use of perioperative antibiotic therapy, surgical procedures and bacteriological sampling depends on the practitioner and may vary according to centre practices, patient characteristics and infection severity. The primary aim of this retrospective bicentric study was to describe patient characteristics and treatment practices in two hand surgery units between January 2022 and December 2023. A secondary objective was to evaluate the impact of bacteriological sampling and perioperative antibiotic use in order to inform a decision-making algorithm. A total of 359 patients were included in the study. Over 80% of treated cases of paronychia were trivial. Preoperative antibiotic therapy was administered to 19.5% of patients and postoperative therapy to 51.5%. Staphylococcus aureus was the most frequent pathogen, accounting for approximately 30% of isolated bacteria. Overall, only 4.7% of bacteria were resistant to empirical therapy with amoxicillin-clavulanic acid. The recurrence rate was 3.9%. No diabetic patient experienced recurrence. Despite differing practices, clinical outcomes were not significantly different. Preoperative antibiotic therapy should be avoided. Postoperative antibiotic therapy does not influence recurrence in cases of uncomplicated paronychia. The clinical benefit of systematic sampling in simple paronychia appears to be limited. In cases of complicated paronychia, thorough excision is essential and empirical antibiotic therapy with amoxicillin-clavulanic acid is appropriate.