Diabetic hand infections: a case series highlighting diagnostic and therapeutic challenges

Diabetic hand infections are uncommon but potentially severe complications of diabetes mellitus. Because of the complex anatomy and functional importance of the hand, these infections may progress rapidly and result in serious morbidity, including osteomyelitis and amputation. Clinical data on this condition remain limited.

This case series included patients hospitalized with diabetic hand infection at a tertiary care center between 2020 and 2026. Patients, ≥ 18 year-old, with confirmed diabetes mellitus and clinical, microbiological, and/or radiological evidence of hand infection were included. Demographic data, comorbidities, HbA1c levels, laboratory findings, microbiological results, imaging findings, and treatment outcomes were reviewed from medical records.

Seven patients were included. Osteomyelitis was identified in 57% of patients, while 43% had isolated soft tissue infection. Polymicrobial infection was present in 85% of cases. Staphylococcus spp. were the most commonly isolated pathogens, followed by Enterococcus spp. and Gram-negative organisms. Gram-negative bacteria were identified in 28% of cases. Surgical intervention was required in most patients, and 28% underwent amputation. Poor glycemic control, minor trauma, polymicrobial infection, and deep tissue involvement were common features in this series.

Diabetic hand infections should be recognized as serious and potentially aggressive complications of diabetes mellitus. Early diagnosis, appropriate imaging, timely surgical management, and culture-guided antimicrobial therapy are essential to improve outcomes. Larger multicenter studies are needed to better define prognostic factors and to guide more standardized treatment strategies.