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Established hand infections: a controlled, prospective study.

P J Stern, J L Staneck, J J McDonough

    The Journal of Hand Surgery
    |September 1, 1983
    PubMed
    Summary
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    In a hand infection study, cefamandole showed higher in vitro sensitivity but led to more complications than nafcillin. Empirical antibiotic choice requires considering factors beyond lab results for effective treatment.

    Area of Science:

    • Infectious Diseases
    • Pharmacology
    • Surgical Infections

    Background:

    • Established hand infections present complex treatment challenges.
    • Bacteriologic analysis is crucial for understanding infection profiles.
    • Mixed aerobic and anaerobic infections are common in hand infections.

    Purpose of the Study:

    • To compare the clinical efficacy of cefamandole and nafcillin in treating established hand infections.
    • To evaluate the impact of in vitro antibiotic sensitivity on patient outcomes.
    • To identify factors influencing complication rates in hand infections.

    Main Methods:

    • A randomized, prospective study involving 200 patients with established hand infections.
    • Bacteriologic cultures were performed to identify causative organisms.

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  • Patients were treated with either cefamandole or nafcillin, and outcomes were monitored.

    • Main Results:

    • Multiple organisms were isolated in 63.5% of cultures, with 26% involving anaerobic bacteria.
    • Complication rates were significantly higher in patients with mixed aerobic and anaerobic infections (26%) compared to aerobic-only infections (9.8%).
    • Despite higher in vitro sensitivity to cefamandole (95%) versus nafcillin (67%), complications occurred more frequently in the cefamandole group.

    Conclusions:

    • In vitro antibiotic sensitivity alone is insufficient for empirical treatment selection in hand infections.
    • Factors such as treatment delay, infection severity, location, cause, and surgical debridement significantly impact complication development.
    • A multifactorial approach is necessary for optimizing antibiotic therapy and patient outcomes in complex hand infections.