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Bacterial colonization of mutilating hand injuries and its treatment
Abstract:
A total of 120 hand injuries were reviewed. Sixty-seven occurred between 1965 and 1972 and were analyzed retrospectively, and 53 occurred between 1972 and 1974 and were analyzed prospectively. The bacterial colonization was determined in 86 injuries. Injuries sustained while handling farm implements tended to be colonized by mixed gram-negative and gram-positive isolates. The gram-negative isolates usually were resistant to all antibiotics, with the exception of gentamicin. However, nine bacterial isolates were resistant to all agents tested. Injuries sustained in the home or industry were colonized by gram-positive organisms. Most were susceptible to semisynthetic penicillinase-resistant penicillins such as methicillin and its congeners. The use of parenteral prophylactic antimicrobial agents in the treatment of mutilating hand injuries was not significant in preventing infection, and their use does not seem to be indicated in farm implement-related injuries. Antimicrobials are of value in home- and industrial-related injuries only when the status of the wound so indicates.
Insights
Prophylactic antibiotics are not recommended for farm-related hand injuries due to resistant bacteria. For home or industrial hand injuries, antimicrobial use should be guided by wound status.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Public Health
Background:
- Hand injuries present a significant clinical challenge.
- Bacterial colonization patterns vary based on injury mechanism.
- Understanding these patterns is crucial for effective treatment.
Purpose of the Study:
- To analyze bacterial colonization in hand injuries.
- To evaluate the efficacy of prophylactic antimicrobial agents.
- To differentiate treatment strategies based on injury source.
Main Methods:
- Retrospective and prospective review of 120 hand injuries.
- Bacterial colonization analysis in 86 cases.
- Correlation of injury mechanism with microbial isolates and antibiotic susceptibility.
Main Results:
- Farm implement injuries showed mixed gram-negative/gram-positive colonization, often resistant to antibiotics except gentamicin.
- Home/industrial injuries primarily had gram-positive colonization, susceptible to methicillin.
- Prophylactic parenteral antimicrobials did not significantly prevent infection in farm injuries.
Conclusions:
- Prophylactic antibiotics are not indicated for farm implement-related hand injuries.
- Antimicrobial therapy for home/industrial hand injuries should be based on clinical wound assessment.
- Tailoring antibiotic strategies to injury type can optimize patient outcomes.