Hand infections in patients with diabetes

Twenty-five hand infections in adult patients with diabetes were reviewed. Eighty percent of the patients were younger than 60 years of age and had diabetes mellitus for less than 5 years' duration. Secondary neurologic, vascular, or cutaneous changes in the hands were present in 5 (20%) patients. A documented instance of trauma was present in 16% of patients. None of the patients had nosocomial infections. Of the 24 (96%) patients who required surgery, 21 had debridement alone and 3 needed amputation of the digit or digits or hand, either as a primary procedure or after initial debridement. Multiple organisms were found in 55% of the positive cultures. Gram negative organisms were documented in 73% of the positive cultures. An antibiotic combination of gentamicin, penicillin G, and cloxacillin covered the entire spectrum of the causative organisms. An aggressive treatment protocol comprising hospital admission, intravenous combination antibiotics, surgical debridement, appropriate diabetic control, and strict elevation of the hand was important in the management of the sepsis, reduction of morbidity, and salvage of the hand. With a followup at 2 years, there was no instance of any repeat episode of the hand infection.