A retrospective cohort study investigating the epidemiology of bacterial hand infections at a tertiary hospital in the Western Cape of South Africa

Abstract

Background: Hand infections can cause serious morbidity and financial implications to patients and healthcare systems. This retrospective cohort study investigates the epidemiology of bacterial hand infections at a tertiary institution over a year, with a secondary objective of investigating factors that modify risk for complications.

Method: Patient demographics, clinical information, microbacterial spectrum, timeframes of patient’s pathway, and risk factors for complication development were investigated. Data related to antibiotic cover and any resistance to commonly used antibiotic therapy, specifically co-amoxiclav (Augmentin) and cloxacillin, was also captured. Relationships between risk factors and complications were investigated with a chi-squared or Fisher’s exact test at an alpha-level of 0.05.

Results: Overall, 529 patients (mean age of 33.0 ± 15.6 years; 73% male) were included. A delay of a median of 6.0 (IQR 3.0–9.0) days between onset of symptoms and admission occurred. Complications were experienced by 23% (n = 124) patients. These patients required soft tissue cover (55%, n = 69), relook-debridement alone (34%, n = 42), or an amputation (10%, n = 13). Methicillin-sensitive Staphylococcus aureus (MSSA) was most frequently cultured, at 79% (n = 281) of all cultured organisms. More of the cultured organisms were sensitive to co-amoxiclav (86%, n = 305) than they were to cloxacillin (78%, n = 278). Patients with necrotising fasciitis and co-amoxiclav resistance had a statistically significant increase in complications.

Conclusion: The findings of this study highlight a high burden of hand infections as well as a high rate of complications following treatment. Furthermore, co-amoxiclav was an appropriate choice of antibiotic cover in this population. Finally, patients with necrotising fasciitis and those with co-amoxiclav-resistant infections are more at risk of complications. These findings should be taken into consideration when treating patients with hand infections.

Level of evidence: 3