Abstract
Background Diabetic hand infections are associated with significant morbidity and disability.
Amputations cause permanent disability, and multiple surgical procedures lead to morbidity.
Diabetic foot infections have been well-studied but literature on hand infections
is limited. We undertook a retrospective study of patients with diabetic hand infections
operated at our center to study the factors at presentation with significant association
with amputation and number of surgical procedures.
Patients and Methods Demographic data of 51 patients was collected. The six parameters, namely, duration
of diabetes, “onset of symptoms to presentation” interval, presence of comorbidities,
HbA1c level, random blood sugar (RBS) levels at admission, and culture characteristics
were selected for statistical analysis to find a relationship with the two outcome
variables: number of procedures done and need for amputation.
Results On bivariate analysis, Gram-negative infection was found to have a significant relationship
with the need for multiple of procedures (p = 0.014). The mean difference between the “onset of symptoms to presentation” interval
between the amputation/non-amputation groups (2.9 days, p = 0.04) and the multiple procedures/non-multiple procedure groups (4.4 days, p = 0.02) was found to be statistically significant. Presence of comorbidities, long duration
of diabetes, HbA1c, and RBS levels at admission did not show any statistically significant
association with the two outcome variables studied.
Conclusion In the present study, we found that infection with Gram-negative organisms is significantly
related to the need for multiple surgical procedures. A delay in presentation can
influence the risk of amputation as well as multiple procedures. Institution of early
appropriate care is important to get a good outcome.
Keywords
diabetes - hand infection - amputation - gram-negative infection - wound infection
