Outcome of delayed presentations of open traumatic hand infections: a prospective cohort study
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Abstract
Objective: To evaluate the outcomes of delayed presentation in patients with open hand infections managed at Civil Hospital Karachi (CHK), with a focus on hospital stay, surgical interventions, and operative duration, to inform clinical decision-making and policy planning.
Methods: A prospective observational study was conducted at the Plastic Surgery Department, CHK, Pakistan from January to June 2022. Ethical approval was obtained from the Institutional Review Board of Dow University of Health Sciences (IRB-2354/DUHS/Approval/2021/708). A total of 188 patients aged 18–65 years with clinically confirmed hand infections were enrolled. Patients were stratified into delayed (>24 hours) and non-delayed (≤24 hours) presentation groups. Exclusion criteria included burn injuries, postoperative infections, and chronic inflammatory disorders. Data were collected on demographics, clinical presentations, comorbidities, severity of infection, microbiology, surgical intervention, and outcomes. Statistical analysis was performed using SPSS version 24, with significance set at p≤0.05.
Results: Of 188 patients, 94 (50%) had delayed presentation. The mean age was 39.56±12.05 years; 88.8% were male. Pseudomonas aeruginosa (59%) and MRSA (35.6%) were the most common organisms. Mild, moderate, and severe infections were noted in 35.6%, 36.7%, and 27.7% of patients, respectively. Debridement was the most common surgery (76.6%). Delayed presentation was significantly associated with longer hospital stay (10.44±2.45 vs. 4.29±0.65 hours), more frequent surgeries (2.32±0.49 vs. 1.01±0.01), and longer operative time (1.57±0.56 vs. 0.47±0.09 hours) (p<0.001 for all).
Conclusion: Delayed presentation in open hand infections is significantly associated with worse clinical outcomes. Early recognition and timely intervention are essential to reduce morbidity and healthcare burden.
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References
1. Türker T, Capdarest-Arest N, Bertoch ST, Bakken EC, Hoover SE, Zou J. Hand infections: a retrospective analysis. Peer J 2014;2:e513. https://doi.org/10.7717/peerj.513
2. Gundlach BK, Sasor SE, Chung KC. Hand infections: epidemiology and public health burden. Hand Clin 2020;36(3):275-83. https://doi.org/10.1016/j.hcl.2020.03.001
3. Houshian S, Seyedipour S, Wedderkopp N. Epidemiology of bacterial hand infections. Int J Infect Dis 2006;10(4):315-9. https://doi.org/10.1016/j.ijid.2005.06.009
4. Ki V, Rotstein C. Bacterial skin and soft tissue infections in adults: a review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. Can J Infect Dis Med Microbiol 2008;19(2):173-84. https://doi.org/10.1155/2008/846453
5. Otto M. Staphylococcus colonization of the skin and antimicrobial peptides. Exp Rev Dermatol 2010;5(2):183-95. https://doi.org/10.1586/edm.10.6
6. Flevas DA, Syngouna S, Fandridis E, Tsiodras S, Mavrogenis AF. Infections of the hand: an overview. EFORT Open Rev 2019;4(5):183-93. https://doi.org/10.1302/2058-5241.4.180082
7. Pavan F, Albarki HS, Vu J, Keating C, Leong JC. Does delay to theater lead to increased infection rates in hand trauma? a retrospective cohort study. Plast Reconstr Surg- Glob Open 2018;6(11):e2025. https://doi.org/10.1097/GOX.0000000000002025
8. Malizos KN, Papadopoulou ZK, Ziogkou AN, Rigopoulos N, Athanaselis ED, Varitimidis SE, et al. Infections of deep hand and wrist compartments. Microorganisms 2020;8(6):838. https://doi.org/10.3390/microorganisms8060838
9. Eron LJ, Lipsky BA, Low DE, Nathwani D, Tice AD, Volturo GA, et al. Managing skin and soft tissue infections: expert panel recommendations on key decision points. J Antimicrob Chemother 2003;52 Suppl 1:i3-17. https://doi.org/10.1093/jac/dkg466
10. Agarwal R, Agarwal D, Agarwal M. Approach to mutilating hand injuries. J Clin Orthop Trauma 2019;15:172-5. https://doi.org/10.1016/j.jcot.2019.08.011
11. Murphy GR, Gardiner MD, Glass GE, Kreis IA, Jain A, Hettiaratchy S. Meta-analysis of antibiotics for simple hand injuries requiring surgery. Br J Surg 2016;103(5):487-92. https://doi.org/10.1002/bjs.10111
12. Johannessen JT, Tabatabaeifar S, Hasanbegovic E. The golden period for suturing of traumatic wounds. Ugeskr Laeger 2022;184(8):V06210536.
13. Juon BH, Iseli M, Kreutziger J, Constantinescu MA, Vögelin E. Treatment of open hand injuries: does timing of surgery matter? a single-centre prospective analysis. J Plast Surg Hand Surg 2014;48(5):330-3. https://doi.org/10.3109/2000656X.2014.886581
14. Bergmann PA, Mauss KL, Liodaki ME, Mailänder P, Siemers F, Stang F. Infection of the hand: evaluation of a two-stage therapy. Handchir Mikrochir Plast Chir 2014;46(1):49-55. https://doi.org/10.1055/s-0033-1364020
15. Ketonis C, Dwyer J, Ilyas AM. Timing of debridement and infection rates in open fractures of the hand: a systematic review. Hand 2017;12(2):119-26. https://doi.org/10.1177/1558944716643294
16. Dastagir K, Luketina R, Kuhbier JW, Ziegler A, Vogt PM, Könneker S. Auswirkung der verspäteten Vorstellung von Handinfektionen beim Handchirurgen – eine retrospektive Single-Center-Studie von 379 Patienten [Impact of delayed presentation of patients with hand infections to hand surgeons: a retrospective single-centre study of 379 patients]. Handchir Mikrochir Plast Chir 2019;51(1):45-8. German. https://doi.org/10.1055/a-0832-2292
17. Davies J, Roberts T, Limb R, Mather D, Thornton D, Wade RG. Time to surgery for open hand injuries and the risk of surgical site infection: a prospective multicentre cohort study. J Hand Surg Eur 2020;45(6):622-8. https://doi.org/10.1177/1753193420905205
18. Baldwin AJ, Jackowski A, Jamal A, Vaz J, Rodrigues JN, Tyler M, et al. Risk of surgical site infection in hand trauma, and the impact of the SARS-CoV-2 pandemic: a cohort study. J Plast Reconstr Aesthet Surg 2021;74(11):3080-6. https://doi.org/10.1016/j.bjps.2021.06.016.
19. Li B, Webster TJ. Bacteria antibiotic resistance: New challenges and opportunities for implant-associated orthopedic infections. J Orthopaed Res 2018;36(1):22-32. https://doi.org/10.1002/jor.23656
20. Sim WP, Ng HJH, Liang BZ, Rajaratnam V. Can open hand injuries wait for their surgery in a tertiary hospital? J Hand Microsurg 2021;13(3):157-63. https://doi.org/10.1055/s-0041-1725220
21. Reasoner K, Desai MJ, Lee DH. Factors influencing infection rates after open hand fractures. J Hand Microsurg 2020;12(01):56-61. https://doi.org/10.1055/s-0039-3399488