HAND INFECTIONS IN PATIENTS WITH DIABETES

Twenty-five hand infections in adult patients with diabetes were revie wed, Eighty percent of the patients were younger than 60 years of age and had diabetes mellitus for less than 5 years' duration, Secondary n eurologic, 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 n eeded amputation of the digit or digits or hand, either as a primary p rocedure or after initial debridement, Multiple organisms were found i n 55% of the positive cultures, Gram negative organisms were documente d in 73% of the positive cultures, An antibiotic combination of gentam icin, penicillin G, and cloxacillin covered the entire spectrum of the causative organisms, An aggressive treatment protocol comprising hosp ital admission, intravenous combination antibiotics, surgical debridem ent, appropriate diabetic control, and strict elevation of the hand wa s important in the management of the sepsis, reduction of morbidity, a nd salvage of the hand, With a followup at 2 years, there was no insta nce of any repeat episode of the hand infection.