Management of hand and upper-extremity infections in heart transplant recipients

Hand and upper-extremity infections are routinely managed by antibiotics, i mmobilization, and limited incision and drainage. However, in immunocomprom ised patients, these infections maybe more aggressive and they may require more emergent treatment. The authors performed a retrospective review of th e Stanford University Medical Center experience with hand and upper-extremi ty infections in 911 cardiac transplant recipients over the past 30 years. Thirteen heart transplant recipients were treated for infections of the han d and upper extremity on an inpatient basis. Ten patients (77 percent) requ ired operative debridement, and three (23 percent) required more than one o perative procedure. Nine patients (69 percent) had bacterial infections, si x (46 percent) had fungal infections [four of these patients (31 percent) h ad both bacterial and fungal infections], one (7.7 percent) had a mycobacte rial infection, and one (7.7 percent) tvas not cultured. Hand and upper-ext remity infections in transplant recipients frequently resulted in deep-spac e infections, tenosynovitis, and osteomyelitis. The authors believe such in fections represent a surgical emergency, requiring immediate evaluation by hand surgeons and early,aggressive treatment.