Leupi W, Simmen H P, Meyer V E
Departement Chirurgie, Universitätsspital Zürich.
Helv Chir Acta. 1992 Mar;58(5):663-6.
In a prospective investigation infections of the upper extremity are examined with respect to incidence, bacterial pathogens, operative or conservative treatment, and duration of disability for work. A total of 255 patients (pts) (170 men, 85 women; mean age 37 years, range 16-85) were entered into the study. In a 12-month period 163 (64%) were treated as outpatients, the condition of 92 pts (36%) required hospitalisation. Conservative and operative treatment was performed in 82 (32%) and 173 (68%) pts, respectively. Conservative treatment included fixation by cast as well as antibiotics (penicillinase resistant penicillin), usually given by the oral route for a mean of 4 days. Surgical procedures consisted of excision and debridement. Intraoperatively intravenous antibiotics were instituted for a mean of 3 days, followed by oral application for another 4 days. In 135 of 173 pts who underwent surgery, sufficient material for bacterial culture was obtained. There was a polymicrobial infection in 50% of pts. Most common isolated pathogens were Staphylococcus aureus, beta-hemolytical streptococci group A, and indigenous skin flora in 34%, 21%, and 11%, respectively. Among the 255 pts there were 26 HIV-positive iv drug abusers, who suffered from abscesses at injection sites. The infections in these immunocompromised HIV-positive pts did not reveal differences with respect to number and species of isolated pathogens as compared to immunocompetent pts. Resistant bacteria were not found. Response to treatment was satisfactory usually within a few days in all but 12 pts (4.7%) in which the failure could be attributed to inadequate primary debridement.
在一项前瞻性调查中，对上肢感染的发病率、细菌病原体、手术或保守治疗以及工作残疾持续时间进行了检查。共有255例患者（170例男性，85例女性；平均年龄37岁，范围16 - 85岁）纳入研究。在12个月期间，163例（64%）作为门诊患者治疗，92例（36%）患者的病情需要住院治疗。分别有82例（32%）和173例（68%）患者接受了保守治疗和手术治疗。保守治疗包括石膏固定以及抗生素（耐青霉素酶青霉素），通常口服给药，平均4天。手术操作包括切除和清创。术中静脉使用抗生素平均3天，随后口服给药4天。在173例接受手术的患者中，有135例获得了足够的细菌培养材料。50%的患者存在混合感染。最常见的分离病原体分别是金黄色葡萄球菌、A组β溶血性链球菌和皮肤固有菌群，占比分别为34%、21%和11%。255例患者中有26例是HIV阳性静脉吸毒者，他们在注射部位出现脓肿。与免疫功能正常的患者相比，这些免疫功能低下的HIV阳性患者的感染在分离病原体的数量和种类方面没有差异。未发现耐药菌。除12例（4.7%）患者外，所有患者对治疗的反应通常在几天内令人满意，这12例治疗失败可归因于初次清创不充分。
