Müller Camillo T, Uçkay Ilker, Erba Paolo, Lipsky Benjamin A, Hoffmeyer Pierre, Beaulieu Jean-Yves
Geneva and Lausanne, Switzerland; and Oxford, United Kingdom From the Hand Surgery Unit, Department of Orthopaedic Surgery, Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva; and the Department of Infectious Diseases, University of Oxford.
Plast Reconstr Surg. 2015 Sep;136(3):338e-343e. doi: 10.1097/PRS.0000000000001510.
Treatment of septic hand tenosynovitis is complex, and often requires multiple débridements and prolonged antibiotic therapy. The authors undertook this study to identify factors that might be associated with the need for subsequent débridement (after the initial one) because of persistence or secondary worsening of infection.
In this retrospective single-center study, the authors included all adult patients who presented to their emergency department from 2007 to 2010 with septic tenosynovitis of the hand.
The authors identified 126 adult patients (55 men; median age, 45 years), nine of whom were immunosuppressed. All had community-acquired infection; 34 (27 percent) had a subcutaneous abscess and eight (6 percent) were febrile. All underwent at least one surgical débridement and had concomitant antibiotic therapy (median, 15 days; range, 7 to 82 days). At least one additional surgical intervention was required in 18 cases (median, 1.13 interventions; range, one to five interventions). All but four episodes (97 percent) were cured of infection on the first attempt after a median follow-up of 27 months. By multivariate analysis, only two factors were significantly associated with the outcome "subsequent surgical débridement": abscess (OR, 4.6; 95 percent CI, 1.5 to 14.0) and longer duration of antibiotic therapy (OR, 1.2; 95 percent CI, 1.1 to 1.2).
In septic tenosynovitis of the hand, the only presenting factor that was statistically predictive of an increased risk of needing a second débridement was the presence of a subcutaneous abscess.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
化脓性手部腱鞘炎的治疗较为复杂，通常需要多次清创和长期抗生素治疗。作者开展此项研究以确定因感染持续或继发恶化而需要进行后续清创（初次清创之后）的相关因素。
在这项回顾性单中心研究中，作者纳入了2007年至2010年期间因手部化脓性腱鞘炎就诊于其急诊科的所有成年患者。
作者确定了126例成年患者（55例男性；中位年龄45岁），其中9例为免疫抑制患者。所有患者均为社区获得性感染；34例（27%）有皮下脓肿，8例（6%）发热。所有患者均接受了至少一次手术清创并同时接受抗生素治疗（中位时间15天；范围7至82天）。18例患者（中位1.13次干预；范围1至5次干预）需要至少再进行一次手术干预。经过中位27个月的随访，除4例（97%）外，所有感染均在首次尝试时治愈。通过多变量分析，只有两个因素与“后续手术清创”这一结果显著相关：脓肿（比值比[OR]，4.6；95%置信区间[CI]，1.5至14.0）和抗生素治疗时间较长（OR，1.2；95%CI，1.1至1.2）。
在手部化脓性腱鞘炎中，唯一在统计学上可预测需要二次清创风险增加的表现因素是存在皮下脓肿。
临床问题/证据水平：风险，III级。
