Qasawa Ryan, Yoho Daniel, Luker Jenna, Markovicz Jake, Siddiqui Aamir
Surgery, Henry Ford Health System, Detroit, USA.
Cureus. 2021 Apr 2;13(4):e14263. doi: 10.7759/cureus.14263.
Purpose For many providers, hand infections among diabetic patients is a condition that necessitates focused inpatient care. These patients are believed to have decreased innate immunity to fight infection, a more virulent course, and difficulty with recovery. Diabetes is considered by some to represent an additional risk factor that can result in an unfavorable outcome if not managed in an aggressive manner. Our own experience suggests that many of these patients can be safely managed in the outpatient setting. The purpose of this project was to better define the clinical outcomes for this population. Methods Evidence-based criteria were utilized to direct inpatient versus outpatient treatment pathways. A database was developed to track hand infections treated by the specialty service. The primary outcome was the resolution of hand infection. Secondary outcomes included specific treatment responses as well as patient characteristic comparisons of the different treatment groups. Independent variables included (parenteral and enteral) antibiotic use and bedside interventions performed. Patients were followed to complete the resolution of infection. Results For all patients managed as outpatients, diabetic patients had statistically significantly decreased improvement rates at two weeks as compared to non-diabetic patients (62% vs 75%, p =0.024). This difference disappeared at two months. Among diabetic patients, those with the highest rate of recovery at two weeks (90%) received intravenous antibiotics, bedside procedures, and oral antibiotics. Patients who did not receive antibiotics or undergo bedside procedures had the lowest percent of improvement (37%). Across all treatment subgroups, bedside procedure was the most impactful intervention. Less than 10% of patients were converted from outpatient to inpatient care, both diabetic and non-diabetic. Conclusions We reviewed our experience managing diabetes mellitus hand infections treated in the outpatient setting. Appropriate and effective treatment is possible, and the results are equivalent to those of patients without diabetes mellitus.
目的 对于许多医疗服务提供者而言，糖尿病患者的手部感染是一种需要集中住院治疗的疾病。这些患者被认为对抗感染的先天免疫力下降，病程更凶险，且恢复困难。一些人认为糖尿病是一个额外的风险因素，如果不积极治疗，可能导致不良后果。我们自己的经验表明，这些患者中的许多人可以在门诊环境中得到安全管理。本项目的目的是更好地界定该人群的临床结局。方法 采用循证标准来指导住院与门诊治疗路径。开发了一个数据库来跟踪专科服务治疗的手部感染。主要结局是手部感染的消退。次要结局包括具体的治疗反应以及不同治疗组患者特征的比较。自变量包括（肠外和肠内）抗生素使用情况以及所进行的床边干预措施。对患者进行随访直至感染完全消退。结果 对于所有门诊管理的患者，糖尿病患者在两周时的改善率与非糖尿病患者相比在统计学上显著降低（62% 对 75%，p = 0.024）。这种差异在两个月时消失。在糖尿病患者中，两周时恢复率最高的患者（90%）接受了静脉抗生素、床边操作和口服抗生素治疗。未接受抗生素治疗或未进行床边操作的患者改善率最低（37%）。在所有治疗亚组中，床边操作是最有影响的干预措施。糖尿病和非糖尿病患者中，不到10%的患者从门诊治疗转为住院治疗。结论 我们回顾了在门诊环境中管理糖尿病手部感染的经验。适当且有效的治疗是可行的，结果与非糖尿病患者相当。
