Frizzell Kaela, Galvis Elkin, Bhandari Laxminarayan
Hand Surgery, Christine M. Kleinert Institute of Hand and Microsurgery, Louisville, USA.
Hand Surgery, Kleinert Kutz and Associates, University of Louisville, Louisville, USA.
Cureus. 2022 Dec 22;14(12):e32825. doi: 10.7759/cureus.32825. eCollection 2022 Dec.
Introduction Pyogenic flexor tenosynovitis (PFT) is a common hand infection that can cause significant morbidity. Although treatment involves surgical debridement and inpatient intravenous (IV) antibiotics, there is a paucity of literature guiding antibiotic use. This study aims to determine if the use of postoperative outpatient oral antibiotics leads to poor outcomes compared to IV antibiotics given in an institutional setting. Methods A retrospective review of 110 patients treated post-operatively with either outpatient oral or inpatient IV antibiotics at our institution from 2016-2019 was performed. All patients underwent surgical debridement. Primary outcomes analyzed included readmission, repeat surgery, and amputation. Clinical parameters including age, diabetes, smoking, duration of symptoms, involvement of surrounding structures (felon, dorsal abscess, osteomyelitis, septic arthritis), culture growth, Michon classification, and duration of antibiotics were analyzed as possible risk factors for poor outcome. The level of evidence of this study is Level 3 Retrospective Cohort Study. Results Seventy-five patients were treated with outpatient oral antibiotics and 35 patients were treated with inpatient IV antibiotics. The oral antibiotics group received antibiotics for 13.1 +/- 9.9 days compared to 18.1 +/-10.4 days in the IV antibiotic group. Patients in the oral antibiotic group had a significantly shorter length of hospitalization at 0.6 +/-1.8 days compared to 3.6 +/-1.8 days in the IV antibiotic group. The readmission rate for the oral antibiotic group was 10.7% compared to 5.7% in the IV antibiotic group. This difference was not statistically significant except in patients who had involvement in surrounding structures. There was no significant difference in repeat surgeries or amputations between the groups. Conclusions The use of outpatient oral antibiotics after surgical debridement for PFT does not significantly increase rates of readmission, repeat surgery, or amputation, except in cases with the involvement of surrounding structures. On subgroup analysis, anaerobic infection and diabetes were significantly associated with amputations. Post-operative oral antibiotics and immediate discharge may be considered for PFT after adequate surgical debridement with close outpatient follow-up in the absence of surrounding structure involvement and diabetes.
引言 化脓性屈指肌腱腱鞘炎（PFT）是一种常见的手部感染，可导致严重的发病情况。尽管治疗包括手术清创和住院静脉注射（IV）抗生素，但指导抗生素使用的文献却很匮乏。本研究旨在确定与在机构环境中给予静脉抗生素相比，术后门诊口服抗生素的使用是否会导致不良结局。
方法 对2016年至2019年在我院接受术后门诊口服或住院静脉抗生素治疗的110例患者进行回顾性研究。所有患者均接受了手术清创。分析的主要结局包括再入院、再次手术和截肢。对年龄、糖尿病、吸烟、症状持续时间、周围结构受累情况（脓性指头炎、背侧脓肿、骨髓炎、化脓性关节炎）、培养结果、米雄分类以及抗生素使用时间等临床参数作为不良结局的可能危险因素进行了分析。本研究的证据级别为3级回顾性队列研究。
结果 75例患者接受门诊口服抗生素治疗，35例患者接受住院静脉抗生素治疗。口服抗生素组接受抗生素治疗的时间为13.1±9.9天，而静脉抗生素组为18.1±10.4天。口服抗生素组患者的住院时间明显较短，为0.6±1.8天，而静脉抗生素组为3.6±1.8天。口服抗生素组的再入院率为10.7%，而静脉抗生素组为5.7%。除了周围结构受累的患者外，这种差异无统计学意义。两组之间再次手术或截肢情况无显著差异。
结论 除周围结构受累的病例外，PFT手术清创后使用门诊口服抗生素不会显著增加再入院、再次手术或截肢的发生率。亚组分析显示，厌氧菌感染和糖尿病与截肢显著相关。在没有周围结构受累和糖尿病的情况下，经过充分的手术清创并进行密切的门诊随访后，PFT患者可考虑术后口服抗生素并立即出院。
