Management of soft-tissue infections of the upper extremity in parenteral drug abusers.

Management of extensive soft-tissue infections of the upper extremity in 23 parenteral drug abusers was reviewed. Bacterial cultures most often revealed oral flora, including streptococcal species in 77 percent of patients and anaerobes in 59 percent. Staph. aureus was present in only one patient. Ninety percent of the organisms were sensitive to penicillin and 98 percent to first-generation cephalosporins. Blood culture specimens, obtained at admission, were negative in 15 patients. All patients responded well to operative debridement, excision of involved veins, and local wound care. Surgical debridement is the mainstay of therapy. We believe that intravenous antibiotic therapy with a first-generation cephalosporin should be used in the acute phase for control of surrounding cellulitis and prevention of bacteremia.