Hand infections in the elderly.

Diagnosis and management of hand infections in the elderly can be challenging. The general principles of rest, elevation, compresses, and drainage when appropriate apply. Antibiotics are important to therapy. Review of data from elderly patients and comparison with a younger population having identical infections show a number of important differences. Temperature, pulse, and white blood cell and differential counts were not elevated significantly enough to be useful. Culture data show fewer pure Staphylococcus aureus infections (20%) and fewer pure gram-positive infections (20%) than the 34% and 56% respectively in a younger population. On the other hand, there were significantly more mixed gram-positive and gram-negative infections (60%). Significantly, the average number of organisms per infection is increased (2.4 vs 1.9 per infection). Antibiotic susceptibility is significantly worse. The cephalosporins and the penicillinase-resistant antibiotics remain good choices.