Simmen H P, Giovanoli P, Battaglia H, Wüst J, Meyer V E
Department of Surgery, University of Zurich Medical School, Switzerland.
J Hand Surg Br. 1995 Dec;20(6):797-800. doi: 10.1016/s0266-7681(95)80050-6.
Despite surgical advances and new antibiotics, upper extremity infections continue to present a serious problem. Soft tissue infections of the upper extremities were prospectively examined to elucidate incidence, cause, bacterial pathogens involved, and treatment. Special attention was paid to infections associated with parenteral drug abuse. During an 18-month period all patients over 16 years of age presenting for treatment of an established infection were included in the study. Conservative treatment consisted of immobilization and antibiotics. Radical débridement with removal of all necrotic tissue was the guideline for operative care. In addition, for both regimens a penicillinase-resistant antibiotic was administered. A total of 415 patients (271 men and 144 women; mean age 36.7 +/- 14.5 years) were enrolled into the study, 55 of whom were parenteral drug abusers; 45 of these were HIV-reactive. Infections of fingers (excluding paronychia), paronychia and abscesses at injection sites were the most common diagnoses. Operative and conservative treatment were performed in 285 and 130 patients respectively. Staphylococcus and streptococcus species were the predominant organisms recovered from 212 specimens of pus. Anaerobic bacteria and yeasts were of minor importance. Therefore, a penicillinase-resistant antibiotic is a good initial choice.
尽管外科技术取得了进步，也有了新型抗生素，但上肢感染仍然是一个严重的问题。我们对上肢软组织感染进行了前瞻性研究，以阐明其发病率、病因、相关细菌病原体及治疗方法。特别关注了与静脉药物滥用相关的感染。在18个月的时间里，所有16岁以上前来治疗已确诊感染的患者都被纳入了研究。保守治疗包括固定和使用抗生素。手术治疗的原则是彻底清创，清除所有坏死组织。此外，两种治疗方案均使用了耐青霉素酶的抗生素。共有415名患者（271名男性和144名女性；平均年龄36.7±14.5岁）被纳入研究，其中55名是静脉药物滥用者；其中45名HIV检测呈阳性。手指感染（不包括甲沟炎）、甲沟炎和注射部位脓肿是最常见的诊断。分别有285名和130名患者接受了手术治疗和保守治疗。从212份脓液标本中分离出的主要病原体是葡萄球菌和链球菌。厌氧菌和酵母菌不太重要。因此，耐青霉素酶的抗生素是一个很好的初始选择。
