Surgical Upper Extremity Infections in Immunosuppressed Patients : A Comparative Analysis With Diagnosis and Treatment Recommendations for Hand Surgeons
Background: Immunosuppression is encountered in patients with oncologic, transplant, and autoimmune disorders. The purpose of this study is to provide guidance for physicians treating surgical hand and upper extremity (UE) infections in immunosuppressed (IS) patients. Methods: We retrospectively reviewed our database of patients presenting with UE infections over 3 years. IS patients were matched randomly to non-IS patients. Patient background, infection presentation, surgical evaluation, and microbiology variables were recorded. Infection variables included mechanism, location, and type. Outcomes included inpatient length of stay (LOS) and need for repeat drainage. Results: We identified 35 IS and 35 non-IS out of 409 UE infection patients. Patients most commonly had a hematologic malignancy (34%) as their IS class, and the most frequent immunosuppressive medication was glucocorticoids (57%). IS patients were more likely to be older and less likely to have a history of drug abuse or hepatitis C virus infections. IS infections were more likely to have idiopathic mechanisms, more likely to involve deeper anatomy such as joints, bone, tendon sheath, or muscle/fascia, and less likely to present with leukocytosis. IS cultures more commonly exhibited atypical Mycoplasma or fungus. There was no difference between IS and non-IS patients regarding LOS or recurrent drainage. Conclusions: Mechanism and white blood cell count are less reliable markers of infection severity in IS patients. Physicians treating infections in IS patients should maintain a higher suspicion for deeper involved anatomy and atypical microbiology. Nonetheless, with careful inpatient management and closer surveillance, outcomes in IS patients can approach that of non-IS patients.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:15 |
|---|---|
| Enthalten in: |
Hand (New York, N.Y.) - 15(2020), 1 vom: 01. Jan., Seite 45-53 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Mull, Aaron B [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Comparative Study |
|---|
| Anmerkungen: |
Date Completed 22.04.2021 Date Revised 13.11.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1177/1558944718789410 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM286760282 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM286760282 | ||
| 003 | DE-627 | ||
| 005 | 20231225052455.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1177/1558944718789410 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0955.xml |
| 035 | |a (DE-627)NLM286760282 | ||
| 035 | |a (NLM)30035635 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Mull, Aaron B |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Surgical Upper Extremity Infections in Immunosuppressed Patients |b A Comparative Analysis With Diagnosis and Treatment Recommendations for Hand Surgeons |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 22.04.2021 | ||
| 500 | |a Date Revised 13.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Background: Immunosuppression is encountered in patients with oncologic, transplant, and autoimmune disorders. The purpose of this study is to provide guidance for physicians treating surgical hand and upper extremity (UE) infections in immunosuppressed (IS) patients. Methods: We retrospectively reviewed our database of patients presenting with UE infections over 3 years. IS patients were matched randomly to non-IS patients. Patient background, infection presentation, surgical evaluation, and microbiology variables were recorded. Infection variables included mechanism, location, and type. Outcomes included inpatient length of stay (LOS) and need for repeat drainage. Results: We identified 35 IS and 35 non-IS out of 409 UE infection patients. Patients most commonly had a hematologic malignancy (34%) as their IS class, and the most frequent immunosuppressive medication was glucocorticoids (57%). IS patients were more likely to be older and less likely to have a history of drug abuse or hepatitis C virus infections. IS infections were more likely to have idiopathic mechanisms, more likely to involve deeper anatomy such as joints, bone, tendon sheath, or muscle/fascia, and less likely to present with leukocytosis. IS cultures more commonly exhibited atypical Mycoplasma or fungus. There was no difference between IS and non-IS patients regarding LOS or recurrent drainage. Conclusions: Mechanism and white blood cell count are less reliable markers of infection severity in IS patients. Physicians treating infections in IS patients should maintain a higher suspicion for deeper involved anatomy and atypical microbiology. Nonetheless, with careful inpatient management and closer surveillance, outcomes in IS patients can approach that of non-IS patients | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a hand surgery | |
| 650 | 4 | |a immunosuppression | |
| 650 | 4 | |a infection | |
| 700 | 1 | |a Sharma, Ketan |e verfasserin |4 aut | |
| 700 | 1 | |a Yu, Jenny L |e verfasserin |4 aut | |
| 700 | 1 | |a Hsueh, Kevin |e verfasserin |4 aut | |
| 700 | 1 | |a Moore, Amy M |e verfasserin |4 aut | |
| 700 | 1 | |a Fox, Ida K |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Hand (New York, N.Y.) |d 2006 |g 15(2020), 1 vom: 01. Jan., Seite 45-53 |w (DE-627)NLM182315967 |x 1558-9455 |7 nnns |
| 773 | 1 | 8 | |g volume:15 |g year:2020 |g number:1 |g day:01 |g month:01 |g pages:45-53 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1177/1558944718789410 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 15 |j 2020 |e 1 |b 01 |c 01 |h 45-53 | ||