Hand infections. Bacteriology and treatment: a prospective study
E. P. Dellinger, M. J. Wertz, S. D. Miller and M. B. Coyle
Department of Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle 98104.
In a prospective, double-blind study, 193 patients hospitalized for
established hand infections were randomized to receive either cefamandole
intravenously followed by cephalexin by mouth or methicillin intravenously
followed by dicloxacillin by mouth. Careful aerobic and anaerobic cultures
were performed. Multiple organisms grew in cultures from 84% of the
patients (over three isolates per infection on average). Human bite wounds
contained anaerobes 43% of the time compared with 12% for other wounds. The
majority of wounds (72%) required operative treatment. In 128 patients
assessable for treatment outcome, results were unsatisfactory in 11 (9%).
There was no difference in outcome between cefamandole (6/59, 10%) and
methicillin (5/59, 8%). The presence of anaerobes, Eikenella corrodens,
human bites, or an increasing number of organisms was associated with an
unsatisfactory response. The presence of Staphylococcus aureus and/or
beta-hemolytic streptococci was associated with a favorable response. The
incidence of antibiotic-resistant isolates did not correlate with outcome.