Septic Tenosynovitis of the Hand: Factors Predicting Need for Subsequent Debridement
Septic Tenosynovitis of the Hand: Factors Predicting Need for Subsequent Debridement
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DOI：
10.1097/prs.0000000000001510
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发表时间：
2015-09-01
影响因子：
3.6
通讯作者：
Beaulieu, Jean-Yves
中科院分区：
文献类型：
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作者：
Mueller, Camillo T.;Uckay, Ilker;Beaulieu, Jean-Yves
背景：脓毒性手腱鞘炎的治疗是复杂的，通常需要多次清创和长期的抗生素治疗。作者进行了这项研究，以确定可能与由于感染持续或继发性恶化而需要后续清创（在初始清创之后）相关的因素。方法：在这项回顾性单中心研究中，作者纳入了2007年至2010年在急诊科就诊的所有感染性手部腱鞘炎成年患者。结果：作者确定了126例成年患者（55例男性，中位年龄45岁），其中9例免疫抑制。所有患者均有社区获得性感染；34例（27%）有皮下脓肿，8例（6%）有发热。所有患者均接受了至少一次手术清创，并同时接受了抗生素治疗（中位数为15天；范围为7至82天）。18例患者至少需要进行一次额外的手术干预（中位数为1.13次干预；范围为1至5次干预）。在中位随访27个月后，除4例（97%）外，所有患者在第一次尝试时感染均被治愈。通过多变量分析，只有两个因素与手术清创后的结果显著相关：脓肿（OR, 4.6; 95% CI, 1.5 - 14.0）和更长的抗生素治疗时间（OR, 1.2; 95% CI, 1.1 - 1.2）。结论：在手部感染性腱鞘炎中，唯一具有统计学预测性的需要第二次清创的风险增加的表现因素是皮下脓肿的存在。临床问题/证据水平：风险，III。
Background: Treatment of septic hand tenosynovitis is complex, and often requires multiple debridements and prolonged antibiotic therapy. The authors undertook this study to identify factors that might be associated with the need for subsequent debridement (after the initial one) because of persistence or secondary worsening of infection.Methods: In this retrospective single-center study, the authors included all adult patients who presented to their emergency department from 2007 to 2010 with septic tenosynovitis of the hand.Results: The authors identified 126 adult patients (55 men; median age, 45 years), nine of whom were immunosuppressed. All had community-acquired infection; 34 (27 percent) had a subcutaneous abscess and eight (6 percent) were febrile. All underwent at least one surgical debridement and had concomitant antibiotic therapy (median, 15 days; range, 7 to 82 days). At least one additional surgical intervention was required in 18 cases (median, 1.13 interventions; range, one to five interventions). All but four episodes (97 percent) were cured of infection on the first attempt after a median follow-up of 27 months. By multivariate analysis, only two factors were significantly associated with the outcome subsequent surgical debridement: abscess (OR, 4.6; 95 percent CI, 1.5 to 14.0) and longer duration of antibiotic therapy (OR, 1.2; 95 percent CI, 1.1 to 1.2).Conclusion: In septic tenosynovitis of the hand, the only presenting factor that was statistically predictive of an increased risk of needing a second debridement was the presence of a subcutaneous abscess.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.