Characteristics and Outcome of Twenty-Nine Implant-Related Infections of the Hand and Fingers: Results from a Twelve-Year Observational Study.

Meier, Rahel; Wirth, Thomas; Vögelin, Esther; Sendi, Parham (2018). Characteristics and Outcome of Twenty-Nine Implant-Related Infections of the Hand and Fingers: Results from a Twelve-Year Observational Study. Surgical infections, 19(7), pp. 729-734. Mary Ann Liebert 10.1089/sur.2018.133

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BACKGROUND Implant-related infections in hand surgery are dreaded complications, potentially leading to loss of finger joint function or amputation. Knowledge about the clinical presentation and treatment concepts of these infections is limited. The aim of this study is to present a consecutive series of patients with implant-related infections of the finger joints and wrist. PATIENTS AND METHODS We identified 25 patients with 29 implant-related infections. Infections were categorized as osteosynthesis-related infections (ORIs) or arthroplasty-related infections (ARIs). Further categorization included early and late post-operative (four weeks or less or more than four weeks after implantation) and exogenous and hematogenous infection. RESULTS Compared with patients with ARIs (n = 11), those with ORIs (n = 14) were predominantly male (n = 11), were younger (mean 43 vs. 65 years, p = 0.0023), had few or no comorbidities, and had an exogenous source of infection. Patients with ARIs were predominantly female with rheumatoid arthritis (n = 8) and had a hematogenous pathogenesis. Infections occurred late in 22 (88%) patients. The most commonly isolated micro-organism was Staphylococcus aureus (n = 12; 48%). All ORIs were treated with implant removal and a median antimicrobial treatment duration of 39 days (interquartile range [IQR] 28-50 days). In the ARI group, the implant was removed in three patients and exchanged in three patients (one-stage exchange in one patient, two-stage exchange in two patients). In five individuals, debridement and implant retention was performed. The median antimicrobial treatment duration for ARIs was 42 days (IQR 30-75 days). The median follow-up time was 96 days (IQR 42-258 days) and infection was cured or presumably cured in 22 patients (88%). CONCLUSION Our series shows distinct host and clinical patterns in ORIs and ARIs, supporting this categorization. The infection prognosis in ORIs is excellent with implant removal and antimicrobial treatment. Treatment concepts in ARIs are often derived from algorithms for periprosthetic joint infections of larger joints and need to be further elucidated.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases > Research
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery > Hand Surgery

UniBE Contributor:

Meier, Rahel; Vögelin, Esther and Sendi, Parham

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

1096-2964

Publisher:

Mary Ann Liebert

Language:

English

Submitter:

Veronika Picha

Date Deposited:

12 Sep 2018 11:31

Last Modified:

21 Feb 2019 13:45

Publisher DOI:

10.1089/sur.2018.133

PubMed ID:

30199330

Uncontrolled Keywords:

hand infections implant-related infections septic arthritis small joints

BORIS DOI:

10.7892/boris.119924

URI:

https://boris.unibe.ch/id/eprint/119924

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