title: Antimicrobial management of septic arthritis of the hand and wrist.
abstract: OBJECTIVE
  The optimal antimicrobial treatment for patients with hand or wrist septic arthritis is unknown. We report the treatment outcomes in patients with these infections.
  
  
  METHODS
  The medical records of 40 consecutive adult patients with hand or wrist septic arthritis treated at our institution from 2000 to 2008 were retrospectively reviewed. The primary outcome measure was treatment failure (histopathologic or microbiologic evidence of relapsed infection from the same joint or a contiguous anatomic area).
  
  
  RESULTS
  Involved joints were the wrist (n = 10, 25 %), metacarpal-phalangeal (n = 11, 27.5 %), proximal interphalangeal (n = 8, 20 %), distal interphalangeal (n = 10, 25 %), and thumb interphalangeal (n = 1, 2.5 %). Methicillin-sensitive (n = 15, 45 %) and -resistant (n = 7, 17.5 %) Staphylococcus aureus were the most common pathogens. Surgical therapies included open arthrotomy with debridement (n = 33, 82.5 %), arthroscopic debridement (n = 2, 5 %), and aspiration alone (n = 5, 12.5 %). Most patients (23/40, 58 %) received less than 1 week of parenteral antimicrobial therapy. Only two patients developed definite antimicrobial treatment failure, one of whom had an atypical mycobacterium infection. Patients with subacute to chronic infections were at high risk for finger amputation.
  
  
  CONCLUSIONS
  When combined with surgical debridement, relatively short courses of parenteral antimicrobial treatment (<1 week) supplemented with oral therapy for an additional 2-3 weeks is usually sufficient antimicrobial therapy for hand or wrist septic arthritis.
authors.affiliation: Section of Infectious Disease, Department of Internal Medicine, Gundersen Health System, 1900 South Avenue, Mail Stop C04-001, La Crosse, WI, 54601, USA, tjkowals@gundersenhealth.org.
authors.forename: T J
authors.initials: TJ
authors.lastname: Kowalski
authors.forename: L A
authors.initials: LA
authors.lastname: Thompson
authors.forename: J D
authors.initials: JD
authors.lastname: Gundrum
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D001707:Biopsy, Needle; D003646:Debridement; D005260:Female; D006225:Hand / Q000382:microbiology* / Q000601:surgery; D050823:Hand Joints / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D013211:Staphylococcus aureus / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents