title: Septic Tenosynovitis of the Hand: Factors Predicting Need for Subsequent Débridement.
abstract: BACKGROUND
  Treatment of septic hand tenosynovitis is complex, and often requires multiple débridements and prolonged antibiotic therapy. The authors undertook this study to identify factors that might be associated with the need for subsequent débridement (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 débridement 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 débridement": 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).
  
  
  CONCLUSIONS
  In septic tenosynovitis of the hand, the only presenting factor that was statistically predictive of an increased risk of needing a second débridement was the presence of a subcutaneous abscess.
  
  
  METHODS
  Risk, III.
authors: Geneva and Lausanne, Switzerland; and Oxford, United Kingdom From the Hand Surgery Unit, Department of Orthopaedic Surgery, Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva; and the Department of Infectious Diseases, University of Oxford.
authors: Camillo T
authors: CT
authors: Müller
authors: Ilker
authors: I
authors: Uçkay
authors: Paolo
authors: P
authors: Erba
authors: Benjamin A
authors: BA
authors: Lipsky
authors: Pierre
authors: P
authors: Hoffmeyer
authors: Jean-Yves
authors: JY
authors: Beaulieu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010326:Pasteurella Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D016979:Pasteurella multocida / Q000302:isolation & purification; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D013717:Tenosynovitis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents