title: The clinical and microbiological profile of the diabetic hand: A retrospective study from South India.
abstract: BACKGROUND
  Pyogenic Infections of the hand in diabetes are largely a tropical entity and published material in the area are rather meagre.
  
  
  METHODS
  This is a retrospective study on the pattern of hand infections and involves the microbiological profile of 39 cases of diabetes hand-related infections admitted to the hospital between the years 2004 and 2010.
  
  
  RESULTS
  This study included 39 patients, among whom 23 (59%) had necrotizing fasciitis (NF), and 16 (9-abscess and 7-tenosynovitis) had nonnecrotizing infection. Among 25 culture positive patients, polymicrobial infections were isolated in 13 (52%) patients, a single organism was isolated in 9 (36%) and 3 (12%) had sterile cultures. Out of the 41 different bacterial isolates, 51.12% were Gram-negative and 48.78% were Gram-positive. Patients with NF had a higher mean glycated hemoglobin (10.83 ± 2.59 vs. 8.64 ± 1.8%,P= 0.020), when compared to the nonnecrotizing group. Patients with NF also had more polymicrobial infections (P= 0.017), and a longer duration of hospitalization when compared to patients without NF (21.8 ± 9.96 vs. 12.7 ± 14.5 days,P= 0.021). Seven (17.94%) patients required amputation of the affected digits of which six (15.38%) had NF.
  
  
  CONCLUSIONS
  Patients with poor glycemic control, polymicrobial infection, delay in presentation, and a prior surgical intervention at another medical center was associated with more severe necrotizing infections. The duration of hospitalization and amputation rates was greater among patients with NF.
authors.affiliation: Dr. Paul Brand Centre for Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Raveendran
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Dukhabandhu
authors.initials: D
authors.lastname: Naik
authors.affiliation: Dr. Paul Brand Centre for Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Raj Pallapati
authors.affiliation: Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: John Jude
authors.initials: JJ
authors.lastname: Prakash
authors.affiliation: Dr. Paul Brand Centre for Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Binu Prathap
authors.initials: BP
authors.lastname: Thomas
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Nihal
authors.initials: N
authors.lastname: Thomas
keywords: Diabetes mellitus; necrotizing fasciitis; polymicrobial infection