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Damayanthi , E. D , Chaidir , R , Hidajat , NN, Arsa , W

Characteristic Hand Infection in Diabetic Patients at Hasan Sadikin General Hospital From January 2009 To September 2012. Damayanthi , E. D , Chaidir , R , Hidajat , NN, Arsa , W Department of Orthopaedic & Traumatology

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Damayanthi , E. D , Chaidir , R , Hidajat , NN, Arsa , W

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  1. Characteristic Hand Infection in Diabetic Patients at HasanSadikin General Hospital From January 2009 To September 2012 Damayanthi , E. D, Chaidir, R, Hidajat, NN, Arsa, W Department of Orthopaedic & Traumatology Faculty of Medicine Universitas Padjadjaran – Hasan Sadikin Hospital, Bandung, Indonesia

  2. Introduction Diabetes mellitus systemic disease associated with increased incidence of morbidity and mortality. 1 Wound infection Imbalance between host resistance and microorganisms, immune defences.1 Diabetic patients have higher chance of getting the hand infections. 1. StottsNA, Wound Infections, Diagnosis and Management, Mosby, Philadelphia, pp. 101106, 2004.

  3. Introduction Infection of the hand is less well recognized than foot Reports from western countries show an increase from less than 5% in 1970 more than 10% in 1999 incidence of diabetes who require a hospital admission for significant hand infection. 2 Tropical Diabetic Hand Syndrome (TDHS) diabetes among patients who have progressive, fulminant hand sepsis. 2 2. BetotmaneA, Faraoun K, Mohhamedi F, Benkhelifa T, Amani ME, Infections of the upper extremity in hospitalized diabetic patients, a prospective study, Diabetes Metab 30:917, 2004.

  4. To find out Characteristic in Diabetic hand infection, Clinical history, Pathological diagnosis, Bacteriology types and numbers of microorganism, type of operations and managementin HasanSadikin Hospital Bandung Period January 2009 – September 2012

  5. Material and Method

  6. Material and Method • Characteristic of hand infection identified from - Clinical history and examination - Pathological diagnosis - Bacteriology types and numbers of microorganism - Type of operations and management • Broad spectrum antibiotic started empirically then adjusted according to the culture and sensitivity report

  7. Result N = 21

  8. Result N = 21

  9. Result N = 21

  10. Result N = 21

  11. Case 1, Male 45 yo

  12. Case 2, Male 43 yo

  13. Case 3, Male 52 yo

  14. Discussion Than non diabetic patients • Hand infections in diabetic patient results deep tissue involvement, multiple operations, sometimes amputation and longer hospital stay • In our series, of 21 patients: → 10 had infections containing gram positive, → 8 gram negative , → 3 fungal infection • We found a similarity of growth pattern in other studies as well. → Gonzalez et al. reported 46% of polymicrobialinfectionsin his study. → Kouralso showed an increased incidence of gram positive and gram negative organisms in diabetic hand infections. 3,4 3. Gonzalez MH, Bochar S, Novotny J et al., Upper extremity infections in patients with diabetes mellitus, J Hand Surg 24:682686, 1999. 4. Francel TJ, Marshall KA, Savage RC, Hand infections in the diabetic and the diabetic renal transplant recipient, Ann PlastSurg 24:304309, 1990.

  15. Discussion 3. Gonzalez MH, Bochar S, Novotny J et al., Upper extremity infections in patients with diabetes mellitus, J Hand Surg 24:682686, 1999. 4. Francel TJ, Marshall KA, Savage RC, Hand infections in the diabetic and the diabetic renal transplant recipient, Ann PlastSurg 24:304309, 1990. Gonzalez et al. reported 39% of diabetic hand infection required amputation. 3 Two more studies of hand infection reported by Francel et al showed only three amputations in 25 diabetic patients. 3, 4 In our series, amputation was required in four (19 %) patients. Relative low incidence of amputation in our study multiple debridement and aggressive approach towards diabetic hand infection.

  16. Discussion Belcher and Clare showed elevation and proper management of hyperglycemia are most important considerations when dealing with a diabetic hand infection. 5 Our study found length of hospitalization is correlated to severity of infection. Furthermore, if polymicrobial infection is present in patients with severe infections there will be a higher rate of multiple debridement. 5. Belcher HJCR, Clare TD, Mini-symposium: The elective hand, CurrOrthop 17:2843, 2003

  17. Conclusion Most common cause Diabetic hand infectionin HasanSadikin Hospital : - Clinical history and examination : trauma - Pathological diagnosis : abcess - Bacteriology types and numbers of microorganism : staphylococcus - Operations and management : debridement

  18. Thank You

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