INTRODUCTIONHand infections in patients with end-stage renal failure (ESRF) are more diffi cult to treat and have had the worse outcomes. This paper examines the epidemiology, bacteriology and outcomes of surgically managed upper limb infections in these vulnerable patients.

MATERIALS AND METHODSAll patients from a single centre with surgically-managed upper limb infections between 2001 and 2007 were reviewed. We collected epidemiological data on demographics, type and site of infection, bacteriology, surgical treatment, complications and mortality.

RESULTSForty-seven out of 803 (6%) patients with surgically managed upper limb infections in the study period had ESRF. The average age was 59 years. ESRF was secondary to diabetes in 88% of cases. Patients presented on average 7 days after onset of symptoms. Abscesses (34%), wet gangrene (26%) and osteomyelitis (11%) were the commonest infections. Methicillin-resistant Staphylococcus aureus (MRSA) was the commonest pathogen (29%), occurring either in isolation or with other organisms. Eighteen percent of single organisms cultured were gram-negative. Multiple organisms occurred in 29%. A median of 2 operations were required. Thirty-six percent of all cases required amputation. Twenty-fi ve percent of patients had a life-threatening event (myocardial infarction or septic shock) during treatment.

CONCLUSIONSESRF patients present late with severe upper limb infections. Nosocomial infections are common. Initial empirical antibiotic treatment should cover MRSA and gram-negative bacteria. Immediate referral to a hand surgery unit is recommended. Multi-disciplinary management of the patient with input from physicians and anaesthetists or intensivists in the perioperative period is necessary to optimise the patient for surgery and to manage active medical comorbidities and complications after surgery.

Adult ; Aged ; Aged, 80 and over ; Amputation ; Diabetes Complications ; Epidemiologic Studies ; Female ; Hand ; surgery ; Hand Injuries ; epidemiology ; etiology ; surgery ; Humans ; Kidney Failure, Chronic ; complications ; epidemiology ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Surgical Wound Infection ; drug therapy ; epidemiology ; etiology

The major aims of this study were to estimate the infection rate and recognize the risk factor for ventriculoperitoneal (VP) shunt infections in children. To analyze shunt infection rate and identify risk factors, a retrospective cohort analysis of 333 consecutive VP shunt series was performed at Seoul National University Children's Hospital in Korea between January 2005 and February 2011. Overall, 35 shunts (10.5%) were infected, which represented an infection rate of 0.075 infection cases per shunt per year. VP shunt infection occurred at a median of 1 month (range, 6 days to 8 months) after insertion. An independent risk factor for shunt infection was undergoing an operation before the first year of life (relative risk 2.31; 95% confidence interval, 1.19-4.48). The most common causative microorganism was coagulase-negative staphylococci in 16 (45.7%) followed by Staphylococcus aureus in 8 (22.9%). Methicillin resistance rate was 83.3% among coagulase-negative staphylococci and S. aureus. In this study, cerebrospinal fluid shunt infection rate was 10.5%. Infection was frequently caused by methicillin-resistant coagulase-negative staphylococci and S. aureus within two months after shunt surgery. Vancomycin may be considered as the preoperative prophylaxis for shunt surgery in a situation where methicillin resistance rate is very high.
Anti-Bacterial Agents/therapeutic use ; Bacterial Infections/drug therapy/*epidemiology/microbiology ; Child ; Child, Preschool ; Cohort Studies ; Humans ; Hydrocephalus/surgery ; Incidence ; Infant ; Infant, Newborn ; Male ; Methicillin-Resistant Staphylococcus aureus/isolation & purification ; Retrospective Studies ; Risk Factors ; Staphylococcus/isolation & purification ; Surgical Wound Infection/drug therapy/*epidemiology/etiology ; Vancomycin/therapeutic use ; Ventriculoperitoneal Shunt/*adverse effects