Risk factors for reoperation in primary hand infections: a multivariate analysis

  • A. Arsalan-WernerEmail author
  • P. Grisar
  • M. Sauerbier



Severe hand infection might cause severe morbidity including stiffness, contracture and possibly amputation. The purpose of this study was to analyse the current epidemiology of adult acute hand infections in a European Hand Surgery Centre and to identify risk factors for secondary surgery.

Materials and methods

We retrospectively analyzed a cohort of 369 consecutive patients with primary infection of the hand that were admitted to our department and required operative treatment. The following variables were recorded: demographics, medical history, cause and location of infection, laboratory values, cultured microorganisms and reoperation rate. Univariate logistical regression was used to identify variables associated with reoperation and backward selection was applied to identify the final multiple variable model.


The mean age at the time of operation was 50.5 years (SD 16.1, range 19–91) and 65.6% of patients were male. Sharp cuts or lacerations were the most common cause (29.0%) for hand infections. 81 different species were cultivated and in 47 patients (12.7%), the cultures were positive for more than one organism. Staphylococcus aureus was the most common cultured organism (19.5%). There were relatively few cases of methicillin-resistant Staphylococcus aureus (2.2%). 80 patients (21.7%) needed more than one operation. We identified three risk factors for reoperation in a multivariate analysis: an elevated value of C-reactive protein at the time of admission, involvement of multiple sites and bacterial growth in culture.


The rate of infections with MRSA in this European cohort was lower compared to reports from the USA. Thus, hand surgeons should choose their empiric antibiotic therapy depending on their patient population. The knowledge of risk factors for severe hand infections might help surgeons to identify patients at risk for additional surgery early.


Hand infection Incidence Methicillin-resistant Staphylococcus aureus Reoperation 



The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors have no conflicting interests.

Ethical approval

The ethics committee of the regional State chamber of Medicine approved the study (FF 2/2018).


  1. 1.
    Akdemir O, Lineaweaver W (2011) Methicillin-resistant Staphylococcus aureus hand infections in a suburban community hospital. Ann Plast Surg 66(5):486–487CrossRefGoogle Scholar
  2. 2.
    Babovic N, Cayci C, Carlsen BT (2014) Cat bite infections of the hand: assessment of morbidity and predictors of severe infection. J Hand Surg Am 39(2):286–290CrossRefGoogle Scholar
  3. 3.
    Bach HG, Steffin B, Chhadia AM, Kovachevich R, Gonzalez MH (2007) Community-associated methicillin-resistant Staphylococcus aureus hand infections in an urban setting. J Hand Surg Am 32(3):380–383CrossRefGoogle Scholar
  4. 4.
    Chapman T, Ilyas AM (2019) Pyogenic flexor tenosynovitis: evaluation and treatment strategies. J Hand Surg Am 44(11):981–985CrossRefGoogle Scholar
  5. 5.
    Fowler JR, Ilyas AM (2013) Epidemiology of adult acute hand infections at an urban medical center. J Hand Surg Am 38(6):1189–1193CrossRefGoogle Scholar
  6. 6.
    Gilchrist B (1996) Wound infection. 1. Sampling bacterial flora: a review of the literature. J Wound Care 5(8):386–388CrossRefGoogle Scholar
  7. 7.
    Gorwitz R, Jernigan D, Powers J, Jernigan J, Jernigan D (2006) Strategies for clinical management of MRSA in the community: summary of an experts’ meeting convened by the centers for disease control and prevention. Centers for Disease Control and Prevention.
  8. 8.
    Gustafsson R, Johnsson P, Algotsson L, Blomquist S, Ingemansson R (2002) Vacuum-assisted closure therapy guided by C-reactive protein level in patients with deep sternal wound infection. J Thorac Cardiovasc Surg 123(5):895–900CrossRefGoogle Scholar
  9. 9.
    Harrison B, Ben-Amotz O, Sammer DM (2015) Methicillin-resistant Staphylococcus aureus infection in the hand. Plast Reconstr Surg 135(3):826–830CrossRefGoogle Scholar
  10. 10.
    Hassan S, Gashau W, Balchin L, Orange G, Wilmshurst A (2011) Incidence of community-acquired meticillin resistant Staphylococcus aureus hand infections in tayside, Scotland: a guide to appropriate antimicrobial prescribing. J Hand Surg Eur 36(3):226–229CrossRefGoogle Scholar
  11. 11.
    Hohendorff B, Sauer H, Biber F et al (2017) Treatment of digital pyogenic flexor tenosynovitis: single open debridement, irrigation, and primary wound closure followed by antibiotic therapy. Arch Orthop Trauma Surg 137(1):141–145CrossRefGoogle Scholar
  12. 12.
    Houshian S, Seyedipour S, Wedderkopp N (2006) Epidemiology of bacterial hand infections. Int J J Infect Dis IJID 10(4):315–319CrossRefGoogle Scholar
  13. 13.
    Huang Y, Cao Y, Zou M et al (2016) A comparison of tissue versus swab culturing of infected diabetic foot wounds. Int J Endocrinol 2016:8198714PubMedPubMedCentralGoogle Scholar
  14. 14.
    Kheiran A, Palial V, Rollett R, Wildin CJ, Chatterji U, Singh HP (2019) Cat bite: an injury not to underestimate. J Plast Surg Hand Surg. CrossRefPubMedGoogle Scholar
  15. 15.
    Lever A, Mackenzie I (2007) Sepsis: definition, epidemiology, and diagnosis. BMJ (Clinical research ed.) 335(7625):879–883CrossRefGoogle Scholar
  16. 16.
    Lisboa T, Waterer G, Rello J (2010) We should be measuring genomic bacterial load and virulence factors. Critical Care Medicine 38(10 Suppl):S656–S662CrossRefGoogle Scholar
  17. 17.
    Ong YS, Levin LS (2009) Hand infections. Plast Reconstr Surg 124(4):225e–233eCrossRefGoogle Scholar
  18. 18.
    Osterman M, Draeger R, Stern P (2014) Acute hand infections. J Hand Surg Am 39(8):1628–1635CrossRefGoogle Scholar
  19. 19.
    Phua J, Ngerng W, See K et al (2013) Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Critical care (London, England) 17(5):R202CrossRefGoogle Scholar
  20. 20.
    Pillukat T, Schadel-Hopfner M, Prommersberger KJ, van Schoonhoven J (2011) Closed irrigation system for pyogenic flexor tenosynovitis of the hand. Operative Orthopadie und Traumatologie 23(3):184–191CrossRefGoogle Scholar
  21. 21.
    Saul D, Dresing K (2018) Surgical treatment of bites. Operative Orthopadie und Traumatologie 30(5):321–341CrossRefGoogle Scholar
  22. 22.
    Smith ME, Robinowitz N, Chaulk P, Johnson K (2014) Comparison of chronic wound culture techniques: swab versus curetted tissue for microbial recovery. Br J Community Nurs 19(Suppl):S22–S26CrossRefGoogle Scholar
  23. 23.
    Turker T, Capdarest-Arest N, Bertoch ST, Bakken EC, Hoover SE, Zou J (2014) Hand infections: a retrospective analysis. PeerJ 2:e513PubMedGoogle Scholar
  24. 24.
    Wilson PC, Rinker B (2009) The incidence of methicillin-resistant Staphylococcus aureus in community-acquired hand infections. Ann Plast Surg 62(5):513–516CrossRefGoogle Scholar
  25. 25.
    Wolfe S, Pederson W, Kozin S, Cohen M (2016) Green’s operative hand surgery. Elsevier, AmsterdamGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department for Plastic, Hand and Reconstructive Surgery, Hand Trauma Center, BG-Trauma Center Frankfurt am MainAcademic Hospital of the Johann Wolfgang Goethe-University Frankfurt am MainFrankfurt am MainGermany
  2. 2.Department of Trauma and Orthopedic Surgery, BG-Trauma Center Frankfurt am MainAcademic Hospital of the Johann Wolfgang Goethe-University Frankfurt am MainFrankfurt am MainGermany

Personalised recommendations