A microbiological analysis of 210 cases of hand osteomyelitis

Objective

Osteomyelitis of the hand in adults often requires debridement of necrotic tissue and antibiotics targeted at organisms isolated from bone samples. This study aims to review organisms associated with hand osteomyelitis to inform clinical decision making.

Methods

A retrospective review of the organisms isolated from 210 patients with osteomyelitis of the phalanges and metacarpals of the hand in a major trauma centre was performed over twelve years.

Results

Microbiological cultures were performed for 195 patients including 122 with positive bone cultures. Staphylococcus aureus was identified in 104 patients (50%), with coagulase negative staphylococci in 57 (27%) and Enterobacterales in 53 (25%). Eighty-eight were polymicrobial infections (42%). Arterial calcification was associated with polymicrobial infections, Enterobacterales and enterococci. Multi-drug resistant organisms occurred in 13 patients and were more frequently Enterobacterales than staphylococci or enterococci.

Conclusions

The high incidence of polymicrobial infections and coagulase negative staphylococci in this series suggests that for suspected cases, early microbiological and histopathological confirmation, ideally via bone biopsy, is optimal for osteomyelitis of the hand.

Level of evidence: IV.