Purpose
To characterize the clinical presentation, common pathogens, antimicrobial susceptibility,
and treatment methods associated with pyogenic flexor tenosynovitis (PFT) in pediatric
patients.
Methods
Patients who underwent surgical treatment for PFT at a large tertiary-care children’s
hospital between 2001 and 2015 were identified. Descriptive summary statistics were
reported on patient demographics, presenting symptoms and clinical examination features,
culture results, treatment strategies, and early complications.
Results
Thirty-two patients (71.9% male) with a mean age of 9.5 ± 5.5 years (range, 0.8–19
years) were included. At least 3 Kanavel signs were present on presentation in 62%
of the cohort, with all 4 signs identified in 34%. Three children (9%) presented with
0 to 1 Kanavel signs, with semiflexed posturing of the digit as the least commonly
(41%) manifested sign. The most frequently cultured organisms were methicillin-resistant
Staphylococcus aureus (MRSA) (38%), methicillin-sensitive S. aureus (22%), and Pasteurella multocida (13%). Multiple organisms were cultured in 19% of cases. Intravenous antibiotics
were administered for a median duration of 4 days (range, 1–16 days) in all cases.
Organisms were sensitive to the initial antibiotic regimen in 81% of cases. All methicillin-resistant
S. aureus infections were sensitive to vancomycin and trimethroprim-sulfamethoxazole, and 83%
were sensitive to clindamycin. Incision and drainage (I&D) was performed in all cases,
with 18% of patients requiring repeat I&D. Surgical approaches included limited incision
(80%), midaxial incision (13%), and Bruner incision (7%). The average length of hospitalization
was 5.1 days. Infection resolved in all cases without readmission. No neurovascular
complications were identified.
Conclusions
The presence of Kanavel signs at presentation are a meaningful indicator of PFT, but
are not uniformly present on examination in children and adolescents. Owing to the
prevalence of antimicrobial resistance and polymicrobial infection, empirical antibiotic
therapy using broad-spectrum agents with MRSA coverage is essential. In our cohort
of pediatric patients with PFT of sufficient severity to warrant surgical management,
prompt I&D along with culture-guided antibiotics predictably resolves infection.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: March 21, 2017
Accepted:
February 10,
2017
Received:
April 26,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
