ABSTRACT
INTRODUCTION: The COVID-19 pandemic in France has recently modified the patients' lifestyles, as well as methods of medical and surgical management. This could explain subsequent changes to the microbiological spectrum, the severity, as well as the scalability of phlegmons of the flexor tendon sheath. The objective of this study was to construct an epidemiological and bacteriological inventory of these hand infections, and to compare the clinical and microbiological data, before and after the COVID-19 pandemic. HYPOTHESIS: The hypothesis of this work was that the phlegmons of the flexor tendon sheath presented specific microbiological characteristics in the tropical environment of our University Hospital Center, and that these characteristics could have changed with the recent introduction of hydro-alcoholic solution (HAS) associated to the COVID-19 pandemic. MATERIAL AND METHODS: The preoperative epidemiological data of our patients were collected between January 2016 and December 2020. The stage of severity, according to the classification of Michon, the use of hydro-alcoholic solution, as well as the early clinical evolution were collected. The cohort was then divided into two groups in order to compare the microbiological profiles, the management and the clinical evolution of patients in the pre-COVID period with those in the post-COVID period. RESULTS: A total of 199 patients were included, 154 patients in the pre-COVID period and 26 in the post-COVID period. We found a majority of MSSA (58.3%, N=105) and negative samples comprised 18.9% (N=34). No statistically significant difference was found between the two groups regarding the bacteriological results. The clinical course was judged to be favorable in 93.5% of cases in the pre-COVID group compared to 80.8% in the post-COVID group (p=0.046). The use of HAS (p<0.0001), as well as the initial stage of severity according to Michon, were significantly higher in group 2 (p=0.04). DISCUSSION: The COVID-19 pandemic has not shown any change in the microbiological spectrum, despite the now daily use of HAS in everyday life. The postoperative clinical evolution was significantly less favorable after the onset of COVID and could be explained by an increase in cases with a more advanced initial stage of severity. LEVEL OF EVIDENCE: IV, Observational epidemiological study.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic in France has recently modified the patients' lifestyles, as well as methods of medical and surgical management. This could explain subsequent changes to the microbiological spectrum, the severity, as well as the scalability of phlegmons of the flexor tendon sheath. The objective of this study was to construct an epidemiological and bacteriological inventory of these hand infections, and to compare the clinical and microbiological data, before and after the COVID-19 pandemic. HYPOTHESIS: The hypothesis of this work was that the phlegmons of the flexor tendon sheath presented specific microbiological characteristics in the tropical environment of our University Hospital Center, and that these characteristics could have changed with the recent introduction of hydro-alcoholic solution (HAS) associated to the COVID-19 pandemic. MATERIAL AND METHODS: The preoperative epidemiological data of our patients were collected between January 2016 and December 2020. The stage of severity, according to the classification of Michon, the use of hydro-alcoholic solution, as well as the early clinical evolution were collected. The cohort was then divided into two groups in order to compare the microbiological profiles, the management and the clinical evolution of patients in the pre-COVID period with those in the post-COVID period. RESULTS: A total of 199 patients were included, 154 patients in the pre-COVID period and 26 in the post-COVID period. We found a majority of MSSA (58.3%, n=105) and negative samples comprised 18.9% (n=34). No statistically significant difference was found between the two groups regarding the bacteriological results. The clinical course was judged to be favorable in 93.5% of cases in the pre-COVID group compared to 80.8% in the post-COVID group (p=0.046). The use of HAS (p<0.0001), as well as the initial stage of severity according to Michon, were significantly higher in group 2 (p=0.04). DISCUSSION: The COVID-19 pandemic has not shown any change in the microbiological spectrum, despite the now daily use of HAS in everyday life. The postoperative clinical evolution was significantly less favorable after the onset of COVID and could be explained by an increase in cases with a more advanced initial stage of severity. LEVEL OF EVIDENCE: IV, Observational epidemiological study.
ABSTRACT
Introduction: La pandémie liée au COVID-19 en France a récemment contribué à modifier le mode de vie des patients ainsi que les modalités de prise en charge médico-chirurgicale. Ces facteurs pourraient être la source de modification du spectre microbiologique, de la gravité ainsi que de l’évolutivité des phlegmons des gaines des fléchisseurs. L’objectif de cette étude étaient de faire un état des lieux épidémiologique et bactériologique de ces infections de la main et de comparer les données cliniques et microbiologiques avant et après la crise sanitaire due à la COVID-19. Hypothèse: L’hypothèse de ce travail était que les phlegmons des gaines des fléchisseurs présentaient des caractéristiques microbiologiques spécifiques dans notre Centre Hospitalier Universitaire en milieu tropical, et que celles-ci ont également pu se modifier avec l’introduction récente de solution hydro-alcoolique lié à la pandémie COVID-19. Matériel et méthodes: Entre janvier 2016 et décembre 2020, l’ensemble des données épidémiologiques pré-opératoires de nos patients ont été colligées Le stade de gravité selon Michon, l’usage de solution hydro-alcoolique ainsi que l’évolution clinique précoce ont été recueillis. La cohorte était ensuite divisée en deux groupes afin de comparer les profils microbiologiques, la prise en charge et l’évolution clinique des patients en période pré-COVID de ceux en période post-COVID. Résultats: Un total de 199 patients ont été inclus, 154 patients en période pré-COVID et 26 en période post-COVID. On retrouvait une majorité de SASM (58,3%, n=105) et 18,9% de prélèvements négatifs (n=34). Aucune différence statistiquement significative n’était retrouvée entre les deux groupes concernant les résultats bactériologiques. L’évolution clinique était jugée comme favorable dans 93,5% des cas du groupe pré-COVID contre 80,8% dans le groupe post-COVID (p=0,046). L’utilisation de SHA (p<0,0001) ainsi que le stade de sévérité initial selon Michon étaient significativement plus important dans le groupe 2 (p=0,04). Discussion: La pandémie liée à la COVID-19 n’a pas montré de changement du spectre microbiologique bien que l’usage de SHA se soit introduit dans nos vies quotidiennes. L’évolution clinique post-opératoire était significativement moins favorable après l’apparition de la COVID et pourrait s’expliquer par une augmentation des cas ayant un stade de gravité initial plus avancé. Niveau de preuve. IV, Etude épidémiologique observationnelle