{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:24:15Z","timestamp":1786973055756,"version":"build-2736575974"},"reference-count":47,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Posttraumatic infections are common in emergency hand surgery. Amputation is the worst outcome and can occur at admission or during the course of antibiotic treatment and iterative surgical debridement. We wondered if the prolongation of antibiotic treatment beyond the usual indication, and more surgical debridement besides its immediate benefit, could reveal additional preventive effect against amputation during or immediately after therapy. Methods: We investigate 166 risk association (variables) of community-acquired (traumatic) hand infection with overall treatment failure using a specifically designed retrospective single-center cohort between 1 November 2018 and 31 October 2020. Results: Among 600 patients (362 males; 71 (11.8%) with diabetes mellitus), 58 (9.7%) required initially unplanned amputation during the therapeutic ourse. Multivariate Cox regression analysis identified only inherent risks associated with \u201camputation\u201d: male sex (hazard ratio [HR] 3.12, 95% confidence interval [CI] 1.28\u20137.69, p = 0.01), age (HR 1.03, 95% CI 1.01\u20131.04, p = 0.03), diabetes (HR 2.40, 95% CI 1.15\u20135.01, p = 0.02), whereas no interventional variables such as early flapping or antibiotic-related parameters (early empirical antibiotic use, total duration of antibiotics including its initial parenteral use, and choice of agent) altered outcomes. Conclusions: In severe (traumatic) hand infections among 600 patients, the outcomes were determined by the extent of trauma and underlying comorbidities. The outcomes do not seem to be effectively reduced by more surgery or initial antibiotic treatment.<\/jats:p>","DOI":"10.3390\/jcm15166314","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:01:26Z","timestamp":1786968086000},"page":"6314","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variables Associated with Amputation Among 600 Community-Acquired Hand Infections\u2014A Surgical and Infectiology Cohort"],"prefix":"10.3390","volume":"15","author":[{"given":"Camillo T.","family":"M\u00fcller","sequence":"first","affiliation":[{"name":"Clinic for Plastic, Reconstructive & Aesthetic Surgery, Evangelical Clinics Essen-Mitte, 45136 Essen, Germany"},{"name":"BeYou.medical S\u00e0rl Private Clinic, 1004 Lausanne, Switzerland"},{"name":"Service de Chirurgie Plastique, Reconstructive et Esth\u00e9tique et de Chirurgie de la Main, D\u00e9partement de L\u2019appareil Locomoteur, Facult\u00e9 de Biologie et M\u00e9decine, University of Lausanne, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Gr\u00fcnfelder","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery, Burn Center, Department for Plastic Surgery, BG Klinik Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany"},{"name":"Plastic and Reconstructive Surgery, Burn Center, Department for Hand- and Peripheral Nerve Surgery and Rehabilitation, BG Klinik Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5552-0973","authenticated-orcid":false,"given":"Ilker","family":"U\u00e7kay","sequence":"additional","affiliation":[{"name":"Infectiology, Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin","family":"Haug","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery, Burn Center, Department for Plastic Surgery, BG Klinik Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany"},{"name":"Plastic and Reconstructive Surgery, Burn Center, Department for Hand- and Peripheral Nerve Surgery and Rehabilitation, BG Klinik Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany"},{"name":"Department of Plastic, Reconstructive, and Aesthetic Surgery, Vivantes Klinikum im Friedrichshain, 10249 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3402-2860","authenticated-orcid":false,"given":"Ulrich","family":"Kneser","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery, Burn Center, Department for Plastic Surgery, BG Klinik Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany"},{"name":"Plastic and Reconstructive Surgery, Burn Center, Department for Hand- and Peripheral Nerve Surgery and Rehabilitation, BG Klinik Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7061-0512","authenticated-orcid":false,"given":"Leila","family":"Harhaus","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery, Burn Center, Department for Plastic Surgery, BG Klinik Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany"},{"name":"Plastic and Reconstructive Surgery, Burn Center, Department for Hand- and Peripheral Nerve Surgery and Rehabilitation, BG Klinik Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany"},{"name":"Department of Hand, Plastic, and Microsurgery, Burn Center, Klinikum Unfallkrankenhaus Berlin, Hand, Replantation, and Microsurgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"},{"name":"Department of Plastic and Reconstructive Surgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Aman","sequence":"additional","affiliation":[{"name":"Service de Chirurgie Plastique, Reconstructive et Esth\u00e9tique et de Chirurgie de la Main, D\u00e9partement de L\u2019appareil Locomoteur, Facult\u00e9 de Biologie et M\u00e9decine, University of Lausanne, 1011 Lausanne, Switzerland"},{"name":"Plastic and Reconstructive Surgery, Burn Center, Department for Plastic Surgery, BG Klinik Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany"},{"name":"Department of Hand, Plastic, and Microsurgery, Burn Center, Klinikum Unfallkrankenhaus Berlin, Hand, Replantation, and Microsurgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"},{"name":"Department of Plastic and Reconstructive Surgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1089\/sur.2007.031","article-title":"Review of Community-Referred Hand Infections","volume":"9","author":"Anwar","year":"2008","journal-title":"Surg. 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