Bacterial colonization of mutilating hand injuries and its treatment.

A total of 120 hand injuries were reviewed. Sixty-seven occurred between 1965 and 1972 and were analyzed retrospectively, and 53 occurred between 1972 and 1974 and were analyzed prospectively. The bacterial colonization was determined in 86 injuries. Injuries sustained while handling farm implements tended to be colonized by mixed gram-negative and gram-positive isolates. The gram-negative isolates usually were resistant to all antibiotics, with the exception of gentamicin. However, nine bacterial isolates were resistant to all agents tested. Injuries sustained in the home or industry were colonized by gram-positive organisms. Most were susceptible to semisynthetic penicillinase-resistant penicillins such as methicillin and its congeners. The use of parenteral prophylactic antimicrobial agents in the treatment of mutilating hand injuries was not significant in preventing infection, and their use does not seem to be indicated in farm implement-related injuries. Antimicrobials are of value in home- and industrial-related injuries only when the status of the wound so indicates.