Diabetic hand infections managed at a regional general hospital: a retrospective cohort study of clinical features, surgical outcomes, and the impact of infection depth and comorbidities

Purpose: Patients with diabetes mellitus (DM) are predisposed to hand infections due to immune dysfunction, angiopathy, and impaired wound healing. Despite their potential for severe complications, diabetic hand infections remain under-recognized. This study aimed to evaluate the clinical features of diabetic hand infections and identify factors associated with adverse outcomes.Methods: We retrospectively reviewed 23 patients with DM hospitalized for hand infections at a regional general hospital between July 2015 and April 2025, including both referred and emergency cases. Infections were classified as superficial hand infection (SHI) or deep hand infection (DHI). Clinical characteristics, microbiological findings, surgical interventions, and outcomes were analyzed. Potential predictors, including body mass index, hemoglobin A1c, DM duration, insulin dependence, infection depth, renal failure, and culture results, were evaluated for associations with outcomes such as amputation, multiple operations (≥2), and mortality.Results: Of the 23 patients (mean age, 63.0 years), 15 had DHI and eight had SHI. All patients underwent surgical debridement; 47.8% required primary amputation, and 17.4% underwent secondary amputation. Deep infection was significantly associated with a higher risk of amputation (odds ratio, 12.8; 95% confidence interval, 1.7–97.2; p=0.013). Within 1 year of admission, five patients died, all due to underlying comorbidities. Gram-negative organisms were more frequently isolated than expected, and fungal infections occurred in three patients.Conclusion: DHI in patients with DM may confer a markedly increased risk of amputation. Early recognition of high-risk features and prompt surgical management may improve outcomes. Prospective multicenter studies are warranted to establish optimal treatment strategies.