Puncture Wound Infections

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Topic updated on 03/07/13 7:02pm
Introduction
  • Mechanism is usually a nail or stick through a sock
    • organism
      • Pseudomonos aeruginosa (gram negative rod) is most common organism from a nail puncture through a sneaker
      • different organisms more common in diabetic and immunocompromised patients
  • Epidemiology
    • following nail puncture through a shoe
      • soft tissue infection occurs in 10% to 15% of cases 
      • osteomyelitis develops in 1-2% of cases
Presentation
  • Presentation
    • often present weeks to a month after initial injury
    • limb
  • Physical exam
    • swollen and tender foot
Imaging
  • Radiographs
    • normal early
    • bone destruction seen later
  • Diagnosis
    • MRI
Treatment
  • Puncture without establish infection
    • prophylactic antibiotic treatment for a recent puncture wound with no clear evidence of infection is controversial
  • Clear evidence of infection
    • ceftazidime or cefepime antiobiotic therapy
      • for established infection initial antibiotics should include ceftazidime or cefepime
      • alternatives include ciprofloxacin (in adults), imipenem, cilastin, 3rd generation cephalosporin
    • surgical debridement
      • indicated in deep infection with osteomyelitis that is not improving with oral antibiotics

 

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