Introduction Epidemiology common injury in certain work-places (i.e. construction sites) approximately 10% develop infection approximately 1-2% develop osteomyelitis Pathophysiology mechanism of injury usually stepping on a nail or stick through a sock/sole of foot microbiology most common cause of soft tissue infection is Staph aureus most common cause of osteomyelitis is pseudomonas Presentation Presentation often present weeks to a month after initial injury limp Physical exam swollen and tender foot obvious wound, with or without tract well-demarcated erythema may present with lymphadenopathy Imaging Radiographs required views ap and lateral findings normal early bone destruction seen later exclude presence of foreign body MRI indications obtain prior to operative irrigation and debridement used to rule out osteomyelitis may occur in 1-2% Treatment Nonoperative tetanus booster, prophylactic antibiotics (controversial) indications recent (within hours) puncture wound with no evidence of infection if open wound, bedside irrigation and debridement no standard prophylactic abx for acute (within hours) injury, but should cover for Pseudomonas Operative surgical debridement indications late/delayed presentation with deep infection with/without osteomyelitis foreign body removal no improvement with PO antibiotics technique tract and soft tissue debridement deep culture bony curretage (if osteo) packing with wick to allow for healing by secondary intention postoperative follow with IV antibiotics (coverage for pseudomonas) convert to PO antibiotics once clinical picture improves antibiotic choice preferred antibiotics ciprofloxacin or levofloxacin (except in children) alternative antibiotics: ceftazidime or cefepime
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.273) A 37-year-old healthy construction worker presents 1 week after stepping on a nail at work. He reports continued pain, fever, and drainage, and his clinical photo is shown in Figure A. Treatment with 7-days of amoxicillin - clavulanic acid did not improve his symptoms. Which additional antibiotic are you most likely to prescribe? Review Topic QID: 4908 FIGURES: A 1 Doubling the dose of Amoxicillin 6% (174/2737) 2 Trimethoprim and sulfamethoxazole 16% (427/2737) 3 Ciprofloxacin 67% (1829/2737) 4 Rifampin 4% (112/2737) 5 Vancomycin 7% (181/2737) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK