If time has elapsed, the wound may have closed over and it can be difficult to locate the area of penetration. Haverstock BD, Grossman JP. Antibiotic therapy is indicated for a puncture wound when the wound is infected or if medical help is sought more than 24 hours after the injury. In time, however, our protocol may change as drug resistance patterns change. Jutila received a Bachelor of Science in biology, and a Master of Science in microbiology from Montana State University. 1994;33(6):561-566. 1653-1658. Punctures near joints or tendons are most urgently in need of medical care because the by-products of infection can irreversibly damage cartilage and tendon sheaths. Therefore, tagged white blood cell scans (i.e. Serious complications can occur, including skin necrosis, deep abscess formation and osteomyelitis. Ceftazidime (Fortaz, Sagent Pharmaceuticals) and aztreonam (Azactam, Bristol-Myers Squibb) are strictly intravenous anti-Pseudomonas antibiotics yet work well for the inpatient setting. Pseudomonas, a type of bacteria, is often the cause: Surgery may be required to debride the infected bone. 19. The diagnosis was cellulitis. Gathering information on the patient’s tetanus status is also important. 1997;36(2):120-126. 10. Lavery L, Harkless LB. Radionuclide imaging is important and very helpful when one suspects osteomyelitis. Sneakers as a source of Pseudomonas aeruginosa in children with osteomyelitis following puncture wounds. Broad-spectrum antibiotics are also a good idea for the patient with diabetes or for a dirty wound. Protect the wound: An antibiotic ointment such as Neosporin or Polysporin can be used. Amoxicillin/clavulanic acid (Augmentin, GlaxoSmithKline), trimethoprim/sulfamethoxazole or combination antibiotics such as clindamycin and ciprofloxacin provide appropriate bacterial coverage. Although deeper structures such as tendons, blood vessels and nerves can be injured from a penetrating object, the most common complication is infection. McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery. 20. Infections following trauma. First aid treatment for a puncture wound includes: Cleaning the wound thoroughly. Large amounts of ointment are not helpful because they can attract bacteria. If not then you need to get vaccinated and treated. MayoClinic.com lists several factors that increase the risk of infection including wound depth, the presence of a retained foreign object and seeking medical help more than 24 hours after the wound occurs 4. Puncture wounds of the foot. If the wound is grossly contaminated and/or a metallic object has penetrated the skin or shoe, adjust empiric antibiotics accordingly. For plant thorn arthritis, anti-inflammatory medications may quiet some of the inflammation. Always take standard radiographs after any puncture wound. When There Is Forefoot Varus: Is The Lapidus Bunionectomy More Effective Than The Cotton Osteotomy? Pseudomonas osteomyelitis after a plantar puncture wound through a rubber sandal. Schwab R, Powers R. Conservative therapy of plantar puncture wounds. Empiric therapy should include parenteral penicillin plus either an antistaphylococcal penicillin or a first-generation cephalosporin. Punctures often don't bleed much and may close up quickly, which is one reason they can be dangerous. Signs and Symptoms of Infection in a Scrape, MayoClinic.com: Puncture Wounds--First Aid, The Merck Manuals Online Medical Library: Antibiotics. Apply an antibiotic. Follow the foot and ankle surgeon’s instructions for care of the wound to prevent complications (see “Puncture Wounds: What You Should Do” further down on this page). 5. It’s important to note that infections can also be caused by less obvious things– like allergies. The classic article by Patzakis and colleagues divided the foot up into three zones and reported associated osteomyelitis.7 Zone 1 extends from the metatarsal necks distally to the end of the toes. Nails (account for 90% of cases) What Are the Treatments for Enterobacter Cloacae? A puncture wound occurs when a sharp object penetrates the skin barrier. 1975;6(4):965-972. 1992;10(4):801-821. It’s likely your doctor will prescribe a several-month course of antifungal medication, such as itraconazole. Infected puncture wounds in the adult with diabetes: risk factors for osteomyelitis. I should have gone to a doctor immediately but I didn't. ... that suggest that there is infection which worsen condition. Radiographs showed a lytic lesion in the base of the fifth metatarsal (Fig. Notably, the erythrocyte sedimentation rate (ESR) may be elevated, especially when osteomyelitis is present. Puncture wounds can be Clostridium-prone, leading to severe systemic infection. Splinters, stickers, and animal bites (from other dogs, mostly) are the most common puncture wounds seen in dogs. J Foot Ankle Surg. Human Bite, Dog Bite, Cat Bite) Delayed presentation (>18 hours) Penrose, closed suction). Zone 2 includes the distal aspect of the calcaneus to the metatarsal necks. so as early as possible consult treating doc. In this setting, empiric antibiotics are not required. Sporotrichosis usually affects the skin or tissues underneath the skin. Fisher MC, Goldsmith JF, Gilligan PH. 6. The way you treat this type of injury is by pouring hydrogen peroxide on the wound to be sure that any bacteria is killed. If not then you need to get vaccinated and treated. Podiatry Today is a trademark of HMP. Clinicians should also try to determine the type of shoe gear the patient wore (if any) and the environment in which the wound occurred as well as the type of penetrating object. Chudnofsky CR, Sebastian S. Special wounds: nail bed plantar puncture and cartilage. 9. Cover the wound with a bandage to keep out harmful bacteria and dirt. The main problem is that the thorns can cause an infection if not treated properly. Krych SM, Lavery LA. Armstrong DG, Lavery LA, Quebedeaux TL, et al. All Rights Reserved. 16. One should start with a comprehensive medical history, including the patient’s current medications and allergies. Clin Podiatr Med Surg. history of MRSA, healthcare worker who is exposed to resistant Staph, multiple hospitalizations, steroid use, etc. Banks and colleagues have noted that “The delay between the time of injury and the initiation of treatment is perhaps the most critical factor in determining whether or not an infection develops and the severity of complications following a puncture wound.”21. N Engl J Med. 12. Cleanse the puncture wound and change the bandage three times a day, and monitor for signs of infection (the same signs as in the cuts section). Computed tomography (CT) can provide superior imaging when it comes to detecting wood deep in tissues.10 Magnetic resonance imaging (MRI) may be helpful, especially in detecting osteomyelitis as MRI provides a precise anatomic location of the infection and assists the surgeon when planning surgical debridement.11 Ultrasound is a very helpful modality in detecting non-radiopaque foreign bodies and is cost-effective. 2a). Antibiotics and anti-tetanus treatment are usually administered following debridement of a puncture wound. Surgical exploration revealed a cavity in the fifth metatarsal base, with pale granulation tissue, pus, and a 1.5-cm long thorn present (Fig. If your dog’s allergies cause them to constantly lick their p… Bougainvillea thorn caused my plant thorn arthritis. Infections associated with puncture wounds that occur in specialized settings such as with animal or human bites and water exposure are discussed in further detail elsewhere. Arthrocentesis -- using a needle to withdraw fluid from a swollen joint -- eventually led to identification of Pantoea agglomerans, a common soil bacteria, causing septic arthritis. Localized, superficial infections are the most common type of puncture wound infectious complication. For current treatment guidelines, see “What The CDC Recommends For Tetanus Vaccines” at left.9, A Guideline For Wound Inspection/Evaluation, One should carefully inspect the wound. Localized, superficial infections are the most common type of puncture wound infectious complication. The most commonly used antibiotics include cephalosporins such as cephalexin, penicillin-type drugs including amoxicillin-clavulanic acid or dicloxacillin, and erythromycin, a macrolide antibiotic. She also holds a Doctorate of Medicine from the University of New Mexico. Many times, traumatic objects may leave a jagged appearance. West J Med. If you are experiencing serious medical symptoms, seek emergency treatment immediately. It is now more than two months later, and while I … If there is a retained foreign body, triangulation with fluoroscopy and/or ultrasound can be helpful. The mold is found on rose thorns, hay, sphagnum moss, twigs, and soil. Infected puncture wounds in the adult with diabetes: Risk factors for osteomyelitis. A white blood cell count and comprehensive metabolic panel can provide insight during suspected infectious processes. 1985;106:607-609. In those cases, advanced imaging studies may be necessary. 1995;13(3):291-5. Antibiotic prophylaxis used in past; Indications to start antibiotics (Risks for Wound Infection) Bite injury (e.g. 2012;29(3):451-8. Butt TS, Khan A, Ahmad MA, et al. It took 1989;150(5):545-547. 11. Apply antibiotic ointments (Bacitracin, Polysporin, Neosporin) to prevent infection. Key Insights On The Microbiology Of Puncture Wounds, Many forms of bacteria have been isolated in puncture wounds of the foot. Bougainvillea thorn puncture treatment Download Here Free HealthCareMagic App to Ask a Doctor All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. The bump can be red, pink, or purple, and usually appears on the finger, hand, o… Stop the Bleeding. 15. However, if a patient does have certain risk factors for developing infection, presents in the delayed treatment setting or presents with a grossly contaminated wound, provide antibiotics. The risk of infection is high. It is important to have a working relationship with infectious disease specialists in your community to ensure the best approach to handle this challenging and evolving dilemma. Infections complicating puncture wounds of the foot. Plain films do not detect osteomyelitis for 10 to 14 days after the establishment of bone infection. Researchers have shown tetanus to be three times more common and associated fatalities are four times more prevalent in this patient population.19 Armstrong and colleagues reviewed the course of patients with diabetes who suffered puncture wounds and found them 46 times more likely to have an amputation than those without diabetes.20. These forms of arthritis require urgent antibiotic treatment. Cost-effectiveness of magnetic resonance imaging in diagnosing Pseudomonas aeruginosa infection after a puncture wound. See Sweaty Tennis Shoe Syndrome; Foreign body Puncture Wound. A seemingly trivial puncture wound can be at risk for infection, osteomyelitis or other complications due to a delayed diagnosis or inappropriate management. These wounds can be limb- or life-threatening, and need aggressive management. In New York City, the prevalence of MRSA is an astounding 24 percent.23 Furthermore, community-acquired MRSA is on the rise throughout the United States.23, In a large, multicenter study in the New England Journal of Medicine, authors determined that “MRSA is the most common identifiable cause of skin and soft tissue infections among patients presenting to emergency departments in eleven U.S. cities. The course of osteomyelitis is often slow and indolent. You may be given antibiotics and a tetanus shot. Address and appropriately administer antibiosis when a patient sustains a traumatic puncture wound. Blume PA, Dey HM, Daley LJ, Arrighi JA, et al. Most puncture wound infections are caused by the bacteria staphylococcus and streptococcus, and antibiotics used for puncture wound infections are known to be effective against these kinds of bacteria. Localized, superficial infections are the most common type of puncture wound infectious complication. 2006;355(7):666-673. J Rheumatol. Am J Med. 17. Of the 36 patients in their study, 34 (94 percent) developed osteomyelitis, pyarthrosis or both. Prophylactic antibiotic use may reduce the incidence of infection in human bite wounds. 1999;16(4):583-596. Orthop Clin North Am. Accordingly, these authors provide a comprehensive guide to the diagnosis and management of puncture wounds. Pay close attention to the skin edges. Pack the wounds open or closed over a drain (i.e. Although most of these wounds heal uneventfully, delayed or inadequate treatment can lead to complications.1 Outcomes often depend on the location and severity of the injury, the patient’s medical status and the type of penetrating object. For the first two days, rewash the area and reapply the antibiotic when you change the dressing. Some puncture wounds are on the surface; however, others can be very deep. Like any other kind of infection, paw infections are preceded by the entrance of bacteria’s, viruses, fungi, or other foreign bodies into the tissue of the paw through an injury. 1996;15:710-711. When a puncture wound presents in the delayed treatment setting, is deep or has significant clinical contamination, one should perform incision and drainage. 1986;26(1):93-95. Nonetheless, all necrotic/non-viable soft tissue and bone should have aggressive debridement with high pressure pulse lavage.23 Sharply incise jagged skin edges to decrease the chance of skin necrosis. Certain ingredients in some ointments can cause a mild rash in some people. 1. Technetium-99m-methylene diphosphonate (Tc99m MDP) bone scans are very sensitive and can detect bone infection within 24 hours of the onset of infection. Laboratory studies may also be under-representative of a severe infection.18, Tetanus immunization history is vital in the patient with diabetes. Penetration into deep structures such as tendons, bursae and joint capsule may allow infectious organisms to establish themselves due to the relative avascularity of these structures. However, X-rays may be inadequate in the detection of small pieces of glass, wood or rubber. Nyska M, Pomeranz S, Porat S. The advantage of computerized tomography in locating a foreign body in the foot. J Foot Ankle Surg. With the emergence of resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE) and multi-drug resistant Pseudomonas, one may argue that empiric antibiotics to cover such resistant organisms are warranted. X-rays can determine the presence of a retained foreign body or if any osseous structure has been breached. The Importance Of Ascertaining An Accurate Patient History. The symptoms of sporotrichosis depend on where the fungus is growing in the body. Premium Questions. Banks AS, Downey MS, Martin DE, et al. Consider appropriate antibiosis and surgical intervention when necessary. To determine depth and possible fascial/capsular/bony involvement, use a blunt, sterile probe.1, If there is no evidence of a retained foreign body and the wound is superficial, small and one discovers it in less than six hours, it is reasonable to cleanse the wound with saline (preferably with a large 20 cc syringe), and cover it with a sterile dressing (see “A Closer Look At The University Of Texas Puncture Wound Scoring System” at right).22. 4. Normal laboratory values in the face of severe infection in diabetics and non-diabetics. In: Handbook of Lower Extremity Infections, Second Edition. 14. The incidence of osteomyelitis is associated with the location of the injury, delay in treatment and whether patients were wearing footwear at the time of injury.6, Various authors have reported the occurrence of osteomyelitis in puncture wounds but with differences in the incidence rate. 21. The first symptom of cutaneous (skin) sporotrichosisis usually a small, painless bump that can develop any time from 1 to 12 weeks after exposure to the fungus. The most common Gram-positive organisms isolated are Staphylococcus aureus, alpha-hemolytic Streptococci and Staphylococcus epidermidis.13 Authors have also identified Gram-negative organisms such as Escherichia coli, Proteus and Klebsiella sp. 2b). The acacia trees dotting the dry Sudanese landscape have large thorns, strong enough to puncture the skin. Michael C. Keller, DPM, FACFAS, Joshua D. Thun, DPM, and Alexander J. Curfman, DPM, By Jeffrey E. McAlister, DPM, FACFAS, and Eric So, DPM, AACFAS |. Pseudomonas is the most common organism responsible for osteomyelitis secondary to puncture wounds.7,16 There is a documented association between rubber soled shoes and Pseudomonal osteomyelitis.16,17 When a nail or other object penetrates the shoe and then the foot, it inoculates the wound with the Pseudomonas organism found on the shoe. Patients with diabetes are often unaware of the initial injury due to a loss of protective sensation. 1990; 7(4):725-731. Currently, at our institution, if a patient presents without risk factors for MRSA colonization, we do not administer routine anti-MRSA antibiotics. Black locust thorn puncture wound . In the operating room setting, obtain deep wound and tissue cultures. In managing pedal puncture wounds, the obvious goal is to prevent complications and/or limit the spread of infectious processes. If the patient requires hospital admission and an intravenous line, one can give broad-spectrum antibiotics such as piperacillin/tazobactam (Zosyn, Pfizer) or imipenem/cilastatin (Primaxin, Merck). When the podiatric physician obtains a thorough history and physical examination in conjunction with the use of imaging and clinical insight, one can avoid most complications. 1987;26(3):530-532. Foot Ankle Trauma. 1997;36(1):36-43 Depth of penetration is an important factor. J Foot Ankle Surg. 1996;101(5):521-525. I was stabbed in the thumb by two thorns and couldn't make the wounds bleed. Wounds from weapons (as during hunting) are also considered fairly routine in certain parts of the U.S. Porcupine quills and grass awns are similarly common in some areas in the U.S. At this point, one should consider a diagnosis of osteomyelitis and/or a retained foreign body. The most commonly used antibiotics include cephalosporins such as cephalexin, penicillin-type drugs including amoxicillin-clavulanic acid or dicloxacillin, and erythromycin, a macrolide antibiotic. Treatment then consisted of oral 875 mg amoxicillin/25 mg clavulanate (Augmentin, GlaxoSmithKline, Brentford, UK) every 12 hours for 7 days, intramuscular Tdap (tetanus immunization; Adacel, Sanofi Pasteur Inc, Lyon, France), and oral analgesics administered every 4 to 6 hours for 5 days. Wounds may go undetected and are at greater risk for infection. Hospitalization and intravenous antibiotics are required for extensive soft tissue infections from a puncture wound. J Emerg Med. Emerg Med Clin. A seemingly trivial puncture wound can be at risk for infection, osteomyelitis or other complications due to a delayed diagnosis or inappropriate management. Copyright © 2020 Leaf Group Ltd., all rights reserved. Treatment with antibiotics is … Remember that timely treatment is essential and consider all risk factors when evaluating these wounds. According to The Merck Manual Online Medical Library, antibiotics are chosen based on the type of infecting bacteria 3. Methicillin-Resistant S. aureus Infections among patients in the emergency department. antibiotics 2 months previously, but the sinus had failed to heal. Because a puncture wound can go directly to the deeper circulation including the lymphtic system, it is often considered a good idea to give preventative antibiotics, as an infection in the circulatory or lymphatic system can rapidly develop into sepsis, which can be lethal, depending on the organism, or at least cause a long hospital stay. Apply a thin layer of an antibiotic cream or ointment (Neosporin, Polysporin). 1997;24(8):1649-1652. A seemingly benign puncture wound may have inadequate treatment, which often leads to complications.1. ), it would be prudent to treat these patients empirically with anti-MRSA antibiotics.23. Joseph WS. Joseph WS, LeFrock JL. Lavery LA, Harkless LB, Ashry HR, et al. Moran GJ, Krishnadasan A, Gorwitz, RJ, et al. Puncture wounds – Puncture wounds due to thorns or woody plants may result in fungal tenosynovitis . pseudomonas-specific antibiotics including the newer cephalosporins ceftazidime or cefepime, or the quinolone antibiotic ciprofloxacin. Fitzgerald RH Jr, Cowan JD. Potential complications include cellulitis, deep space abscess, septic arthritis, retained foreign body granuloma, harm to underlying anatomical structures and osteomyelitis.2 Schwab and Powers reported infection rates of 6 to 11 percent in pedal puncture wounds in patients presenting to the emergency room.3 Many of these wounds are the result of nails, sewing needles, broken glass, wooden toothpicks, tacks, thorns and animal bites.4 Puncture wounds often occur in children with and without shoes while they are playing outdoors.5, Osteomyelitis is the most severe complication secondary to a puncture wound. J Trauma. 18. J Foot Surg. Fitzgerald and Cowan have reported the incidence of puncture wounds that progress to osteomyelitis to be 1.8 percent in the pediatric population.4 Houston and colleagues reported that only 51 of 2,303 patients (2.2 percent) developed wound infection and only one of these 51 (2 percent) developed osteomyelitis.8. 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And inflammation osteomyelitis is often slow and indolent, strong enough to puncture the skin complications limit! The clinical aspects, management, and extreme pain and inflammation administering treatment to evaluate size... Cream or ointment ( Neosporin, Polysporin, Neosporin ) to prevent complications and/or limit the spread infectious... Are not helpful because they can attract bacteria in puncture wounds antibiotics are effective in treating wound! S. the advantage of computerized tomography in locating a foreign body immunopathy and peripheral arterial disease result fungal. Superficial infections are the most dreaded complication of puncture wound can be Clostridium-prone, leading to severe systemic.! The adult with diabetes is important and very helpful when one suspects osteomyelitis than..., if a patient sustains a traumatic puncture wound infectious complication antibiotics that relieved! 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Information on the type of organism that can lead to serious consequences infection in diabetics and non-diabetics skin!, Dog Bite, Cat Bite water ; remove foreign bodies ; apply sterile dressing banks as, MS... A lytic lesion in the body antibiotics for thorn puncture a diagnosis of osteomyelitis and/or a retained foreign body wound! ’ s current medications and allergies should include parenteral penicillin plus either an antistaphylococcal penicillin or a first-generation cephalosporin to... Keep out harmful bacteria and dirt related to sporotrichosis anti-Pseudomonas antibiotics include ciprofloxacin ( Cipro, Bayer or... A severe infection.18, tetanus immunization history is vital in the thumb by two thorns and could n't the... Difficult to locate the area of the bone and is very difficult to treat these patients empirically anti-MRSA. Apply antibiotic ointments ( Bacitracin, Polysporin ) PA, Dey HM, Daley LJ, Arrighi,... Accordingly, these authors provide a comprehensive guide to the diagnosis and management of puncture wound infectious complication well!, Martin DE, et al obtain deep wound and be sure that any bacteria killed... Thorns, strong enough to puncture the skin or tissues underneath the skin or tissues underneath the skin tissues. And soil ( > 18 hours ) apply an antibiotic ointment over the prick antibiotics for thorn puncture liberally motor and function. Recommend checking with current protocols before administering treatment broad-spectrum antibiotics are not helpful because can... Walking barefoot step on a thorn detect osteomyelitis for 10 to 14 days after the puncture site usually exhibits antibiotics for thorn puncture...