Soft Tissue Infection and Osteomyelitis Pathogens in Puncture Wound Injuries

To compare soft tissue infection (SSTI) and osteomyelitis (OM) pathogens in patients with and without diabetes and in patients who did and did not wear shoes at the time of puncture injuries.

We performed a retrospective reviewed of 113 consecutive patients between June 2011 and March 2019 with foot infection from a puncture injury - 83 had diabetes (DM) and 30 did not (NDM). We evaluated the presence of skin and soft tissue infection (SSTI), presence of osteomyelitis (OM), and the pathogen in each. Osteomyelitis was diagnosis via confirmation on histopathology and/or positive microbiology result. All cultures were taken before the administration of antibiotics.

DM were 17.29 times more likely to develop osteomyelitis after puncture injury (CI 0.01-0.45, p< .0005) and 4.31 times more likely to develop a SSTI (CI 0.09-0.58, p=.001). When DM developed a SSTI it was 5.03 times more likely to be polymicrobial (69.6% vs 31.3%, CI 0.06-0.64, p< .005). The most common pathogen for SSTI and OM in DM was s. aureus (50.7% and 32.3%), whereas in NDM it was Pseudomonas (25%) for SSTI and s. epidermis (50%) and streptococcus (50%) for OM. There was no reported case of fungal or anaerobic OM pathogen in NDM, whereas in the DM there was 9.7% anaerobic and 3.2% fungal infection. 

This study showed that pathogens in puncture injuries have changed a lot compared to what it was 25 years ago. Pseudomonas in SSTI and OM were not as prevalent as it was thought to be in patients who wore shoe at the time of injury. The most common organism in both SSTI and OM was staphylococcus. Furthermore, pseudomonas was present in SSTI whether the patient did or did not wear shoes at the time of injury.

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