Pseudomonas Osteochondritis Complicating Puncture Wounds of the Foot in Children: A 10-Year Evaluation

• Published in: The Journal of infectious diseases Vol. 160; no. 4; pp. 657 - 661
• Main Authors: Jacobs, Richard F., McCarthy, Richard E., Elser, Joseph M.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.10.1989; University of Chicago Press
• Subjects: Abscesses; Adolescent; Antibiotics; Arthritis; Arthritis, Infectious - complications; Bacterial arthritis and osteitis; Bacterial diseases; Biological and medical sciences; Bones; Cellulitis; Child; Child health services; Child, Preschool; Female; Follow-Up Studies; Foot Injuries; Human bacterial diseases; Humans; Infant; Infections; Infectious diseases; Joints; Major Articles; Male; Medical sciences; Osteochondritis - complications; Osteochondritis - drug therapy; Osteochondritis - etiology; Osteochondritis - surgery; Prospective Studies; Pseudomonas; Pseudomonas aeruginosa - isolation & purification; Pseudomonas Infections - drug therapy; Pseudomonas Infections - etiology; Pseudomonas Infections - surgery; Shoes; Staphylococcus aureus - isolation & purification; Tennis shoes; Wound Infection - drug therapy; Wound Infection - etiology; Wound Infection - surgery; Wounds, Penetrating - complications; Human; Pseudomonadales; Diseases of the osteoarticular system; Lower limb; Arthritis; Foot; Infection; Antibiotic; Chemotherapy; Treatment; Surgery; Osteochondritis; Bacteriosis; Bacteria; Pseudomonadaceae; Complication; Pseudomonas aeruginosa; Puncture; Child
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/160.4.657

From 1978 to 1988, microbiologically proven Pseudomonas osteochondritis and septic arthritis following nail puncture wound to the foot was diagnosed in 77 children aged 18 mo-19 y (77 and 17 cases, respectively). The syndromes were found in children with a history of wearing tennis shoes (70 cases), other shoes (5), and no shoes (2). All cases had surgical debridement of the infected cartilage or bone and drainage of infected joints. Pseudomonas aeruginosa was isolated in 38 cases and in conjunction with Staphylococcus aureus in 18. Anti-Pseudomonas antibiotics were initiated in all cases before surgical exploration; the average duration of treatment was 7.5 ± 1.2 d postoperatively. Patient follow-up was 5.2 ± 3.4 y (median, 4.8 y; range, 3 mo-10 y). Two relapses occurred; both patients had a previously undetected septic arthritis. These data suggest that with aggressive surgical management, Pseudomonas osteochondritis and septic arthritis can be treated effectively with postoperative antibiotics for 7 d.