Infectious complications of puncture wounds
- Larry M Baddour, MD, FIDSA
Larry M Baddour, MD, FIDSA
- Professor of Medicine
- Mayo Clinic College of Medicine
- Aaron M Brown, MD, FACEP
Aaron M Brown, MD, FACEP
- Assistant Professor
- Department of Emergency Medicine
- University of Pittsburgh
Puncture wounds are penetrating injuries caused by a pointed object. They are common injuries, particularly to the plantar surface of the foot and other areas of the distal extremities, and occur in all age groups. Infections, ranging from mild soft tissue involvement to osteomyelitis, are the main complication resulting from puncture wound injuries.
The clinical aspects, management, and prevention of puncture wound infections are reviewed here. 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. (See "Soft tissue infections due to dog and cat bites" and "Soft tissue infections due to human bites" and "Soft tissue infections following water exposure".)
Prevention of HIV and infection with hepatitis viruses following a needlestick exposure is also discussed in detail elsewhere. (See "Management of healthcare personnel exposed to HIV" and "Prevention of hepatitis B virus and hepatitis C virus infection among healthcare providers".)
Mechanism of injury — Puncture wounds can occur in a broad array of circumstances. Puncture wounds to the sole of the foot from stepping on an object are the most common. The majority of plantar puncture wounds are due to nails; less commonly, glass, wood, or other metal objects are the source of the puncture. Puncture wounds around the area of the metatarsal-phalangeal joints often penetrate deeper because this is a weight-bearing area .
The incidence of infection following a puncture wound is uncertain, as many individuals do not present to medical care following such injuries. As an example, in a survey of 200 general emergency department patients, 44 percent reported at least one prior plantar puncture wound . Of the 156 wound reported, 50 percent were brought to medical attention, among which the self-reported infection rate was 11 percent.
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- Mechanism of injury
- Risk factors associated with infection
- CLINICAL FEATURES
- History and physical examination
- Laboratory tests
- Identifying the microbial etiology
- General management
- Foreign body removal
- Debridement and drainage
- Antibiotic therapy
- - Plantar puncture infection
- - Non-plantar infections
- Tetanus immunization
- Wound care
- Foreign body assessment and removal
- Antibiotic prophylaxis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS