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

Abstract

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.

Osteomyelitis in Children

“…This can often be accomplished through interventional radiology. Surgical debridement is more critical for optimal treatment of osteomyelitis associated with contiguous infections, direct inoculation, or chronic osteomyelitis [10,12]. Hyperbaric oxygen may be a useful adjunctive treatment measure in the management of chronic osteomyelitis that is refractory to standard approaches [57].…”

“…Group B streptococcus and gram-negative enterics are important agents in the neonatal period. Salmonella species are the most common cause of osteomyelitis in children with hemoglobinopathies [9] and Pseudomonas aeruginosa is particularly associated with puncture wounds of the calcaneus, metatarsal, and tarsal bones [10]. Haemophilus influenzae type b infection is now rare from the success of the H influenzae type b conjugate vaccine.…”

Pseudomonas arthropathy in an older patient

“…In contrast, it is well documented in children and young adults presenting with septic arthritis following a traumatic wound [1][2][3]. In intravenous drug users, P. aeruginosa is a common organism implicated in septic arthritis, arising through haematological spread [4,5].…”

Characterization of the poxAB Operon Encoding a Class D Carbapenemase in Pseudomonas aeruginosa,

“…Additionally, P. aeruginosa has also been isolated from holy water, aerators, baby baths, hot tubs, swimming pools, contact lens solutions, cosmetics and even the innersole of sneakers (39)(40)(41)(42)(43)(44)(45)(46). In short, aqueous and moist environments seem to be the natural and preferred reservoirs for P. aeruginosa and such environments, when contaminated, can be potential sources of infection.…”

“…Contact lens solutions that are contaminated, or even tap water used for the handling of contact lens, can all serve as potential sources of infection (19). Osteomyelitis, or infection of the bone, has also been reported, especially in children after incurring puncture wounds in the feet, with the source of the infection often being the sole or inner pad of the sneaker that was worn at the time of the injury (46,58). Osteomyelitis can also occur in intravenous drug users (59,60).…”