Infected puncture wounds in diabetic and nondiabetic adults.
OBJECTIVE
To evaluate bone and soft tissue pathogens resulting from puncture wounds among diabetic and nondiabetic adults.


METHODS
We used a case-control design to compare bacterial pathogens in diabetic and nondiabetic subjects with foot infections precipitated by puncture injuries. We used ICD-9-CM code E920.8 to identify 77 diabetic and 69 nondiabetic patients admitted to the hospital for infected puncture wounds. We identified surgical bone and soft tissue cultures and number and type of organisms per culture.


RESULTS
Nondiabetic subjects had significantly less osteomyelitis (13 vs. 35%, P < 0.01) than diabetic subjects and were infected by fewer organisms. Pseudomonas was the most common cause of osteomyelitis among nondiabetic subjects (P < 0.001). Staphylococcus aureus was more common in diabetic bone (P < 0.001) and soft tissue (P < 0.001) infections. Polymicrobial osteomyelitis was more common in diabetic subjects. There was a longer delay until diabetic subjects received medical treatment compared with nondiabetic subjects (8.7 vs. 5.3 days, P < 0.002). Diabetic subjects were more likely to have neuropathy (P < 0.001) and to have sustained their injuries while barefoot (P < 0.006).


CONCLUSIONS
Puncture wounds in diabetic subjects were commonly associated with polymicrobial infections. Pseudomonas was the most common cause of nondiabetic osteomyelitis. These results have implications for differential emergent and chronic treatment of puncture wounds in diabetic versus nondiabetic subjects.
Lavery
L A
LA
Department of Orthopaedics, University of Texas Health Science Center at San Antonio 78284, USA. lavery@uthscsa.edu
Walker
S C
SC
Harkless
L B
LB
Felder-Johnson
K
K
D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D018409:Foot Injuries / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000382:microbiology; D010019:Osteomyelitis / Q000453:epidemiology / Q000382:microbiology; D012016:Reference Values; D014946:Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D014950:Wounds, Penetrating / Q000503:physiopathology*