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A Comparison of Pathogens in Skin and Soft-Tissue Infections and Pedal Osteomyelitis in Puncture Wound Injuries Affecting the Foot

David H. TruongSurgical Service, Podiatry Section, Veterans Affairs North Texas Health Care System, Dallas, TX.
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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 DPM, MS
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Javier La FontaineDepartment of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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Matthew MaloneInfectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia.
South West Sydney Limb Preservation and Wound Research, Liverpool Hospital, South Western Sydney LHD, Sydney, Australia.

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Dane K. WukichDepartment of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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Kathryn E. DavisDepartment of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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Lawrence A. LaveryDepartment of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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Background: To compare pathogens involved in skin and soft-tissue infections (SSTIs) and pedal osteomyelitis (OM) in patients with and without diabetes with puncture wounds to the foot.

Methods: We evaluated 113 consecutive patients between June 1, 2011, and March 31, 2019, with foot infection (SSTIs and OM) from a puncture injury sustained to the foot. Eighty-three patients had diabetes and 30 did not. We evaluated the bacterial pathogens in patients with SSTIs and pedal OM.

Results: Polymicrobial infections were more common in patients with diabetes mellitus (83.1% versus 53.3%; P = .001). The most common pathogen for SSTIs and OM in patients with diabetes was Staphylococcus aureus (SSTIs, 50.7%; OM, 32.3%), whereas in patients without diabetes it was Pseudomonas (25%) for SSTIs. Anaerobes (9.4%) and fungal infection (3.1%) were uncommon. Pseudomonas aeruginosa was identified in only 5.8% of people with diabetes.

Conclusions: The most common bacterial pathogen in both SSTIs and pedal OM was S aureus in patients with diabetes. Pseudomonas species was the most common pathogen in people without diabetes with SSTIs.

Corresponding author: David H. Truong, DPM, MS, Surgical Service, Veterans Affairs North Texas Health Care System, 4500 S Lancaster Rd, MC 112, Dallas, TX 75216. (E-mail: David.Truong1@va.gov)