advertising
-
1
Hassel B: Tetanus: pathophysiology, treatment, and the possibility of using botulinum toxin against tetanus-induced rigidity and spasms. Toxins (Basel) 5: 73, 2013.
-
2
Centers for Disease Control and Prevention (CDC): Tetanus surveillance—United States, 2001-2008. MMWR Morb Mortal Wkly Rep 60: 365, 2011.
-
3
Centers for Disease Control and Prevention: Tetanus: for clinicians. Available at: https://www.cdc.gov/tetanus/clinicians.html. Accessed January 25, 2020.
-
4
Infectious Diseases Society of America: Tetanus in areas affected by a hurricane: risk, prevention, and management guidance for clinician. Available at: https://www.idsociety.org/news–publications-new/cdc-alerts/tetanus-in-areas-affected-by-a-hurricane-risk-prevention-and-management-guidance-for-clinicians/. Accessed December 7, 2019.
-
5
World Health Organization: Prevention and management of wound infection. Available at: https://www.who.int/publications/i/item/prevention-and-management-of-wound-infection. Accessed February 22, 2020.
-
6
Lavery LA, Harkless LB, Ashry HR, et al.: Infected puncture wounds in adults with diabetes: risk factors for osteomyelitis. J Foot Ankle Surg 33: 561, 1994.
-
7
Lavery LA, Walker SC, Harkless LB, et al.: Infected puncture wounds in diabetic and nondiabetic adults. Diabetes Care 18: 1588, 1995.
-
8
Armstrong DG, Lavery LA, Quebedeaux TL, et al.: Surgical morbidity and the risk of amputation due to infected puncture wounds in diabetic versus nondiabetic adults. South Med J 90: 384, 1997.
-
9
Hollander JE, Singer AJ, Valentine SM, et al.: Risk factors for infection in patients with traumatic lacerations. Acad Emerg Med 8: 716, 2001.
-
10
Truong DH, Johnson MJ, Crisologo PA, et al.: Outcomes of foot infections secondary to puncture injuries in patients with and without diabetes. J Foot Ankle Surg 58: 1064, 2019.
-
11
Centers for Disease Control and Prevention: Tetanus: wound management for tetanus prevention. Available at: https://www.cdc.gov/tetanus/clinicians.html. Accessed February 10, 2020.
-
12
Abbate R, Di Giuseppe G, Marinelli P, et al.: Appropriate tetanus prophylaxis practices in patients attending emergency departments in Italy. Vaccine 26: 3634, 2008.
-
13
Talan DA, Abrahamian FM, Moran GJ, et al.: Tetanus immunity and physician compliance with tetanus prophylaxis practices among emergency department patients presenting with wounds. Ann Emerg Med 43: 305, 2004.
-
14
Centers for Disease Control and Prevention: Tetanus Surveillance–United States, 2001–2008. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6012a1.htm. Accessed Dec 22, 2022.
-
15
Kuscu F, Kurtaran B, Ulu A, et al.: Diabetic foot wounds: which patients are more prone to tetanus? Open Forum Infect Dis 4(suppl 1): S113, 2017.
-
16
Armstrong DG, Lavery LA, Harkless LB: Validation of a diabetic wound classification system: the contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 21: 855, 1998.
-
17
Armstrong DG, Lavery LA, Vela SA, et al.: Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med 158: 289, 1998.
-
18
American Diabetes Association: 2. classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care 42 (suppl 1): S28, 2019.
-
19
Feng Y, Schlösser FJ, Sumpio BE: The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. J Vasc Surg 50: 675, 2009.
-
20
Olaiya MT, Hanson RL, Kavena KG, et al.: Use of graded Semmes Weinstein monofilament testing for ascertaining peripheral neuropathy in people with and without diabetes. Diabetes Res Clin Pract 151: 1, 2019.
-
21
Sutter RW, Cochi SL, Brink EW, et al.: Assessment of vital statistics and surveillance data for monitoring tetanus mortality, United States, 1979–1984. Am J Epidemiol 131: 132, 1990.
-
22
Rogers LC, Frykberg RG: Tetanus prophylaxis for diabetic foot ulcers. Clin Podiatr Med Surg 23: 769, 2006.
-
23
McMahon MM, Bistrian BR: Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am 9: 1, 1995.
-
24
Alexieqicz JM, Kumar D, Smorgorzewski M, et al.: Elevated cytosolic calcium and impaired proliferation of B lymphocytes in type II diabetes mellitus. Am J Kidney Dis 30: 98, 1997.
-
25
Kilic D, Kaygusuz S, Saygun M, et al.: Seroprevalence of tetanus immunity among noninsulin-dependent diabetes mellitus. J Diabetes Complications 17: 258, 2003.
-
26
US Department of Health & Human Services: Diphtheria tetanus & pertussis vaccine: what you need to know. Available at: http://dhhs.ne.gov/Behavioral%20Health%20Documents/TDaP_Vaccine_Information.pdf. Accessed January 25, 2020.
-
27
McVicar J: Should we test for tetanus immunity in all emergency department patients with wounds? Emerg Med J 30: 177, 2013.
-
28
Rhee P, Nunley M, Demetriades D, et al.: Tetanus and trauma: a review and recommendations. J Trauma Acute Care Surg 58: 1082, 2005.
-
29
Centers for Disease Control and Prevention: Tetanus: surveillance. Available at: https://www.cdc.gov/tetanus/surveillance.html. Accessed February 8, 2020.
High-Risk Patients with Infected Puncture Wounds and Appropriate Tetanus Prophylaxis
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Search for other papers by David H. Truong in
Current site
Google Scholar
PubMed
Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Campbelltown Campus, Sydney, Australia.
Search for other papers by Matthew Malone in
Current site
Google Scholar
PubMed
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Search for other papers by Javier La Fontaine in
Current site
Google Scholar
PubMed
Search for other papers by Dane K. Wukich in
Current site
Google Scholar
PubMed
Search for other papers by Orhan K. Oz in
Current site
Google Scholar
PubMed
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Search for other papers by Lawrence A. Lavery in
Current site
Google Scholar
PubMed
Background: We sought to evaluate clinicians’ compliance with national guidelines for tetanus vaccination prophylaxis in patients with high-risk feet.
Methods: We retrospectively evaluated 114 consecutive patients between June 1, 2011, and March 31, 2019, who presented to the emergency department with a foot infection resulting from a puncture injury. Eighty-three patients had diabetes mellitus and 31 patients did not have diabetes mellitus. Electronic medical records were used to collect a broad range of study data on patient demographics, medical history, tetanus immunization history and tetanus status on presentation to the emergency department, peripheral arterial disease, sensory neuropathy, laboratory values, and clinical/surgical outcomes.
Results: Of the 114 patients who presented to the emergency department with a puncture wound, 53 (46.5%) did not have up-to-date tetanus immunization. Of those patients, 79.2% received a tetanus-containing vaccine booster, 3.8% received intramuscular tetanus immunoglobulin, 3.8% received both a tetanus-containing vaccine booster and tetanus immunoglobulins, and 20.8% received no form of tetanus prophylaxis. Comparing data between patients with and without diabetes mellitus, there were no statistically significant differences in tetanus prophylaxis.
Conclusions: Guidelines for tetanus prophylaxis among high-risk podiatric medical patients in this study center are not followed in all patients. Patients with diabetes mellitus are at high risk for exposure to tetanus; therefore, we recommend that physicians take a detailed tetanus immunization history and vaccinate patients if the tetanus history is unclear.
advertising
