Infected Puncture Wounds in Diabetic and Nondiabetic Adults
- Lawrence A Lavery, MPH, DPM,
- Steven C Walker, MD, PHD,
- Lawrence B Harkless, DPM and
- Kim Felder-Johnson, DPM
- Mexican American Medical Treatment Effectiveness Research Center, University of Texas Health Science Center at San Antonio San Antonio, Texas
- Department of Orthopaedics, University of Texas Health Science Center at San Antonio San Antonio, Texas
- Department of Anesthesiology and Operative Services, Brooke Army Medical Center San Antonio, Texas
- Address correspondence and reprint requests to Lawrence A. Lavery, MPH, DPM, Department of Orthopaedics, the University of Texas Health Science Center, San Antonio, TX 78284. E-mail: lavery{at}uthscsa.edu
Abstract
OBJECTIVE To evaluate bone and soft tissue pathogens resulting from puncture wounds among diabetic and nondiabetic adults.
RESEARCH DESIGN AND 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.
- Received March 22, 1995.
- Revision received August 10, 1995.
- Accepted August 10, 1995.
- Copyright © 1995 by the American Diabetes Association
