Evaluation of puncture injuries for infectious complications

* Refer to the topic on Tetanus immunization for indications on tetanus prophylaxis.
¶ Deep infection includes deep space abscess, septic arthritis, necrotizing soft tissue infection, tenosynovitis, and osteomyelitis.
Δ Risk factors include increased age, diabetes mellitus, deeply penetrating wounds, injuries to the forefoot or through shoes, grossly contaminated or organic/vegetative penetrating object.
◊ For patients with known or suspected deep infection, magnetic resonance imaging or computed tomography is preferred. Otherwise, plain radiographs or ultrasonography can identify foreign bodies although the sensitivity of ultrasound is limited and surgical-related decisions should not be based on the absence of findings on ultrasound.
§ There are no prospective, randomized trials that have examined the role of antibiotic administration in the prevention of infection following puncture wounds. We suggest not routinely administering prophylactic antibiotics. It is reasonable to use them in patients at high risk for infection, such as those who have contaminated puncture wounds (especially with organic matter), diabetes mellitus, immunodeficiency, a retained organic foreign body, and an injury through an intact shoe.
¥ Inert foreign bodies that are not causing pain or infection that cannot easily be removed may be left in place.
‡ Broader empiric coverage may be warranted depending on the exposure (eg, to dirt or water). Refer to the topic on Infectious complications of puncture wounds for more details on empiric antibiotic regimens.