Streptococcal toxic shock syndrome from a puncture wound to the foot

Survey on Plantar Puncture Injury in the Emergency Department

Objective

This survey aimed at identifying the characteristics of plantar puncture injury in our locality.

Methods

This was a prospective consecutive case study. All patients presenting with plantar puncture injury were recruited and the characteristics of the injury were documented.

Results

64 patients (M: 50; F:14) suffering from plantar puncture injury were recruited from 1st July 1998 to 30th November 1998. Forty nine (76.6%) cases involved metallic nails and 40 (62.5%) cases occurred in construction site. Forefoot and hindfoot were the parts where injuries were usually found. There were signs suggestive of infection in 10 patients (15.6%) on presentation. No bone infection was found. The patients were prescribed 3 days of prophylactic or a full course of therapeutic antibiotics. Fourteen patients (22%) turned up for follow up after one week and no infective complications were identified.

Conclusions

Serious complications due to plantar puncture injury were uncommon in our group of subjects. Plantar puncture injuries were most prevalent at construction sites. Construction site workers should be better educated in the occupational protection and first aid of such injuries.

Community-acquired bacteraemia in a rural area: predominant bacterial species and antibiotic resistance

The invasion of the bloodstream represents one of the most important sequelae of infection. This study was conducted over an 18-month period to determine the predominant bacterial agents of a community-acquired bacteraemia seen at health centres in a rural area of Jordan, and their antibiotic susceptibilities. Blood samples were collected and cultured from 215 patients who presented with fever and presumed diagnosis of a bacteraemia. Isolates were identified and tested for antibiotic susceptibility. The variables included the age and sex of the patients, aetiology, sources of the bacteraemia, risk factors, treatment and outcome. One hundred and twenty-six (58.6%) blood cultures were positive. Children less than 14 years old accounted for 34.9% of these, and 38% were from patients that were more than 50 years old. The most frequent aetiologic agents were Staphylococcus aureus, followed by Brucella melitensis and Streptococcus pneumoniae. A wide range of resistance to commonly used antimicrobial agents and multidrug resistance was documented in 44.4% of the isolates. The most frequent sources of the bacteraemia were urinary (15.9%), respiratory (14.3%), no source of the bacteraemia identified (primary bacteraemia) (13.5%), gastrointestinal (12.7%) and soft-tissue infection (7.9%). No identifiable risk factor for infection could be determined in 34% of the patients. The predominant pathogens identified and the relatively high prevalence of antibiotic resistance of the isolates are most probably due to the nature and lifestyle of this rural population and the use of empiric treatment. Characteristics permitting recognition of patients with such strains would aid infection control efforts in the community.