What bacteria and Gram type are typically covered by antibiotics (ABx) for a nail puncture wound through a shoe?

From the Guidelines

For a nail puncture wound through a shoe, empiric antibiotic coverage should target Staphylococcus aureus (gram-positive cocci) and Pseudomonas aeruginosa (gram-negative bacilli), which are the most common pathogens in this scenario. The recommended regimen is amoxicillin-clavulanate 875/125 mg orally twice daily for 5-7 days, as suggested by the Infectious Diseases Society of America guidelines 1. For patients with penicillin allergy, consider trimethoprim-sulfamethoxazole (TMP-SMX) DS twice daily plus ciprofloxacin 500 mg twice daily. In areas with high MRSA prevalence, TMP-SMX or doxycycline 100 mg twice daily should be added to the regimen 1. The shoe environment creates a unique risk because footwear harbors both skin flora (primarily gram-positive) and environmental organisms (including gram-negative bacteria) from soil and water exposure. Pseudomonas is particularly concerning in deep puncture wounds through shoes, as it can cause serious soft tissue infections. Some key points to consider in the management of nail puncture wounds through shoes include:

• Prompt wound cleaning to reduce the risk of infection
• Tetanus prophylaxis if needed, to prevent tetanus infection
• Close follow-up for signs of infection, such as increased redness, swelling, or purulent discharge
• Consideration of the patient's allergy history and MRSA prevalence in the area when selecting an antibiotic regimen The guidelines from the Infectious Diseases Society of America provide a comprehensive approach to managing skin and soft tissue infections, including those caused by nail puncture wounds through shoes 1.

From the FDA Drug Label

Amoxicillin/clavulanic acid has been shown to be active against most isolates of the following bacteria, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section Gram-positive bacteria Staphylococcus aureus Gram-negative bacteria Enterobacter species Escherichia coli Haemophilus influenzae Klebsiella species Moraxella catarrhalis

The bacteria that can cause infection from a nail puncture through a shoe are likely to be Gram-positive and Gram-negative bacteria.

• Gram-positive bacteria: Staphylococcus aureus
• Gram-negative bacteria: Enterobacter species, Escherichia coli, Haemophilus influenzae, Klebsiella species, Moraxella catarrhalis 2

From the Research

Bacteria Involved in Nail Puncture Wounds

• The bacteria involved in nail puncture wounds through shoes include:
  • Pseudomonas aeruginosa, a Gram-negative bacterium 3
  • Staphylococcus aureus, a Gram-positive bacterium 3
• These bacteria can cause infections such as cellulitis and osteochondritis, which may require surgical intervention and antibiotic treatment 3, 4

Antibiotic Coverage

• Antibiotics such as ciprofloxacin have been shown to be effective against Pseudomonas aeruginosa and Staphylococcus aureus 3, 5
• However, the increasing resistance of Pseudomonas aeruginosa to antibiotics necessitates the use of newer agents and combination therapy 5
• The choice of antibiotic coverage should be guided by the epidemiology, patient's risk factors, site of infection, and available treatment options 5, 6

Treatment of Nail Puncture Wounds

• Treatment of nail puncture wounds through shoes may involve surgical exploration to remove foreign bodies and debridement of infected tissue 4, 7
• Antibiotic therapy may be necessary to prevent or treat infections, and the choice of antibiotic should be based on the suspected or confirmed causative organism 3, 5, 6
• Ultrasound examination may be useful as an adjunct to surgical exploration, but it has low sensitivity for detecting foreign bodies and should not be relied on to rule out the need for surgery 7