Management of Pediatric Puncture Wounds Through Shoes

Initial Assessment and Management

The Infectious Diseases Society of America recommends thorough wound cleansing and debridement, removing any foreign material or necrotic tissue, for pediatric puncture wounds through shoes 1, 2
The Infectious Diseases Society of America suggests obtaining appropriate specimens for culture from infected wounds prior to starting antibiotics by scraping with a sterile scalpel or dermal curette from the base of a debrided wound 1, 2
The Infectious Diseases Society of America advises against culturing clinically uninfected wounds unless for specific epidemiological purposes 2

The American Academy of Orthopaedic Surgeons recommends starting empiric antibiotic therapy promptly for clinically infected wounds, as delay >3 hours increases infection risk 3
The American Academy of Orthopaedic Surgeons suggests using an oral fluoroquinolone (if age-appropriate) or parenteral anti-pseudomonal agent as empiric therapy for mild to moderate infections 3
The American Academy of Orthopaedic Surgeons recommends parenteral anti-pseudomonal therapy for severe infections 3, 4

The American Academy of Pediatrics states that fluoroquinolones may be justified in special circumstances, such as osteomyelitis or osteochondritis caused by P. aeruginosa 5
The American Academy of Pediatrics advises considering the risks and benefits carefully before prescribing fluoroquinolones to pediatric patients 5

The Infectious Diseases Society of America recommends seeking surgical consultation for failure to respond to appropriate antibiotic therapy 4

The Infectious Diseases Society of America recommends 1-2 weeks of appropriate antibiotic therapy for superficial infections without complications 4
The Infectious Diseases Society of America suggests continuing antibiotic therapy until there is evidence that the infection has resolved, but not necessarily until the wound has completely healed 4

The Infectious Diseases Society of America recommends close follow-up to ensure resolution of infection 4