Long term radiologic outcome of Pseudomonas osteomyelitis of the foot

The medical records of 27 patients with puncture wound-induced Pseudomonas aeruginosa osteomyelitis/septic arthritis of the foot hospitalized from 1980 through 1988 were reviewed. Twenty patients received anti-Pseudomonas therapy for greater than 21 days and 7 patients received anti-Pseudomonas therapy for less than or equal to 21 days. There was no difference in age, sex, race, duration of wound or symptoms before admission or in admission physical findings including temperature, lymphadenopathy, puncture site appearance or admission laboratory data including white blood cell count or erythrocyte sedimentation rate between the two groups. All children but two in the long term therapy group had surgical as well as parenteral anti-Pseudomonas therapy. Fifteen patients returned for follow-up radiographs 1 to 8 1/2 years after hospitalization, 10 of 20 who had received therapy for greater than 21 days and 5 of 7 who had received therapy for less than or equal to 21 days. Poor radiologic outcome, ranging from bony deformity to joint space abnormality, was noted in 4 patients, of whom 3 had had joint involvement. Clinical abnormality was noted in only one adolescent male, and he had the most severe radiologic sequelae. The longer term functional significance of these radiologic anomalies awaits further delineation.