A penetrating injury with a cocktail stick resulting in a spreading infection with Streptococcus milleri

BMJ Case Rep. 2009:2009:bcr02.2009.1592. doi: 10.1136/bcr.02.2009.1592. Epub 2009 Jul 26.

Abstract

This case deals with a penetrating injury with a cocktail stick sustained to the right foot in a 72-year-old woman. Despite being discharged from the Accident and Emergency Department on empirical oral antibiotic therapy, she went on to develop a severe cellulitis, necessitating admission for intravenous antibiotics, multiple debridement procedures under general anaesthesia and eventual split thickness skin grafting to repair areas of necrosis. This case raises a number of important issues, including the potential hazards of apparently so trivial an injury with a common household item, the absence of any benefit of plain radiography in these injuries and the need for exploration and debridement early in the management, in the face of a refractory response to empirical antibiotics.