P-1711. Evaluation of Microbiology and Antibiotic Prescribing Behavior of Foot Puncture Wound Infection: An Opportunity for Antimicrobial Stewardship

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Abstract Background The primary pathogen(s) of soft tissue infections, including those of the foot, are β-hemolytic Streptococci and Staphylococcus aureus (SA). Pseudomonas aeruginosa (PsA) has been implicated as a cause of foot infections after sustaining a nail puncture wound through a sneaker, historically leading to recommendations for prescribing empiric anti-PsA antibiotics (abx). At Olive View-UCLA Medical Center (Sylmar, CA), we evaluated the microbiology and empiric abx prescribing behavior of foot puncture wound infections. Methods Retrospective chart review on adults (≥ 18 years) admitted with an ICD-10 code for puncture wound from January 1, 2017 to December 31, 2023. Inclusion criteria included foot infection after sustaining nail, screw, staple, thumbtack, or razorblade puncture. Non-foot puncture wound and puncture from an object other than those listed in the inclusion criteria were excluded. Anti-PsA abx was defined as either piperacillin-tazobactam, cefepime, ceftazidime, or ciprofloxacin. Results 58 cases were reviewed and 45 met inclusion criteria. The majority of puncture wound was due to nail (n=34, 76%) followed by screw (n=6, 13%) [Table 1]. Empiric anti-PsA abx was prescribed in the emergency department in 41/45 (91%); empiric anti-PsA abx was prescribed or continued by the admitting physician in 19/45 (42%). Anti-PsA abx average days of therapy (DOT) was 2 days [IQR 2-3]. Wound culture was obtained in 44 cases, with no isolation of PsA. The majority of pathogens consisted of methicillin-susceptible SA (26/44 cases, 59%) and Streptococcus agalactiae (19/44, 43%) [Figure 1]. Infection involving both SA and Streptococcus spp. was seen in 15 cases (34%). Subsequent foot infection with PsA within 30 days of puncture wound infection did not occur in any cases. Conclusion PsA was not isolated in any cases of foot puncture wound infections, although the majority were started on an empiric anti-PsA abx, per historical recommendations. The primary pathogen(s) were SA and/or Streptococcus spp. Therefore, current evidence shows that PsA is not a significant pathogen of foot puncture wound infections, and this represents an opportunity for antimicrobial stewardship services to prioritize empiric abx against SA and Streptococcus spp., and not against PsA, for this infection type. Disclosures All Authors: No reported disclosures