Puncture wound-induced Achromobacter xylosoxidans osteomyelitis of the foot.

Sir . —Achromobacter xylosoxidans is a gram-negative bacteria, found in the vertebrate intestinal tract and isolated from aqueous environments. The majority of infections caused by A xylosoxidans are either nosocomially acquired or involve immunocompromised hosts, but sporadic communityacquired infections in presumed normal patients have been described. 1 Osteomyelitis of the foot following puncture wounds through sneakers is most often associated with Pseudomonas aeruginosa or other Pseudomonas species. 2-4 We describe a child with community-acquired A xylosoxidans osteomyelitis of the foot that resulted from a puncture wound. Patient Report .—A previously healthy 11-year-old boy stepped on two nails 2.5 weeks before seeking care. The nails penetrated his tennis shoe to a presumed depth of about 2 inches. Immediately after the injury, the foot was soaked in hydrogen peroxide and alcohol. The wounds initially appeared to be healing well without evidence of drainage, pain, or swelling. In the week before admission the child