What is the most likely organism responsible for osteomyelitis from a nail puncture through a shoe?

Osteomyelitis that results from a nail puncture through a shoe is most commonly associated with Pseudomonas aeruginosa. This organism is particularly relevant in cases involving penetrating injuries, especially those that occur through the foot, as is the case with a puncture wound from a shoe.

Pseudomonas aeruginosa is a gram-negative bacterium that is known for its virulence and ability to thrive in moist environments, making it a frequent pathogen in infections related to foot injuries, especially in individuals such as those with diabetes or who have compromised immune systems. When a nail punctures through the sole of a shoe, it can introduce this organism directly into bone or soft tissue, leading to osteomyelitis.

In contrast, while Staphylococcus aureus is a common cause of many soft tissue infections and osteomyelitis, it is less commonly associated specifically with puncture wounds from shoes compared to Pseudomonas. Escherichia coli typically causes infections that are more associated with abdominal or urinary tract origins, rather than puncture wounds. Streptococcus pneumoniae is primarily known for causing respiratory infections and is not a common pathogen in osteomyelitis due to a puncture wound.

Thus, understanding the specific pathogens