puncture wound Pseudomonas Crepitance, subcutaneous air on XR, or gangrene Clostridium species or other anaerobes Immunocompromised hosts Pseudomonas, other GNRs, anaerobes Pseudomonas accounts for up to 70–90% of plantar puncture– associated osteomyelitis; the benefit of postpuncture prophylactic antibiotics is unclear Broad-spectrum antibiotics covering anaerobes and aerobes + early surgical consultation if concern exists for necrotizing fasciitis If neutropenic, a child may not have redness, induration, or pus, but will have tenderness; examination findings may not correlate with the extent of disease GAS, group A streptococcus (S pyogenes ); Hib, Haemophilus influenzae type b; PCN, Penicillin; GNRs, gram-negative rods; XR, radiograph