Gram-negative bacterial toe web infection: Successful treatment with a new third generation cephalosporin

Characteristics, Associated Diseases, and Management of Gram­negative Toe-web Infection: A French Experience

“…G ram-negative toe-web infection (GNTWI) is characterised by marked denudation of the toe-web spaces, extending along the plantar surface with a welldelimited hyperkeratotic macerated rim and a purulent, sometimes greenish and malodorous exudate (1)(2)(3)(4)(5). Pseudomonas aeruginosa is the most commonly identified of the various causative microorganisms (Proteus sp., Escherichia coli, Morganella morganii, Enterobacter sp., and Enterococcus faecalis) (2)(3)(4). The predisposing factors can be local or regional; i.e.…”

“…The predisposing factors can be local or regional; i.e. interdigital tinea; occlusion; humidity; history of inappropriate treatment with antifungals, antibiotics, and topical corticosteroids; and contact/atopic eczema (2)(3)(4)(5).…”

“…The long healing time and high recurrence rate of GNTWI make treatment challenging (2,3,5). Two small case series and a prospective study of 123 cases discussed the use of systemic antibiotics in severe and refractory GNTWI (2)(3)(4). However, the efficacy of systemic antibiotics has not been assessed, nor has the risk of development of antibiotic-resistant strains.…”

Toe web malodorous maceration with well‐demarcated punch‐out edge

“…Foot intertrigo is a spectrum of relatively common and troubling disorders in humid weather or occluded conditions (1). It can be induced by Candida albicans, gram-positive bacteria and gram-negative bacteria as well, the latter of which was defined as a distinct disorder of GNTWI by Amonette and Rosenburg in 1973 (2).…”

“…Antiseptic and astringent agents, such as aluminium chloride and Castellani's paint, are helpful in severely macerated, bacterially infected interspaces. In addition to the pharmacological approach, herbal soaking or superficial debridement dressing may remove the necrotic tissue and allow topical agents to penetrate the infected area faster (1,5,7,8). Systemic antibiotics should be considered if topical therapy alone was inadequate for treatment.…”