Successful Outpatient Treatment of Severe Diabetic-Foot Myositis and Osteomyelitis Caused by Extensively Drug-Resistant Enterococcus faecalis with Teicoplanin plus Rifampicin: A Case Report

Abstract

Patient: Male, 76-year-old Final Diagnosis: Extensively drug-resistant Enterococcus faecalis diabetic-foot myositis and osteomyelitis Symptoms: Fever, pain to his left lower foot and altered level of consciousness Clinical Procedure: Surgical debridement combined with the administration of teicoplanin plus rifampicin in the outpatient setting, completing in-total a twelve-week course of antibiotic therapy Specialty: Endocrinology and Metabolic • Infectious Diseases • General and Internal Medicine Objective: Rare disease Background: Foot ulcers are high-morbidity and debilitating complications of diabetes mellitus, and carry significantly increased rates of associated major amputations. They contribute to significantly worse quality of life. Osteomyelitis is a frequent complication of diabetic foot ulcers, since bacteria can contiguously spread from soft tissues to the bone, involving the cortex first and then the bone marrow. Unfortunately, clinically unsuspected osteomyelitis is frequent in persisting diabetic foot ulcers. It is associated with limb amputations and increased mortality. Case Report: We describe a 76-year-old man with long-standing insulin-treated type 2 diabetes, who experienced extensively drug-resistant Enterococcus faecalis diabetic foot myositis and osteomyelitis associated with sepsis. He was successfully treated with surgical debridement combined with the administration of teicoplanin plus rifampicin in the outpatient setting, completing, in total, a twelve-week course of antibiotic therapy. Conclusions: Clinically unsuspected osteomyelitis in patients with persisting diabetic foot ulcers has been associated with infections from highly resistant bacteria. Early and accurate diagnosis of diabetic foot osteomyelitis, as well as proper therapeutic approach (antimicrobial and surgical), is of great importance to reduce the risk of minor and major amputations, septic shock leading to multiple organ failure, and overall mortality.

The diabetic sausage toe: Prevalence, presentation and outcomes

“…Our findings demonstrated that surgery, either conservative or amputation, was often needed for infection control and healing in our cases. Out of the two case reports published in the literature, one reported a successful treatment with antibiotics alone 6 and for the other, success was gained through conservative surgery associated with antibiotherapy 5 . Finally, our results did not show significant difference in amputation rates between acute and chronic cases.…”

“…Very few cases reported single cases of sausage toe 5,6 and only one case series dating from year 2000 reported the outcomes of this condition 3 . The term could be underused due to the vaguely defined extent of its clinical signs.…”