Diabetic Foot Infection with MRSA and ESBL positive

Authors: Loudry Amsal Elfa Gustanar1, Nani Zaitun2

1
Internal Medicine Residency Program, Faculty of Medicine, Lambung Mangkurat University,
Ulin General Hospital Banjarmasin
2
Tropic Infection Division,Internal Medicine Department, Faculty of Medicine, Lambung
Mangkurat University, Ulin General Hospital Banjarmasin
Corresponding author’s Email : loudryaeg@gmail.com

Background: Diabetic foot infection is one of the most common diabetes related cause of
hospitalization. The frequent pathogens are Enterobacteriaceae (87.7%), Staphylococcus
aureus (43.3%), anaerobic bacteria (17%), Streptococcus pyogenes (7.8%) and Methicillin
resistant Staphylococcus aureus strains (11.6%). Among the Enterobacteriaceae Extended
Spectrum Betha Lactamase (ESBL) producing strains are (6%). The prevalence of MRSA
infection and ESBL producing organisms in diabetic foot infection increased worldwide and
several outbreaks have been reported. It could provide more severe problems and will
increase the mortallity and morbidity of the disease.
Case Description: We present a case of a 46 years old Indonesian male who was a known
case of type-II Diabetes Mellitus and on irregular medications was admitted with wide ulcer
wound in the the left ankle extended to the heel, and ulcer wound in right ankle. The man also
have history of fever 5 days before admissions and we found the leucosytosis about
23.500x109/l. From the results of wound cultures taken from the base of the patient's wounds,
we get the results of MRSA infection. First we manage the infection in the patient with
Ceftriaxon and Metronidazole, then we used vancomycin, in according with antimicrobial
sensitivity test. Re-culture from the wound was performed again in these patients, after 7 days
of vancomycin administration, and we got klabsiella pn ESBL positive result.
Conclusion: Patient with diabetic foot infection have been reported with MRSA and ESBL
positive infection, by giving antimicrobial that match the result of the sensitivity test, clinical
improvement was found. Diabetic foot infection, latest can be caused by various types of
germs that are resistant to antimicrobials.

Keyword : Diabetic Foot Infection, MRSA, ESBL positive, Antimicrobial Sensitivity Test