An Unusual Case of Proteus mirabilis-Induced Severe Contiguous Bacterial Osteomyelitis in an Elderly Nursing Home Resident: A Case Report.

Contiguous bacterial osteomyelitis results from the spread of a variety of pyogenic bacteria from nearby skin, soft tissue, or joint infections into the underlying bone. This report describes a case of severe contiguous bacterial osteomyelitis in an 82-year-old female nursing home resident with newly diagnosed and comorbid peripheral arterial disease, along with a history of decubitus ulcers as a result of presumed neglect at her residence. The patient initially presented with multiple ulcerative lesions overlying the left foot and ankle with associated severe pain and chronic vascular insufficiency. The patient was empirically started on broad-spectrum antibiotics, with a subsequent wound culture demonstrating heavy growth of Proteus mirabilis. Multiple imaging modalities irrefutably demonstrated destructive bony changes characteristic of osteomyelitis. Left below-the-knee amputation was thereafter agreed upon as the most beneficial treatment method, with concomitant prolonged antibiotic therapy. This case emphasizes the importance of providing adequate medical and preventative care for elderly nursing home residents in an effort to reduce the incidence of contiguous bacterial osteomyelitis, a topic rarely discussed in current literature.