Limb salvage in diabetic foot necrotizing fasciitis complicated by extensively drug-resistant Acinetobacter baumannii: a case report of an integrative treatment approach.

BACKGROUND

When diabetic foot ulcers (DFUs) complicated by necrotizing fasciitis (NF) show persistent culture positivity for extensively drug-resistant Acinetobacter baumannii (XDR-AB), systemic antimicrobial options are severely limited, posing a severe challenge to limb salvage. Exploring integrative intervention strategies in this setting is of great clinical significance.

CASE PRESENTATION: A 59-year-old patient was admitted with a 20-day history of a right foot ulcer and a 10-year history of poorly controlled type 2 diabetes mellitus. The patient was initially diagnosed with diabetic foot ulcer, which progressed to lower-limb necrotizing fasciitis and septic shock requiring intensive care unit (ICU) supportive treatment. Due to persistent recovery of XDR-AB from wound cultures and severely limited effective systemic antibiotic options, the team used traditional Chinese medicine (TCM) as adjunctive therapy alongside standard debridement, vacuum sealing drainage (VSD), and intensive care support. Following the intervention, the patient's systemic inflammatory markers gradually stabilized despite persistent culture positivity, without recurrent sepsis. With the progressive clearance of necrotic tissue and the growth of healthy granulation tissue, the team successfully performed staged skin grafting while wound cultures remained positive on days 65 and 109, with complete graft take after both procedures. After 115 days of comprehensive treatment, the right lower limb wound stabilized, and the limb was successfully salvaged, allowing for a smooth discharge.

CONCLUSION

For complex cases of DFUs complicated by NF and XDR-AB culture positivity where antibiotics are severely restricted, the addition of TCM to standard multidisciplinary care was associated with infection control and wound repair and may represent an exploratory limb-salvage approach. However, its generalizability and exact efficacy require further validation through subsequent research.