Open AccessDiabetic Foot Osteomyelitis Caused by Francisella Tularensis
Author(s) -
Wissam K Kabbara,
AUTHOR_ID,
Maha-Sarah Fansa,
AUTHOR_ID
Publication year - 2021
Publication title -
journal of infectious diseases and case reports
Language(s) - English
Resource type - Journals
ISSN - 2634-8861
DOI - 10.47363/jidscr/2021(2)152
Subject(s) - medicine , ciprofloxacin , osteomyelitis , francisella tularensis , tazobactam , piperacillin , surgery , antibiotics , microbiology and biotechnology , imipenem , biology , antibiotic resistance , pseudomonas aeruginosa , biochemistry , genetics , virulence , gene , bacteria
Purpose: A rare patient case of a diabetic foot osteomyelitis caused by Francisella tularensis is presented. Summary: A 69-year-old Caucasian female was admitted for the treatment of diabetic foot osteomyelitis. Her past medical history included type II diabetes mellitus, hypertension, chronic kidney disease, coronary artery disease, hypothyroidism, hyperuricemia and thyroidectomy. Empiric antimicrobial therapy consisting of clindamycin 600mg i.v. every 8hrs and impanel/cilastatin 200 mg i.v. every 6hrs hours was initiated immediately after admission. During her hospitalization, a pus sample from the infection site was taken for culture which showed a gram negative microorganism: Francisella tularensis. The strain was resistant to all the antibiotics tested with the exception of ciprofloxacin, ofloxacin, gentamicin, ceftazidime, cefepime, piperacillin/tazobactam and colistin. After culture results, the treatment regimen was changed to piperacillin/tazobactam 4.5g i.v. every 12hrs and ciprofloxacin 400mg i.v. every 12hrs. The patient continued to receive both antibiotics during hospitalization for 9 days with noted clinical improvement. The patient was discharged on piperacillin/tazobactam 4.5g i.v. every 12hrs and oral ciprofloxacin 500mg every 12hrs to complete a total duration of 6 weeks. Conclusion: This is the first reported case of a diabetic foot osteomyelitis caused by Francisella tularensis.