ANTIBIOTIC RESISTANCE AND CLINICAL MANAGEMENT CHALLENGES IN A PATIENT WITH LOWER-LIMB NECROTIZING FASCIITIS AND CHRONIC KIDNEY DISEASE: A CASE REPORT

Author

Sri Vaishnavi P, Shifa Sidhiq Fatima C, Mr. Prathap A

Abstract

Necrotizing soft-tissue infections move fast and need quick recognition by doctors, swift surgery to control the source, and the right antimicrobial therapy. Choosing the antibiotics is especially difficult when antimicrobial resistance appears in a patient who already has renal dysfunction. We report the case of a female who came to the hospital with large swelling on the left lower leg, redness, tenderness, and many spots of skin affected after an initial bite that was reported. Her condition was worsened by kidney disease, obesity, and signs that suggested a systemic infection. Lab tests showed a white blood cell count with many neutrophils, Anemia, elevated blood urea, high serum creatinine, and metabolic problems that match severe renal dysfunction. The patient had wound debridement surgeries and a fasciotomy as part of the surgical care. A wound culture and sensitivity test showed resistance to every antibiotic that was tested, which made therapy very difficult. During treatment, the patient had a reaction to intravenous meropenem, so meropenem was stopped. The next steps in care involved keeping the wound clean, surgical debridement, and careful monitoring of kidney function and infection markers. A later pus culture showed no growth. This case shows how important it is to get microbiological samples and to do antimicrobial susceptibility tests in severe soft-tissue infections, especially when the usual therapy might not work because of antimicrobial resistance. It also shows how difficult it is to choose antibiotics when there is resistance, a drug allergy, and kidney impairment at the same time.

Keywords

Necrotizing fasciitis, antimicrobial resistance, antibiotic susceptibility testing, chronic kidney disease, wound culture, surgical debridement, antimicrobial stewardship.

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References

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