An 83-year-old male with type 2 diabetes mellitus was admitted due to severe hypoglycemia secondary to oral antidiabetic agents.
On admission he presented trauma with wound on the back of the left foot that resulted in a left talar pressure ulcer diagnosed as diabetic foot.
Median culture was positive for PAMR and MRSA.
Subsequently, by antibiogram it was evaluated that the PAMR was sensitive only to colistin (MIC < 2) and intermediate to amikacin (MIC = 16/19azol) and MRSA was sensitive to cotrimoxa.
Treatment was initiated with 0.1% colistin cream with a daily application in the cure and cotrimoxazole 800/160 mg was administered orally every 12 hours for the treatment of MRSA.
The ulcer evolution was favorable.
According to medical criteria, topical treatment with colistin was completed after 23 days, performing an ulcer culture at 4 days whose result was negative for MRSA, so treatment was discontinued.
Clinical improvement of the ulcer at the end of topical treatment with colistin was remarkable.
The patient was treated with cotrimoxazole according to MRSA.
Systemic treatment with intravenous colistin was not administered in any of the cases.
In conclusion, the results suggest that the 0.1% colistin preparation prepared by the pharmacy service could be useful for the treatment of ulcers infected by PAMR negativizing exudate culture in one case.
It was not possible to have a culture after treatment in one of the patients, although medical criteria observed growth of borders and granulation tissue, indicative of clinical improvement.
The increase in cases of this infection and the lack of information regarding efficacy and results raises the need for further research in the field of topical colistin to reach more solid conclusions about the possibilities of using this treatment.
1.
P. March López1, S. Redondo Capafons2, D. Cruz Guerrero3 and R. Garriga Biosca2 1Resident Armacéutic.
Training service.
Elementary hospital
Spain.
2Farmacéutica Adjunta.
Training service.
Elementary hospital
Spain.
Adjusted treatment
Centre Soci-Sanitari Resident L ́Ametlla del Vallés.
Fundació Vallparadis.
Grup Mutua Ter.
Term (Barcelona).
Spain.
