A 62-year-old man with long-standing type 2 diabetes mellitus secondary to chronic pancreatitis with a tendency to hypoglycemia due to the administration of fast insulin, multiple admissions due to urinary infections and functional impairment.
Upon admission, the patient suffered from abandonment of personal hygiene with uncontrolled elimination habits, chronic renal failure, diabetic ketoacidosis and a grade III sacral ulcer.
Culture of the ulcer exudate showed that it was positive for PAMR and Staphylococcus aureus resistant (SACRM) and antibiogram showed that the PAMR was sensitive only to colistin (MIC < 2) .
MRSA was sensitive to cotrimoxazole (MIC < 1/19) and intermediate to clindamycin (MIC = 1.9).
Treatment was initiated with 0.1% colistin cream with daily application in the cure and cotrimoxazole 800/160 mg was administered orally every 12 hours for the treatment of MRSA.
After one month of treatment, a favorable clinical evolution of the ulcer was observed, with growth of borders and granulation tissue, which had not been observed before the topical treatment.
The patient died due to chronic renal failure exacerbated by urinary sepsis, reason why a culture could not be available after treatment.
