Diabetic foot ulcer leading to septic shock: A rare case of multidrug-resistant infection in an uncontrolled diabetic patient

Ernas, Suhendra M; Aulia, Fauqa Arinil

doi:10.21608/mid.2025.367884.2621

	Diabetic foot ulcer leading to septic shock: A rare case of multidrug-resistant infection in an uncontrolled diabetic patient
Microbes and Infectious Diseases
Articles in Press, Accepted Manuscript, Available Online from 30 April 2025
Document Type: Short Reports (case reports)
DOI: 10.21608/mid.2025.367884.2621
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Authors
Suhendra M Ernas ¹^{, 2}; Fauqa Arinil Aulia ³^{, 2}
¹Clinical Pathology Specialization Program, Department of Clinical Pathology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
²Department of Clinical Pathology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
³Department of Clinical Pathology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
Abstract
Diabetic foot ulcer is a serious complication of diabetes mellitus, frequently leading to infections, amputations, and sepsis. We report a case of a 57-year-old female with a 10-year history of type 2 diabetes mellitus without regular treatment who presented with a progressive left foot ulcer that developed for 1.5 months. Laboratory findings revealed leukocytosis, thrombocytopenia, and acute kidney injury in diabetic kidney disease. Blood and tissue cultures identified extended-spectrum beta-lactamase-producing Escherichia coli, complicating antimicrobial selection and limiting treatment options. The patient was diagnosed with diabetic foot ulcer (Wagner Grade 4), septic shock, and acute kidney injury on diabetic kidney disease, requiring IV fluids, insulin therapy, broad-spectrum antibiotics (ampicillin-sulbactam and cefoperazone-sulbactam), electrolyte correction, albumin transfusion, and vasopressor support. Despite intensive treatment and intensive care unit admission, the patient’s condition continued to deteriorate, leading to multi-organ failure and death during hospitalization. This case underscores the aggressive nature of diabetic foot ulcers in the presence of multidrug-resistant infections and delayed intervention, highlighting the need for early recognition, targeted antimicrobial therapy, and a multidisciplinary approach.
Keywords
Diabetic Foot; Septic Shock; Antimicrobial Resistance; Global Health; Multidrug-Resistant Bacteria


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