A report was received that a patient with chronic leg ulcers and reduced lower extremity circulation experienced infection and began worsening.The ulcers have been regularly treated and controlled while using mepilex dressing by home care and hospital since diagnosis 2015 - left foot, 2017 - right foot.Wound cultivation from (b)(6) 2017 positive for staphylococcus aureus, escherichia coli and klebsiella pneumoniae.Prescribed ekvacillin, pressure relief and dressing changes, initially 3x week, then increased to daily changes in connection with the patient's worsening condition.(b)(6) 2017 increased amount of exudate, smell, and positive wound cultivation for staphylococcus aureus, streptococci and gram-negative bacteria was noted.Replacing ekvacillin to cefotaxim since gram-negative bacteria has grown and worsened the infection.Vascular surgeon informed it is preferable not to use compression therapy due to pitting edema, which is well controlled after a few days of iv antibiotics and furix treatment.Returned home with continued use of mepilex dressing.Returned to hospital on (b)(6) 2017 where fly larvae was detected in the wound.Necrosis on top of infected toe.Due to bad microcirculation and diabetes, there was no wound revision conducted.Instead a bilateral amputation to lower leg was planned.Dressing changed to gauze & tape on (b)(6) 2017.Discharged (b)(6) 2017 with oral antibiotics for osteitis ongoing.No amputation required.Superficial wounds have healed.The wound on the top of the right hallux have dried.
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