Pan-resistant Acinetobacter baumannii–associated necrotising fasciitis in a patient with stroke, tachycardia-induced cardiomyopathy, and diabetes mellitus in a tertiary hospital of South India: a multidisciplinary challenge

Angelin Grace T, Sowmya R, Samiksha M, Ann Jency A*

Swamy Vivekanandha College of Pharmacy, Elayampalayam, Namakkal, Tamil Nadu, India

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Angelin Grace T, Sowmya R, Samiksha M, Ann Jency A, 2025. Pan-resistant Acinetobacter baumannii–associated necrotising fasciitis in a patient with stroke, tachycardia-induced cardiomyopathy, and diabetes mellitus in a tertiary hospital of South India: a multidisciplinary challenge. Journal of medical pharmaceutical and allied sciences, V 14 - I 6, Pages - 01 – 04. Doi: https://doi.org/10.55522/jmpas.V14I6.6977

ABSTRACT

Acinetobacter baumannii is a gram-negative, non-motile, oxidase-negative bacillus. This is one of the most significant nosocomial microorganisms involved in various conditions, including septicemia, endocarditis, osteomyelitis, and soft tissue infections. Acinetobacter baumannii with necrotising fasciitis is life-threatening and not well-documented. Necrotising fasciitis (NF) is a severe, rapidly progressing infection with high mortality, especially in immunocompromised patients. A 52-year-old female patient with a history of Type 2 DM presented with complaints of generalised tiredness and weakness for the past 5 days. She has been recently diagnosed with necrotising fasciitis on her left upper thigh by another hospital and has been on regular dressing. Since her condition didn’t improve, she was admitted for wound debridement. On investigations, the patient was also diagnosed with tachycardia-induced cardiomyopathy and subacute ischaemic stroke. An ophthalmologist's opinion was consulted for the patient’s diabetic retinopathy. During the stay, she developed diaper dermatitis and ACD. Initially, the patient had hypokalemia (2.9 mmol/L); therefore, potassium correction was performed. Treatment consisting of antibiotics, analgesics, NSAIDs, cerebroactive agents, beta blockers, statins and multivitamin supplements was given. Though provided with a broad-spectrum antibiotic (Ciprofloxacin), the patient didn’t get symptomatic relief. Thus, a culture sensitivity test was sent, which showcased Acinetobacter baumannii with pan-resistance. The patient was further managed and discharged after improvement. Managing NF becomes highly challenging when the causative organisms exhibit pan-resistance. This case highlights the diagnostic and therapeutic challenges of pan-resistant NF in a patient with diabetes, stroke, and cardiomyopathy.

Keywords:

Antimicrobial resistance, Nosocomial infection, Critical care management, Soft tissue infection

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