Limb salvage in diabetic foot necrotizing fasciitis complicated by extensively drug-resistant Acinetobacter baumannii: a case report of an integrative treatment approach.
Tian Y, Shi Y, et al. • Frontiers in endocrinology • 2026
Addition of traditional Chinese medicine (TCM) to standard multidisciplinary care was associated with infection control and wound repair in a case of diabetic foot necrotizing fasciitis complicated by extensively drug-resistant Acinetobacter baumannii, resulting in successful limb salvage after 115 days of comprehensive treatment.
Key Findings
Results
A 59-year-old patient with diabetic foot ulcer complicated by necrotizing fasciitis and XDR-AB infection achieved successful limb salvage after 115 days of comprehensive treatment.
Patient had a 20-day history of right foot ulcer and a 10-year history of poorly controlled type 2 diabetes mellitus at admission.
The condition progressed to lower-limb necrotizing fasciitis and septic shock requiring ICU supportive treatment.
Wound cultures remained persistently positive for XDR-AB throughout the treatment course.
After 115 days of comprehensive treatment, the right lower limb wound stabilized and the patient was discharged with the limb intact.
Results
Systemic inflammatory markers gradually stabilized despite persistent XDR-AB culture positivity, without recurrent sepsis during the treatment course.
No recurrent episodes of sepsis were documented after the initial septic shock presentation.
The treatment team used TCM as adjunctive therapy alongside standard debridement, vacuum sealing drainage (VSD), and intensive care support.
Results
Staged skin grafting was successfully performed and achieved complete graft take on two occasions despite wound cultures remaining positive for XDR-AB at the time of both procedures.
Wound cultures were positive for XDR-AB on day 65, at the time of the first skin grafting procedure.
Wound cultures remained positive on day 109, at the time of the second skin grafting procedure.
Complete graft take was achieved after both staged skin grafting procedures.
Progressive clearance of necrotic tissue and growth of healthy granulation tissue preceded successful grafting.
Methods
Traditional Chinese medicine (TCM) was used as an adjunctive therapy in a setting where systemic antimicrobial options were severely limited due to XDR-AB infection.
XDR-AB persistent wound culture positivity created a situation where 'systemic antimicrobial options are severely limited.'
TCM was added to a multidisciplinary regimen that also included standard debridement, vacuum sealing drainage (VSD), and intensive care support.
The authors describe this as an 'exploratory limb-salvage approach' for complex cases where antibiotics are severely restricted.
The authors acknowledge that the generalizability and exact efficacy of TCM in this context 'require further validation through subsequent research.'
Background
Diabetic foot ulcers complicated by necrotizing fasciitis and persistent XDR-AB infection represent a severe clinical challenge for limb salvage, with very limited standard treatment options.
XDR-AB persistence in wound cultures in the setting of necrotizing fasciitis was described as 'posing a severe challenge to limb salvage.'
The case highlights that when culture positivity persists and systemic antibiotic options are exhausted, alternative integrative strategies may need to be explored.
The authors note that 'exploring integrative intervention strategies in this setting is of great clinical significance.'
This is reported as a single case report, limiting the ability to generalize findings.
What This Means
This research describes a single patient case in which a 59-year-old with long-standing poorly controlled diabetes developed a severe foot wound infection that spread to cause necrotizing fasciitis (a rapidly destructive 'flesh-eating' soft tissue infection) and life-threatening blood poisoning (septic shock). The bacteria causing the infection, Acinetobacter baumannii, was classified as 'extensively drug-resistant,' meaning nearly all standard antibiotics were ineffective against it. Facing very limited antibiotic options and the risk of losing the limb, the medical team added traditional Chinese medicine (TCM) therapies to their standard treatment approach, which also included surgical wound cleaning, vacuum-assisted drainage, and intensive care unit support. Despite the bacteria never being fully eliminated from wound cultures during treatment, the patient's body-wide inflammatory response stabilized, no further episodes of blood poisoning occurred, and the wound gradually developed healthy tissue. Skin grafting procedures performed on days 65 and 109—even while wound cultures were still positive for the resistant bacteria—were both successful, and after 115 days of treatment, the patient was discharged with the limb intact.
This research suggests that in extreme cases where drug-resistant bacteria make standard antibiotic treatment nearly impossible, a combined integrative approach including TCM alongside conventional surgical and intensive care methods may help control infection and support wound healing well enough to save a limb. The finding that successful skin grafting occurred even with persistent wound culture positivity challenges the assumption that bacterial clearance must precede reconstructive procedures in every case. However, because this is a single case report involving one patient, the authors themselves caution that the results cannot be broadly generalized and that further research—including controlled studies—would be needed to determine how well this approach works across different patients and settings.
Tian Y, Shi Y, Liu P, Xu Q, Zhang C, Zhang Y. (2026). Limb salvage in diabetic foot necrotizing fasciitis complicated by extensively drug-resistant Acinetobacter baumannii: a case report of an integrative treatment approach.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1936922