Lawsuit is a Reminder: Be Suspicious of Worsening Infections and Know Local Susceptibilities

A man who reported to a Kansas City-area urgent care center with an open wound on the bottom of his foot—and who ended up losing his leg when his cellulitis worsened and he ultimately developed gangrene and sepsis—is suing the physician who first saw him, alleging that she failed to prescribe the right antibiotic, never cultured his wound, and declined to order any lab work whatsoever. The suit claims the doctor prescribed broad-spectrum antibiotics that were ineffective for cellulitis (the diagnosis of which is not in dispute) during his first visit. He called the doctor when he felt the antibiotic wasn’t helping, only to be told that he had to give the medication more time to do its job; she also wrote him a refill. He returned to the clinic about a week later as his condition continued to deteriorate, culminating with the diagnosis of gangrene. He was sent to a local hospital, where he was also diagnosed with sepsis and had his leg amputated. Regardless of the validity of the allegations or the outcome of the legal case, this story is a reminder to consider—and test for—all reasonable possibilities when patients present with open wounds; to increase suspicion and assessment when patients fail to respond to a medication you prescribed; and, as noted in a case report available in the JUCM archive, to base antibiotic prescribing decisions on local microbial susceptibilities.