Diabetes mellitus is a widespread condition affecting up to 30% of the population of developing nations worldwide. Diabetic foot infections transpire when local tissue damage occurs, and colonizing surface bacteria overwhelm the diabetic immune system. This immune failure leads to critical colonization, followed by infection and deeper tissue penetration in a compromised host. With the rise of these infections, there is a commensurate rise in antibiotic resistance, most often in a group of gram positive and gram negative bacteria known as the ESKAPE group of pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa and Enterobacter species). Herein, a case of poly-microbial Methicillin-resistant Staphylococcus aureus (MRSA) cellulitis, progressing from the infected paronychia of the hallux, in a 59-year old diabetic Caucasian female on daily insulin injections is reported. This infection occurred secondary to onychocryptosis (ingrown nail) surgery. After the failure of two self-administered courses of ciprofloxacin, the patient was successfully treated with an 870 nm/930 nm laser system that is customarily utilized to treat onychomycosis, and an oral regimen of doxycycline. This photo-biologic technology was chosen for a combined therapy with the oral doxycycline, as it has been previously shown to, (a) potentiate tetracycline, erythromycin and ciprofloxacin in vitro against MRSA and levofloxacin-resistant Escherichia coli, and (b) potentiate topical erythromycin in human clinical studies, clearing erythromycin-resistant MRSA from the human nares.
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