Diffuse Recalcitrant Osteomyelitis and Joint Septicemia Because of Bowel Perforation Secondary to Gunshot Injury: A Case Report.

ABSTRACT

CASE A previously healthy 22-year-old man was brought into the emergency department after sustaining a low-velocity, civilian gunshot wound to the abdomen that perforated the bowel. Over the next 300 days, he would be admitted and discharged multiple times, requiring a total of 48 debridements, 23 different antimicrobials in 81 unique combinations, and had 18 different microbes cultured from various sites in bone, joint, and blood. Multiorganism bacteremia and fungemia culminated in above-knee amputation because of progression of infection, all in a nonimmunocompromised host. CONCLUSION: Despite following clinical guidelines, patients can still fail evidence-based treatment algorithms. A humbling reminder is that medicine is never one-size-fits-all.