Peripheral arterial disease (PAD) is a common complication of Diabetes Mellitus (DM) and often culminates in amputation of the affected foot. Pseudomonas aeruginosa infections associated with PAD are difficult to treat due to their multi-drug resistance. Herein we report a 38 year old male who reported with DM, chronic kidney disease (CKD) and rest pain of the right second toe in October 2011. He underwent percutaneous transluminal angioplasty (PTA) which was unsuccessful. The gangrene of the toes worsened and amputation of the right second toe was done. Bacteriological examination showed presence of P. aeruginosa which during the course of antibiotic therapy became multi-drug resistant. Gangrene and abscess of the foot worsened and amputation of the right third toe was performed. Then autologous peripheral blood mononuclear cell (PBMNC) therapy was performed but as infection control could not still be achieved, the fourth toe was amputated. A protocol of foot bath using carbonic water, local usage of antibiotics (Polymyxin-B), and basic fibroblast growth factor (b-FGF) spray was then employed after which the infection could be controlled and improvement in vascularity of the right foot could be observed in angiography. This combined approach after proper validation could be considered for similar cases.

中文翻译：

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将自体外周血单个核细胞与成纤维细胞生长因子疗法以及严格的感染控制相结合，可成功治愈患有慢性肾功能衰竭和严重脚趾坏疽的糖尿病患者的肢体。

周围动脉疾病（PAD）是糖尿病（DM）的常见并发症，通常最终导致患病脚的截肢。与PAD相关的铜绿假单胞菌感染由于其多药耐药性而难以治疗。本文中，我们报道了一名38岁的男性，该男性在2011年10月报告患有DM，慢性肾脏疾病（CKD）和右第二脚的休息疼痛。他接受了未成功的经皮腔内血管成形术（PTA）。脚趾坏疽加重，右脚第二只脚被截肢。细菌学检查显示铜绿假单胞菌的存在，在抗生素治疗过程中铜绿假单胞菌成为多药耐药的。坏疽和足部脓肿加重，右三脚趾被截肢。然后进行自体外周血单个核细胞（PBMNC）治疗，但由于仍无法实现感染控制，因此将第四个脚趾切掉。然后采用碳酸水足浴，局部使用抗生素（多粘菌素-B）和碱性成纤维细胞生长因子（b-FGF）喷雾的方案，之后可以控制感染并可以改善右脚的血管在血管造影中观察到。对于类似的情况，可以考虑适当验证后的这种组合方法。然后使用碱性成纤维细胞生长因子（b-FGF）喷雾，之后可以控制感染并在血管造影中观察到右脚的血管性改善。对于类似的情况，可以考虑适当验证后的这种组合方法。然后使用碱性成纤维细胞生长因子（b-FGF）喷雾，之后可以控制感染并在血管造影中观察到右脚的血管性改善。对于类似的情况，可以考虑适当验证后的这种组合方法。