Topical Probiotic Therapy in Diabetic Foot Ulcers: An Intra-Patient Descriptive Case Report

Chronic diabetic foot ulcers remain a major clinical challenge due to persistent inflammation, impaired tissue repair, and microbial dysbiosis. We report the case of a 62-year-old male with diabetes mellitus presenting with two chronic diabetic foot ulcers managed using different local treatment strategies within the same patient. One wound received conventional wound care, while the second was treated with topical probiotic therapy containing Enterococcus faecium and Saccharomyces boulardii. Wound progression was assessed over eight weeks using the RESVECH 2.0 scale (Results Expected from Chronic Wound Healing), serial wound measurements, and microbiological cultures obtained before and after treatment. Although baseline wound characteristics differed between lesions—with the probiotic-treated ulcer being smaller and less severe at presentation—the probiotic-treated plantar ulcer demonstrated progressive reduction in RESVECH 2.0 scores and complete closure by week 8, whereas the conventionally treated ulcer remained partially open at the end of follow-up. Serial microbiological assessment demonstrated persistent colonization with Providencia stuartii and changes in antimicrobial susceptibility profiles during follow-up. Although limited to a single-patient observation, these findings support further investigation of microbiome-targeted approaches as adjunctive strategies in chronic wound management.