A COVID-19 Silver Lining—Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017–2022)
Antibiotic resistance (AR) associated with chronic limb-threatening ischemia (CLTI) poses additional challenges for the management of ischemic leg ulcers, increasing the likelihood of severe outcomes. This study assessed AR prevalence in bacteria isolated from CLTI-associated leg ulcers before (1 Ja...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-12-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/13/1/35 |
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| author | Amaraporn Rerkasem Pak Thaichana Nuttida Bunsermvicha Rawee Nopparatkailas Supapong Arwon Saranat Orrapin Termpong Reanpang Poon Apichartpiyakul Saritphat Orrapin Boonying Siribumrungwong Nongkran Lumjuan Kittipan Rerkasem José G. B. Derraik |
| author_facet | Amaraporn Rerkasem Pak Thaichana Nuttida Bunsermvicha Rawee Nopparatkailas Supapong Arwon Saranat Orrapin Termpong Reanpang Poon Apichartpiyakul Saritphat Orrapin Boonying Siribumrungwong Nongkran Lumjuan Kittipan Rerkasem José G. B. Derraik |
| author_sort | Amaraporn Rerkasem |
| collection | DOAJ |
| description | Antibiotic resistance (AR) associated with chronic limb-threatening ischemia (CLTI) poses additional challenges for the management of ischemic leg ulcers, increasing the likelihood of severe outcomes. This study assessed AR prevalence in bacteria isolated from CLTI-associated leg ulcers before (1 January 2017–10 March 2020; <i>n</i> = 69) and during (11 March 2020–31 December 2022; <i>n</i> = 59) the COVID-19 pandemic from patients admitted with positive wound cultures to a regional hospital in Chiang Mai (Thailand). There was a marked reduction in AR rates from 78% pre-pandemic to 42% during the pandemic (<i>p</i> < 0.0001), with rates of polymicrobial infections 22 percentage points lower (from 61% to 39%, respectively; <i>p</i> = 0.014). There were reduced AR rates to amoxicillin/clavulanate (from 42% to 4%; <i>p</i> < 0.0001) and ampicillin (from 16% to 2%; <i>p</i> = 0.017), as well as multidrug resistance (19% to 8%; <i>p</i> = 0.026). Factors associated with increased AR odds were polymicrobial infections (adjusted odds ratio (aOR) 5.6 (95% CI 2.1, 15.0); <i>p</i> = 0.001), gram-negative bacteria (aOR 7.0 (95% CI 2.4, 20.5); <i>p</i> < 0.001), and prior use of antibiotics (aOR 11.9 (95% CI 1.1, 128.2); <i>p</i> = 0.041). Improvements in infection control measures and hygiene practices in the community during the pandemic were likely key factors contributing to lower AR rates. Thus, strategic public health interventions, including community education on hygiene and the informed use of antibiotics, may be crucial in mitigating the challenges posed by AR in CLTI. Further, advocating for more judicious use of empirical antibiotics in clinical settings can balance effective treatment against AR development, thereby improving patient outcomes. |
| first_indexed | 2024-03-08T11:07:26Z |
| format | Article |
| id | doaj.art-9a5e9c5d6c1f47fc8127b9eb7301e4c1 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-08T11:07:26Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-9a5e9c5d6c1f47fc8127b9eb7301e4c12024-01-26T14:36:53ZengMDPI AGAntibiotics2079-63822023-12-011313510.3390/antibiotics13010035A COVID-19 Silver Lining—Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017–2022)Amaraporn Rerkasem0Pak Thaichana1Nuttida Bunsermvicha2Rawee Nopparatkailas3Supapong Arwon4Saranat Orrapin5Termpong Reanpang6Poon Apichartpiyakul7Saritphat Orrapin8Boonying Siribumrungwong9Nongkran Lumjuan10Kittipan Rerkasem11José G. B. Derraik12Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, ThailandEnvironmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, ThailandClinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandDepartment of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandClinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandClinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandClinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandClinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, ThailandDepartment of Surgery, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathum Thani 12120, ThailandDepartment of Surgery, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathum Thani 12120, ThailandResearch Center for Molecular and Cell Biology, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, ThailandEnvironmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, ThailandEnvironmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, ThailandAntibiotic resistance (AR) associated with chronic limb-threatening ischemia (CLTI) poses additional challenges for the management of ischemic leg ulcers, increasing the likelihood of severe outcomes. This study assessed AR prevalence in bacteria isolated from CLTI-associated leg ulcers before (1 January 2017–10 March 2020; <i>n</i> = 69) and during (11 March 2020–31 December 2022; <i>n</i> = 59) the COVID-19 pandemic from patients admitted with positive wound cultures to a regional hospital in Chiang Mai (Thailand). There was a marked reduction in AR rates from 78% pre-pandemic to 42% during the pandemic (<i>p</i> < 0.0001), with rates of polymicrobial infections 22 percentage points lower (from 61% to 39%, respectively; <i>p</i> = 0.014). There were reduced AR rates to amoxicillin/clavulanate (from 42% to 4%; <i>p</i> < 0.0001) and ampicillin (from 16% to 2%; <i>p</i> = 0.017), as well as multidrug resistance (19% to 8%; <i>p</i> = 0.026). Factors associated with increased AR odds were polymicrobial infections (adjusted odds ratio (aOR) 5.6 (95% CI 2.1, 15.0); <i>p</i> = 0.001), gram-negative bacteria (aOR 7.0 (95% CI 2.4, 20.5); <i>p</i> < 0.001), and prior use of antibiotics (aOR 11.9 (95% CI 1.1, 128.2); <i>p</i> = 0.041). Improvements in infection control measures and hygiene practices in the community during the pandemic were likely key factors contributing to lower AR rates. Thus, strategic public health interventions, including community education on hygiene and the informed use of antibiotics, may be crucial in mitigating the challenges posed by AR in CLTI. Further, advocating for more judicious use of empirical antibiotics in clinical settings can balance effective treatment against AR development, thereby improving patient outcomes.https://www.mdpi.com/2079-6382/13/1/35bacteriachronic limb-threatening ischemiacommunity healthischemic leg ulcerempirical antibiotic usegram-negative |
| spellingShingle | Amaraporn Rerkasem Pak Thaichana Nuttida Bunsermvicha Rawee Nopparatkailas Supapong Arwon Saranat Orrapin Termpong Reanpang Poon Apichartpiyakul Saritphat Orrapin Boonying Siribumrungwong Nongkran Lumjuan Kittipan Rerkasem José G. B. Derraik A COVID-19 Silver Lining—Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017–2022) Antibiotics bacteria chronic limb-threatening ischemia community health ischemic leg ulcer empirical antibiotic use gram-negative |
| title | A COVID-19 Silver Lining—Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017–2022) |
| title_full | A COVID-19 Silver Lining—Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017–2022) |
| title_fullStr | A COVID-19 Silver Lining—Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017–2022) |
| title_full_unstemmed | A COVID-19 Silver Lining—Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017–2022) |
| title_short | A COVID-19 Silver Lining—Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017–2022) |
| title_sort | covid 19 silver lining decline in antibiotic resistance in ischemic leg ulcers during the pandemic a 6 year retrospective study from a regional tertiary hospital 2017 2022 |
| topic | bacteria chronic limb-threatening ischemia community health ischemic leg ulcer empirical antibiotic use gram-negative |
| url | https://www.mdpi.com/2079-6382/13/1/35 |
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