PMID- 38247594
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240128
IS  - 2079-6382 (Print)
IS  - 2079-6382 (Electronic)
IS  - 2079-6382 (Linking)
VI  - 13
IP  - 1
DP  - 2023 Dec 29
TI  - 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).
LID - 10.3390/antibiotics13010035 [doi]
LID - 35
AB  - 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; n = 69) and during (11 March 2020-31 December 2022; n = 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 (p < 0.0001), with rates 
      of polymicrobial infections 22 percentage points lower (from 61% to 39%, 
      respectively; p = 0.014). There were reduced AR rates to amoxicillin/clavulanate 
      (from 42% to 4%; p < 0.0001) and ampicillin (from 16% to 2%; p = 0.017), as well 
      as multidrug resistance (19% to 8%; p = 0.026). Factors associated with increased 
      AR odds were polymicrobial infections (adjusted odds ratio (aOR) 5.6 (95% CI 2.1, 
      15.0); p = 0.001), gram-negative bacteria (aOR 7.0 (95% CI 2.4, 20.5); p < 
      0.001), and prior use of antibiotics (aOR 11.9 (95% CI 1.1, 128.2); p = 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.
FAU - Rerkasem, Amaraporn
AU  - Rerkasem A
AD  - Environmental-Occupational Health Sciences and Non-Communicable Diseases Research 
      Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 
      50200, Thailand.
AD  - Research Center for Infectious Disease and Substance Use, Research Institute for 
      Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand.
FAU - Thaichana, Pak
AU  - Thaichana P
AD  - Environmental-Occupational Health Sciences and Non-Communicable Diseases Research 
      Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 
      50200, Thailand.
FAU - Bunsermvicha, Nuttida
AU  - Bunsermvicha N
AD  - Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, 
      Chiang Mai University, Chiang Mai 50200, Thailand.
FAU - Nopparatkailas, Rawee
AU  - Nopparatkailas R
AD  - Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang 
      Mai 50200, Thailand.
FAU - Arwon, Supapong
AU  - Arwon S
AD  - Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, 
      Chiang Mai University, Chiang Mai 50200, Thailand.
FAU - Orrapin, Saranat
AU  - Orrapin S
AD  - Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, 
      Chiang Mai University, Chiang Mai 50200, Thailand.
FAU - Reanpang, Termpong
AU  - Reanpang T
AD  - Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, 
      Chiang Mai University, Chiang Mai 50200, Thailand.
FAU - Apichartpiyakul, Poon
AU  - Apichartpiyakul P
AD  - Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, 
      Chiang Mai University, Chiang Mai 50200, Thailand.
FAU - Orrapin, Saritphat
AU  - Orrapin S
AUID- ORCID: 0000-0002-1330-6215
AD  - Department of Surgery, Faculty of Medicine, Thammasat University, Rangsit Campus, 
      Pathum Thani 12120, Thailand.
FAU - Siribumrungwong, Boonying
AU  - Siribumrungwong B
AD  - Department of Surgery, Faculty of Medicine, Thammasat University, Rangsit Campus, 
      Pathum Thani 12120, Thailand.
FAU - Lumjuan, Nongkran
AU  - Lumjuan N
AD  - Research Center for Molecular and Cell Biology, Research Institute for Health 
      Sciences, Chiang Mai University, Chiang Mai 50200, Thailand.
FAU - Rerkasem, Kittipan
AU  - Rerkasem K
AD  - Environmental-Occupational Health Sciences and Non-Communicable Diseases Research 
      Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 
      50200, Thailand.
AD  - Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, 
      Chiang Mai University, Chiang Mai 50200, Thailand.
FAU - Derraik, Jose G B
AU  - Derraik JGB
AUID- ORCID: 0000-0003-1226-1956
AD  - Environmental-Occupational Health Sciences and Non-Communicable Diseases Research 
      Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 
      50200, Thailand.
AD  - Department of Women's and Children's Health, Uppsala University, 75185 Uppsala, 
      Sweden.
AD  - Department of Pediatrics: Child and Youth Health, Faculty of Medical and Health 
      Sciences, University of Auckland, Auckland 1142, New Zealand.
LA  - eng
PT  - Journal Article
DEP - 20231229
PL  - Switzerland
TA  - Antibiotics (Basel)
JT  - Antibiotics (Basel, Switzerland)
JID - 101637404
PMC - PMC10812686
OTO - NOTNLM
OT  - Gram staining
OT  - bacteria
OT  - chronic limb-threatening ischemia
OT  - community health
OT  - empirical antibiotic use
OT  - gram-negative
OT  - gram-positive
OT  - infection control
OT  - ischemic leg ulcer
OT  - multidrug resistance
OT  - peripheral arterial disease
OT  - polymicrobial infection
OT  - public health
OT  - susceptibility
COIS- The authors declare no conflicts of interest.
EDAT- 2024/01/22 06:42
MHDA- 2024/01/22 06:43
PMCR- 2023/12/29
CRDT- 2024/01/22 04:24
PHST- 2023/10/28 00:00 [received]
PHST- 2023/12/13 00:00 [revised]
PHST- 2023/12/21 00:00 [accepted]
PHST- 2024/01/22 06:43 [medline]
PHST- 2024/01/22 06:42 [pubmed]
PHST- 2024/01/22 04:24 [entrez]
PHST- 2023/12/29 00:00 [pmc-release]
AID - antibiotics13010035 [pii]
AID - antibiotics-13-00035 [pii]
AID - 10.3390/antibiotics13010035 [doi]
PST - epublish
SO  - Antibiotics (Basel). 2023 Dec 29;13(1):35. doi: 10.3390/antibiotics13010035.