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).

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).

Publication date: Dec 29, 2023

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.

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Concepts Keywords
Antibiotic bacteria
Basel chronic limb-threatening ischemia
Thailand community health
empirical antibiotic use
Gram staining
infection control
ischemic leg ulcer
multidrug resistance
peripheral arterial disease
polymicrobial infection
public health


Type Source Name
disease MESH COVID-19
drug DRUGBANK Silver
disease IDO antibiotic resistance
disease MESH Leg Ulcers
disease MESH chronic limb-threatening ischemia
disease VO Bacteria
disease MESH polymicrobial infections
drug DRUGBANK Amoxicillin
drug DRUGBANK Clavulanic acid
drug DRUGBANK Ampicillin
disease MESH infection
drug DRUGBANK Isoxaflutole
disease VO effective
disease MESH Non Communicable Diseases
disease MESH Substance Use
drug DRUGBANK Etoperidone
disease MESH peripheral arterial disease
disease IDO susceptibility
drug DRUGBANK Coenzyme M
disease MESH atherosclerosis
disease IDO blood
disease MESH ulcers
disease MESH ischemia
disease MESH bacterial infections
disease MESH inflammation
disease MESH treatment failure
disease MESH foot ulcers
disease VO population
drug DRUGBANK Methionine
disease MESH syndrome
disease MESH wound infections
disease MESH Diabetes mellitus
disease MESH Hypertension
disease MESH Dyslipidemia
disease MESH Tachycardia
disease MESH Tachypnea
disease IDO history
disease MESH gangrene
disease MESH osteomyelitis
drug DRUGBANK Clindamycin
drug DRUGBANK Ciprofloxacin
drug DRUGBANK Oxacillin
drug DRUGBANK Erythromycin
drug DRUGBANK Piperacillin
drug DRUGBANK Tazobactam
drug DRUGBANK Meticillin
drug DRUGBANK Vancomycin
drug DRUGBANK Pentaerythritol tetranitrate
drug DRUGBANK Fusidic Acid
drug DRUGBANK Trimethoprim
drug DRUGBANK Sulfamethoxazole
disease VO Bacilli

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