Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
Charité -Universitätsmedizin Berlin, Institute for Hygiene and Environmental Medicine, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
PLoS One. 2023 Aug 11;18(8):e0290103. doi: 10.1371/journal.pone.0290103. eCollection 2023.
Severe wound infections in patients with peripheral artery disease (PAD) are common, potentially life- and limb-threatening, and difficult to treat. Evidence on patients with infected leg ulcers in PAD is scarce. This study aims to provide insight into the microbiological patterns and antimicrobial resistance (AMR) of specific pathogens in patients with arterial leg ulcers.
In this retrospective, consecutive, single-centre study 16,553 patients underwent an endovascular revascularization procedure between 2012 and 2021. Of these, 1,142 patients had PAD Rutherford category 5 or 6 with infected leg ulcers. Logistic regression was used to identify risk factors for Staphylococcus aureus-associated infections.
A total of 3,431 bacterial isolates were detected, of which 2,335 (68.1%) bacterial isolates were gram-positive and 1,096 (31.9%) were gram-negative species. The most prevalent bacteria were S. aureus (18.6%), Enterococcus faecalis (9.1%) and S. epidermidis (7.8%). Pseudomonas aeruginosa (5.6%), Proteus mirabilis (3.7%) and Escherichia coli (3.4%). The resistance of S. aureus isolates to clindamycin was 11.0%. Resistance to oxacillin was rare (1.5%). P. aeruginosa is frequently resistant to ciprofloxacin (14.4%) whilst intrinsically resistant to trimethoprim/sulfamethoxazole. P. mirabilis and E. coli were frequently resistant to both ciprofloxacin (7.3; 20.7%) and trimethoprim/sulfamethoxazole (24.6; 22.6%), respectively. Resistance to amoxicillin/clavulanic acid was high among E. coli isolates (36.8%). Multi-drug resistance (MDR) was rare among S. aureus and P. aeruginosa isolates. In contrast, the proportion of MDR was high in E. coli isolates. End-stage renal disease was independently positively associated with S. aureus identification (p = .042).
S. aureus was the most common pathogen in arterial leg ulcers with end-stage renal disease being an independent risk factor. Clindamycin resistance was common, making empirical therapy likely to fail. Isolated E. coli species had a high proportion of MDR.
外周动脉疾病（PAD）患者的严重伤口感染很常见，可能危及生命和肢体，且难以治疗。有关 PAD 合并感染性下肢溃疡患者的证据很少。本研究旨在提供动脉性下肢溃疡患者特定病原体的微生物模式和抗菌药物耐药性（AMR）的相关见解。
在这项回顾性、连续的单中心研究中，2012 年至 2021 年间共有 16553 名患者接受了血管腔内血运重建术。其中，1142 名患者 Rutherford 分类为 5 或 6 类，存在感染性下肢溃疡。采用逻辑回归确定金黄色葡萄球菌感染相关危险因素。
共检测到 3431 株细菌分离株，其中 2335 株（68.1%）为革兰阳性菌，1096 株（31.9%）为革兰阴性菌。最常见的细菌是金黄色葡萄球菌（18.6%）、粪肠球菌（9.1%）和表皮葡萄球菌（7.8%）。铜绿假单胞菌（5.6%）、奇异变形杆菌（3.7%）和大肠埃希菌（3.4%）。金黄色葡萄球菌分离株对克林霉素的耐药率为 11.0%。对苯唑西林的耐药性罕见（1.5%）。铜绿假单胞菌对环丙沙星（14.4%）经常耐药，而对复方磺胺甲噁唑具有固有耐药性。奇异变形杆菌和大肠埃希菌对环丙沙星（分别为 7.3%；20.7%）和复方磺胺甲噁唑（分别为 24.6%；22.6%）均有较高的耐药性。大肠埃希菌分离株对阿莫西林/克拉维酸的耐药率较高（36.8%）。金黄色葡萄球菌和铜绿假单胞菌分离株中多药耐药（MDR）罕见。相比之下，大肠埃希菌分离株的 MDR 比例较高。终末期肾病与金黄色葡萄球菌的鉴定独立呈正相关（p=0.042）。
金黄色葡萄球菌是动脉性下肢溃疡最常见的病原体，终末期肾病是一个独立的危险因素。克林霉素耐药很常见，可能导致经验性治疗失败。分离的大肠埃希菌有很高的 MDR 比例。
