Salm Jonas, Ikker Franziska, Noory Elias, Beschorner Ulrich, Kramer Tobias Siegfried, Westermann Dirk, Zeller Thomas
Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg im Breisgau, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Hygiene and Environmental Medicine, 12203 Berlin, Germany.
J Clin Med. 2024 Oct 18;13(20):6219. doi: 10.3390/jcm13206219.
: Patients with peripheral artery occlusive disease (PAD) are at risk of developing foot ulcers, which can subsequently lead to foot infections and an increased risk of amputation. In cases of severe ischemic foot infections (IFIs), the empirical use of antibiotics can be limb-saving. However, there is currently no evidence-based guidance on the choice of empirical antibiotic therapy for IFI. This retrospective single-center cohort study included 216 hospitalized patients with severe IFI undergoing endovascular revascularization. Weighted-Incidence Syndromic Combination Antibiograms (WISCAs) were calculated to guide empirical antibiotic choice. The two most common causative pathogens for IFI were and , with frequencies of 19.8% and 6.1%, respectively. The calculation of WISCAs revealed a low empirical coverage of amoxicillin (AMX) or clindamycin (CLN) with 21.6% and 27.7%, respectively. The empirical coverage of amoxicillin/clavulanic-acid (AMC), trimethoprim/sulfmethoxazole (SXT), and ciprofloxacin (CIP) was 50.6%, 53.1%, and 55.4%, respectively. Piperacillin/tazobactam (PT) exhibited the highest empirical coverage, with 82.5% as calculated by WISCAs. The calculated WISCAs did not significantly alter when stratified by the clinical characteristics of the patients. The empirical antibiotic coverage of CLN and AMX was low. SXT represents a promising empirical alternative in the case of IFI, irrespective of comorbidities and the WIfI score. WISCAs can assist in the decision-making process regarding empirical antibiotic therapy choices in cases of IFI.
外周动脉闭塞性疾病（PAD）患者有发生足部溃疡的风险，进而可能导致足部感染和截肢风险增加。在严重缺血性足部感染（IFI）的病例中，经验性使用抗生素可能挽救肢体。然而，目前尚无关于IFI经验性抗生素治疗选择的循证指南。这项回顾性单中心队列研究纳入了216例接受血管内血运重建术的重度IFI住院患者。计算加权发病率综合征组合抗菌谱（WISCAs）以指导经验性抗生素选择。IFI最常见的两种致病病原体分别为[具体病原体1]和[具体病原体2]，频率分别为19.8%和6.1%。WISCAs的计算显示阿莫西林（AMX）或克林霉素（CLN）的经验性覆盖率较低，分别为21.6%和27.7%。阿莫西林/克拉维酸（AMC）、甲氧苄啶/磺胺甲恶唑（SXT）和环丙沙星（CIP）的经验性覆盖率分别为50.6%、53.1%和55.4%。哌拉西林/他唑巴坦（PT）的经验性覆盖率最高，根据WISCAs计算为82.5%。根据患者的临床特征进行分层时，计算出的WISCAs没有显著变化。CLN和AMX的经验性抗生素覆盖率较低。无论合并症和WIfI评分如何，SXT在IFI病例中是一种有前景的经验性替代药物。WISCAs可协助IFI病例中经验性抗生素治疗选择的决策过程。
