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Arterial leg ulcers-Bacterial patterns, antimicrobial resistance and clinical characteristics, a retrospective

Jonas Salm1, Tanja Böhme1, Elias Noory1

  • 1Department 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.

Plos One
|August 11, 2023
PubMed
Abstract

Insights

Severe wound infections in patients with peripheral artery disease (PAD) are common. Staphylococcus aureus is the most frequent pathogen, and high clindamycin resistance suggests empirical therapy may fail.

Area of Science:

  • Vascular Surgery
  • Infectious Diseases
  • Microbiology

Background:

  • Severe wound infections in patients with peripheral artery disease (PAD) are a significant clinical challenge, often leading to limb and life-threatening complications.
  • Limited evidence exists regarding the specific microbiological profiles and antimicrobial resistance patterns in infected leg ulcers associated with PAD.

Purpose of the Study:

  • To investigate the microbiological landscape of infected arterial leg ulcers in patients with PAD.
  • To determine antimicrobial resistance (AMR) patterns of key pathogens, focusing on Staphylococcus aureus.
  • To identify risk factors associated with Staphylococcus aureus infections in this patient cohort.

Main Methods:

  • Retrospective analysis of 1,142 patients with PAD (Rutherford category 5 or 6) and infected leg ulcers undergoing endovascular revascularization (2012-2021).
  • Identification and antimicrobial susceptibility testing of bacterial isolates.
  • Logistic regression analysis to identify risk factors for Staphylococcus aureus-associated infections.

Main Results:

  • Staphylococcus aureus was the most prevalent pathogen (18.6%), followed by Enterococcus faecalis (9.1%) and S. epidermidis (7.8%).
  • Significant clindamycin resistance (11.0%) was observed in S. aureus isolates, while oxacillin resistance was low (1.5%).
  • Escherichia coli exhibited high rates of multidrug resistance (MDR), including to amoxicillin/clavulanic acid (36.8%).
  • End-stage renal disease was an independent risk factor for S. aureus identification (p = .042).

Conclusions:

  • Staphylococcus aureus is the predominant pathogen in arterial leg ulcers among PAD patients, particularly those with end-stage renal disease.
  • High clindamycin resistance in S. aureus necessitates careful consideration for empirical antibiotic therapy.
  • The high prevalence of MDR in E. coli highlights the complex challenges in treating these infections.

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