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Article

Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to Support Empirical Antibiotic Therapy Decisions in Infected Ischemic Leg Ulcers—A Feasibility Study

by
Jonas Salm
1,*,
Franziska Ikker
1,
Elias Noory
1,
Ulrich Beschorner
1,
Tobias Siegfried Kramer
2,3,
Dirk Westermann
1 and
Thomas Zeller
1
1
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
2
Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Hygiene and Environmental Medicine, 12203 Berlin, Germany
3
LADR der Laborverbund Dr. Kramer & Kollegen, 21502 Geesthacht, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(20), 6219; https://doi.org/10.3390/jcm13206219
Submission received: 4 September 2024 / Revised: 26 September 2024 / Accepted: 15 October 2024 / Published: 18 October 2024
(This article belongs to the Section Epidemiology & Public Health)
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Abstract

Objective: 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. Methods and Design: 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. Results: The two most common causative pathogens for IFI were S. aureus and P. aeruginosa, 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. Conclusions: 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.
Keywords: chronic limb-threatening ischemia; ischemic foot infection; antibiotics; antimicrobial resistance; peripheral artery occlusive disease chronic limb-threatening ischemia; ischemic foot infection; antibiotics; antimicrobial resistance; peripheral artery occlusive disease

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MDPI and ACS Style

Salm, J.; Ikker, F.; Noory, E.; Beschorner, U.; Kramer, T.S.; Westermann, D.; Zeller, T. Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to Support Empirical Antibiotic Therapy Decisions in Infected Ischemic Leg Ulcers—A Feasibility Study. J. Clin. Med. 2024, 13, 6219. https://doi.org/10.3390/jcm13206219

AMA Style

Salm J, Ikker F, Noory E, Beschorner U, Kramer TS, Westermann D, Zeller T. Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to Support Empirical Antibiotic Therapy Decisions in Infected Ischemic Leg Ulcers—A Feasibility Study. Journal of Clinical Medicine. 2024; 13(20):6219. https://doi.org/10.3390/jcm13206219

Chicago/Turabian Style

Salm, Jonas, Franziska Ikker, Elias Noory, Ulrich Beschorner, Tobias Siegfried Kramer, Dirk Westermann, and Thomas Zeller. 2024. "Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to Support Empirical Antibiotic Therapy Decisions in Infected Ischemic Leg Ulcers—A Feasibility Study" Journal of Clinical Medicine 13, no. 20: 6219. https://doi.org/10.3390/jcm13206219

APA Style

Salm, J., Ikker, F., Noory, E., Beschorner, U., Kramer, T. S., Westermann, D., & Zeller, T. (2024). Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to Support Empirical Antibiotic Therapy Decisions in Infected Ischemic Leg Ulcers—A Feasibility Study. Journal of Clinical Medicine, 13(20), 6219. https://doi.org/10.3390/jcm13206219

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