{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:20:15Z","timestamp":1790317215987,"version":"4.1.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T00:00:00Z","timestamp":1691712000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and design<\/jats:title>\n<jats:p>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 <jats:italic>Staphylococcus aureus<\/jats:italic>-associated infections.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>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 <jats:italic>S<\/jats:italic>. <jats:italic>aureus<\/jats:italic> (18.6%), <jats:italic>Enterococcus faecalis<\/jats:italic> (9.1%) and <jats:italic>S<\/jats:italic>. <jats:italic>epidermidis<\/jats:italic> (7.8%). <jats:italic>Pseudomonas aeruginosa<\/jats:italic> (5.6%), <jats:italic>Proteus mirabilis<\/jats:italic> (3.7%) and <jats:italic>Escherichia coli<\/jats:italic> (3.4%). The resistance of <jats:italic>S<\/jats:italic>. <jats:italic>aureus<\/jats:italic> isolates to clindamycin was 11.0%. Resistance to oxacillin was rare (1.5%). <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> is frequently resistant to ciprofloxacin (14.4%) whilst intrinsically resistant to trimethoprim\/sulfamethoxazole. <jats:italic>P<\/jats:italic>. <jats:italic>mirabilis<\/jats:italic> and <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> 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 <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> isolates (36.8%). Multi-drug resistance (MDR) was rare among <jats:italic>S<\/jats:italic>. <jats:italic>aureus<\/jats:italic> and <jats:italic>P<\/jats:italic>. <jats:italic>aeruginosa<\/jats:italic> isolates. In contrast, the proportion of MDR was high in <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> isolates. End-stage renal disease was independently positively associated with <jats:italic>S<\/jats:italic>. <jats:italic>aureus<\/jats:italic> identification (p = .042).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p><jats:italic>S<\/jats:italic>. <jats:italic>aureus<\/jats:italic> 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 <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> species had a high proportion of MDR.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0290103","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T17:26:37Z","timestamp":1691774797000},"page":"e0290103","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Arterial leg ulcers\u2014Bacterial patterns, antimicrobial resistance and clinical characteristics, a retrospective single-centre cohort, 2012\u20132021"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9841-3417","authenticated-orcid":true,"given":"Jonas","family":"Salm","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"B\u00f6hme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Noory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Beschorner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias Siegfried","family":"Kramer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Zeller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,8,11]]},"reference":[{"issue":"3","key":"pone.0290103.ref001","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1038\/nrcardio.2016.179","article-title":"Peripheral artery disease: epidemiology and global perspectives","volume":"14","author":"FGR Fowkes","year":"2017","journal-title":"Nat Rev Cardiol"},{"issue":"6","key":"pone.0290103.ref002","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1056\/NEJM199202063260605","article-title":"Mortality over a Period of 10 Years in Patients with Peripheral Arterial Disease","volume":"326","author":"MH Criqui","year":"1992","journal-title":"N Engl J Med"},{"issue":"11","key":"pone.0290103.ref003","doi-asserted-by":"crossref","first-page":"e006550","DOI":"10.1161\/CIRCOUTCOMES.120.006550","article-title":"Cause of Death Among Patients With Peripheral Artery Disease","volume":"13","author":"A Kochar","year":"2020","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"3","key":"pone.0290103.ref004","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/S0741-5214(97)70045-4","article-title":"Recommended standards for reports dealing with lower extremity ischemia: Revised version","volume":"26","author":"RB Rutherford","year":"1997","journal-title":"J Vasc Surg"},{"issue":"2","key":"pone.0290103.ref005","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1056\/NEJMcp1709326","article-title":"Chronic Limb-Threatening Ischemia","volume":"379","author":"A. 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