{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:23:09Z","timestamp":1790709789756,"version":"4.1.0"},"reference-count":49,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,29]],"date-time":"2023-12-29T00:00:00Z","timestamp":1703808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chiang Mai University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Antibiotic resistance (AR) associated with chronic limb-threatening ischemia (CLTI) poses additional challenges for the management of ischemic leg ulcers, increasing the likelihood of severe outcomes. This study assessed AR prevalence in bacteria isolated from CLTI-associated leg ulcers before (1 January 2017\u201310 March 2020; n = 69) and during (11 March 2020\u201331 December 2022; n = 59) the COVID-19 pandemic from patients admitted with positive wound cultures to a regional hospital in Chiang Mai (Thailand). There was a marked reduction in AR rates from 78% pre-pandemic to 42% during the pandemic (p &lt; 0.0001), with rates of polymicrobial infections 22 percentage points lower (from 61% to 39%, respectively; p = 0.014). There were reduced AR rates to amoxicillin\/clavulanate (from 42% to 4%; p &lt; 0.0001) and ampicillin (from 16% to 2%; p = 0.017), as well as multidrug resistance (19% to 8%; p = 0.026). Factors associated with increased AR odds were polymicrobial infections (adjusted odds ratio (aOR) 5.6 (95% CI 2.1, 15.0); p = 0.001), gram-negative bacteria (aOR 7.0 (95% CI 2.4, 20.5); p &lt; 0.001), and prior use of antibiotics (aOR 11.9 (95% CI 1.1, 128.2); p = 0.041). Improvements in infection control measures and hygiene practices in the community during the pandemic were likely key factors contributing to lower AR rates. Thus, strategic public health interventions, including community education on hygiene and the informed use of antibiotics, may be crucial in mitigating the challenges posed by AR in CLTI. Further, advocating for more judicious use of empirical antibiotics in clinical settings can balance effective treatment against AR development, thereby improving patient outcomes.<\/jats:p>","DOI":"10.3390\/antibiotics13010035","type":"journal-article","created":{"date-parts":[[2023,12,29]],"date-time":"2023-12-29T06:18:13Z","timestamp":1703830693000},"page":"35","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A COVID-19 Silver Lining\u2014Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017\u20132022)"],"prefix":"10.3390","volume":"13","author":[{"given":"Amaraporn","family":"Rerkasem","sequence":"first","affiliation":[{"name":"Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Research Center for Infectious Disease and Substance Use, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pak","family":"Thaichana","sequence":"additional","affiliation":[{"name":"Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuttida","family":"Bunsermvicha","sequence":"additional","affiliation":[{"name":"Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawee","family":"Nopparatkailas","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supapong","family":"Arwon","sequence":"additional","affiliation":[{"name":"Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saranat","family":"Orrapin","sequence":"additional","affiliation":[{"name":"Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Termpong","family":"Reanpang","sequence":"additional","affiliation":[{"name":"Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poon","family":"Apichartpiyakul","sequence":"additional","affiliation":[{"name":"Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1330-6215","authenticated-orcid":false,"given":"Saritphat","family":"Orrapin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathum Thani 12120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boonying","family":"Siribumrungwong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathum Thani 12120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nongkran","family":"Lumjuan","sequence":"additional","affiliation":[{"name":"Research Center for Molecular and Cell Biology, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kittipan","family":"Rerkasem","sequence":"additional","affiliation":[{"name":"Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1226-1956","authenticated-orcid":false,"given":"Jos\u00e9 G. B.","family":"Derraik","sequence":"additional","affiliation":[{"name":"Environmental-Occupational Health Sciences and Non-Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Department of Women\u2019s and Children\u2019s Health, Uppsala University, 75185 Uppsala, Sweden"},{"name":"Department of Pediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/eurheartj\/ehx095","article-title":"2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: The European Stroke Organization (ESO), The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)","volume":"39","author":"Aboyans","year":"2018","journal-title":"Eur. Heart. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2019.02.016","article-title":"Global vascular guidelines on the management of chronic limb-threatening ischemia","volume":"69","author":"Conte","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_3","unstructured":"Sidawy, A.N., and Perler, B.A. (2022). Rutherford\u2019s Vascular Surgery and Endovascular Therapy, Elsevier Health Sciences."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"449","DOI":"10.3400\/avd.ra.18-00122","article-title":"The diagnostic classification of critical limb ischemia","volume":"11","author":"Azuma","year":"2018","journal-title":"Ann. Vasc. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ventoruzzo, G., Mazzitelli, G., Ruzzi, U., Liistro, F., Scatena, A., and Martelli, E. (2023). Limb salvage and survival in chronic limb-threatening ischemia: The need for a fast-track team-based approach. J. Clin. Med., 12.","DOI":"10.20944\/preprints202308.1664.v1"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"277","DOI":"10.3400\/avd.ra.18-00073","article-title":"Countermeasures against infection in critical limb ischemia treatments","volume":"11","author":"Izumi","year":"2018","journal-title":"Ann. Vasc. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"683","DOI":"10.2147\/VHRM.S2186","article-title":"The influence of polymorbidity, revascularization, and wound therapy on the healing of arterial ulceration","volume":"4","author":"Tautenhahn","year":"2008","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Matta-Guti\u00e9rrez, G., Garc\u00eda-Morales, E., Garc\u00eda-\u00c1lvarez, Y., \u00c1lvaro-Afonso, F.J., Molines-Barroso, R.J., and L\u00e1zaro-Mart\u00ednez, J.L. (2021). The influence of multidrug-resistant bacteria on clinical outcomes of diabetic foot ulcers: A systematic review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10091948"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"12618","DOI":"10.21037\/apm-21-3406","article-title":"Risk factors for multidrug-resistant bacterial infections in patients with diabetic foot ulcers: A systematic review and meta-analysis","volume":"10","author":"Xia","year":"2021","journal-title":"Ann. Palliat. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Salm, J., Bohme, T., Noory, E., Beschorner, U., Kramer, T.S., Westermann, D., and Zeller, T. (2023). Arterial leg ulcers\u2014Bacterial patterns, antimicrobial resistance and clinical characteristics, a retrospective single-centre cohort, 2012\u20132021. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0290103"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"204","DOI":"10.4103\/0377-4929.41685","article-title":"Spectrum of microbial flora in diabetic foot ulcers","volume":"51","author":"Bansal","year":"2008","journal-title":"Indian J. Pathol. Microbiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1586\/eri.13.19","article-title":"Antibiotic resistance rates in causative agents of infections in diabetic patients: Rising concerns","volume":"11","author":"Boyanova","year":"2013","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e179","DOI":"10.1016\/S2666-5247(22)00355-X","article-title":"Antimicrobial resistance in patients with COVID-19: A systematic review and meta-analysis","volume":"4","author":"Langford","year":"2023","journal-title":"Lancet Microbe"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.cmi.2022.12.006","article-title":"Antibiotic resistance associated with the COVID-19 pandemic: A systematic review and meta-analysis","volume":"29","author":"Langford","year":"2023","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"108797","DOI":"10.1016\/j.diabres.2021.108797","article-title":"Antibiotic resistance in diabetic foot infection: How it changed with COVID-19 pandemic in a tertiary care center","volume":"175","author":"Caruso","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Petrakis, V., Panopoulou, M., Rafailidis, P., Lemonakis, N., Lazaridis, G., Terzi, I., Papazoglou, D., and Panagopoulos, P. (2023). The impact of the COVID-19 pandemic on antimicrobial resistance and management of bloodstream infections. Pathogens, 12.","DOI":"10.20944\/preprints202304.1195.v1"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"dlab167","DOI":"10.1093\/jacamr\/dlab167","article-title":"Reduced transmission of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) in patients with haematological malignancies hospitalized in an Italian hospital during the COVID-19 pandemic","volume":"3","author":"Micozzi","year":"2021","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1177\/10781552211043836","article-title":"Lesson learned from the pandemic: Isolation and hygiene measures for COVID-19 could reduce the nosocomial infection rates in oncology wards","volume":"28","author":"Guven","year":"2022","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bentivegna, E., Luciani, M., Arcari, L., Santino, I., Simmaco, M., and Martelletti, P. (2021). Reduction of multidrug-resistant (MDR) bacterial infections during the COVID-19 pandemic: A retrospective study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18031003"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"107622","DOI":"10.1016\/j.jdiacomp.2020.107622","article-title":"Surgical treatment of diabetic foot ulcers during the COVID-19 pandemic in China","volume":"34","author":"Tao","year":"2020","journal-title":"J. Diabetes Complicat."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Saleem, Z., Haseeb, A., Godman, B., Batool, N., Altaf, U., Ahsan, U., Khan, F.U., Mustafa, Z.U., Nadeem, M.U., and Farrukh, M.J. (2023). Point prevalence survey of antimicrobial use during the COVID-19 pandemic among different hospitals in Pakistan: Findings and implications. Antibiotics, 12.","DOI":"10.3390\/antibiotics12010070"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1111\/jgs.17722","article-title":"Risk from delayed or missed care and non-COVID-19 outcomes for older patients with chronic conditions during the pandemic","volume":"70","author":"Smith","year":"2022","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"dlaa051","DOI":"10.1093\/jacamr\/dlaa051","article-title":"CON: COVID-19 will not result in increased antimicrobial resistance prevalence","volume":"2","author":"Collignon","year":"2020","journal-title":"JAC Antimicrob. Resist."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.ajic.2020.10.019","article-title":"Unintended consequences of infection prevention and control measures during COVID-19 pandemic","volume":"49","author":"Wee","year":"2021","journal-title":"Am. J. Infect. Control"},{"key":"ref_26","first-page":"e31126","article-title":"A retrospective study of the overuse of extended-spectrum antibiotics in patients with community-acquired pneumonia with risk for methicillin-resistant Staphylococcus aureus and\/or Pseudomonas aeruginosa","volume":"14","author":"Luu","year":"2022","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1136\/bmj.317.7159.654","article-title":"Community acquired infections and bacterial resistance","volume":"317","author":"Goossens","year":"1998","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S122","DOI":"10.1038\/nm1145","article-title":"Antibacterial resistance worldwide: Causes, challenges and responses","volume":"10","author":"Levy","year":"2004","journal-title":"Nat. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1038\/s41467-021-21157-9","article-title":"Impact of the COVID-19 nonpharmaceutical interventions on influenza and other respiratory viral infections in New Zealand","volume":"12","author":"Huang","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_30","first-page":"268","article-title":"Lessons from Thailand\u2019s response to the COVID-19 pandemic","volume":"50","author":"Plipat","year":"2020","journal-title":"Thai J Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1038\/s41598-022-06008-x","article-title":"Reconstruction of the transmission dynamics of the first COVID-19 epidemic wave in Thailand","volume":"12","author":"Wilasang","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e3280","DOI":"10.1002\/dmrr.3280","article-title":"Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Lipsky","year":"2020","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"38","DOI":"10.31925\/farmacia.2023.1.5","article-title":"Antibiotic susceptibility and resistance of bacterial pathogens in chronic leg ulcers: A retrospective cohort study","volume":"71","year":"2023","journal-title":"Farmacia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1046\/j.0022-202x.2001.00043.x","article-title":"Skin microflora and bacterial infections of the skin","volume":"6","author":"Chiller","year":"2001","journal-title":"J. Investig. Dermatol. Symp. Proc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/IDR.S260708","article-title":"A longitudinal evaluation of the bacterial pathogens colonizing chronic non-healing wound sites at a United States military treatment facility in the Pacific Region","volume":"14","author":"Nahid","year":"2021","journal-title":"Infect. Drug. Resist."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.ejvs.2006.11.027","article-title":"Influence of secondary infection on amputation in chronic critical limb ischemia","volume":"33","author":"Jaccard","year":"2007","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1024\/0301-1526.32.1.18","article-title":"Does infection affect amputation rate in chronic critical leg ischemia?","volume":"32","author":"Kummer","year":"2003","journal-title":"Vasa"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"482","DOI":"10.3934\/microbiol.2018.3.482","article-title":"An overview of the antimicrobial resistance mechanisms of bacteria","volume":"4","author":"Reygaert","year":"2018","journal-title":"AIMS Microbiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/j.jiph.2021.10.020","article-title":"Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects","volume":"14","author":"Uddin","year":"2021","journal-title":"J. Infect. Public Health"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Davin-Regli, A., and Pag\u00e8s, J.-M. (2015). Enterobacter aerogenes and Enterobacter cloacae; versatile bacterial pathogens confronting antibiotic treatment. Front. Microbiol., 6.","DOI":"10.3389\/fmicb.2015.00392"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Kyriakidis, I., Vasileiou, E., Pana, Z.D., and Tragiannidis, A. (2021). Acinetobacter baumannii antibiotic resistance mechanisms. Pathogens, 10.","DOI":"10.3390\/pathogens10030373"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2890","DOI":"10.1161\/CIR.0b013e318276fbcb","article-title":"Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association","volume":"126","author":"Aboyans","year":"2012","journal-title":"Circulation"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.jvs.2006.12.037","article-title":"Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)","volume":"45","author":"Norgren","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref_44","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":"Rutherford","year":"1997","journal-title":"J. Vasc. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1111\/iwj.12475","article-title":"2015 International Working Group on the Diabetic Foot Guidance on the prevention and management of foot problems in diabetes","volume":"12","author":"Jones","year":"2015","journal-title":"Int. Wound J."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Singhal, N., Kumar, M., Kanaujia, P.K., and Virdi, J.S. (2015). MALDI-TOF mass spectrometry: An emerging technology for microbial identification and diagnosis. Front. Microbiol., 6.","DOI":"10.3389\/fmicb.2015.00791"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e00062-17","DOI":"10.1128\/CMR.00062-17","article-title":"Practical guidance for clinical microbiology laboratories: Implementing a quality management system in the medical microbiology laboratory","volume":"31","author":"Carey","year":"2018","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_48","first-page":"157","article-title":"WHO declares COVID-19 a pandemic","volume":"91","author":"Cucinotta","year":"2020","journal-title":"Acta Biomed."},{"key":"ref_49","first-page":"24","article-title":"Preparing the wound bed 2003: Focus on infection and inflammation","volume":"49","author":"Sibbald","year":"2003","journal-title":"Ostomy Wound Manag."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/1\/35\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:44:10Z","timestamp":1760132650000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/1\/35"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,29]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["antibiotics13010035"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13010035","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,29]]}}}