A COVID-19 Silver Lining-Decline in Antibiotic Resistance in Ischemic Leg Ulcers during the Pandemic: A 6-Year Retrospective Study from a Regional Tertiary Hospital (2017-2022).

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 2017-10 March 2020; n = 69) and during (11 March 2020-31 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 < 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 < 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 < 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.

Cardiovascular risks in Asian HIV-infected patients receiving boosted-protease inhibitor-based antiretroviral treatment.

INTRODUCTION: Increased risk of cardiovascular disease in HIV-infected patients was tought to be the cause of multiple mechanistic factors, which changing the HIV care landscape. Antiretroviral therapy (ART), especially protease inhibitors (PI), is one of common HIV treatments that may have some association with this. The mechanism of PI in comparison to other regimens, however, are not clearly understood. METHODOLOGY: Age-and gender-match HIV-infected patients treated with either boosted-PI-based regimen (boosted-PI group, N=30) or NNRTI-based ART (non-PI group, N = 30) were recruited for this cross-sectional study. Parameters determined cardiovascular risks, inflammation, endothelial function, and bone metabolic function were evaluated. RESULTS: Compared with non-PI, patients in the boosted-PI group had more evidence of dyslipidemia. No statistical difference in the prevalence of subclinical atherosclerosis was found between the two groups. Circulating levels of inflammatory markers, C-reactive protein (CRP) (5.4±9.1 vs. 14.9 ± 19.4 mg/L, p = 0.019) and lectin-liked oxidized lipoprotein receptor-1 (LOX-1) (387 ± 299 vs. 554 ± 324 pg/mL, p = 0.042) were lower in boosted-PI group. Contrastingly, Vascular adhesion molecules-1 (VCAM-1) (160.2 ± 80.0 vs. 147.8 ± 66.3 ng/mL, p = 0.010), and osteoprotegerin (OPG) (153.7 ± 57.1 vs. 126.4 ± 35.8, p = 0.031) were higher. After adjustment in the multivariate analysis, PI treatment is the only independent parameter associated with the changes of CRP, LOX-1, VCAM-1, and OPG. Subgroup analysis showed that ARV treatment effects differed among participant having dyslipidemia. CONCLUSIONS: The major mechanism in which PI-mediated was triggering atherogenesis could be through alteration of lipid metabolism and endothelial function, but no evidence of accelerated pro-inflammatory response was attested.

Predictive Factors for Post-Ischemic Compartment Syndrome in Non-Traumatic Acute Limb Ischemia in a Lower Extremity.

Objective: Compartment syndrome (CS) is serious complication following revascularization of acute limb ischemia (ALI). However, predictive factors associated with CS remain unclear. This study aimed to identify these predictive factors. Materials and Methods: Twenty-two patients who presented with non-traumatic ALI between November 2013 and October 2015 were enrolled and monitored for CS in this prospective cohort study. Predictive factors were compared between the CS and non-CS groups. Results: There were 5 patients in the CS group and 17 patients in the non-CS group. Four predictive factors were associated with CS: (1) inadequate backflow (80% and 12% in the CS and non-CS groups, respectively; P=.001); (2) serum creatine kinase (CK) level (20,683 U/L and 911 U/L in the CS and non-CS groups, respectively; P<.001); (3) positive fluid balance after admission (4,324 mL and 1,223 mL in the CS and non-CS groups, respectively; P<.001); and (4) Rutherford category IIB (100% and 18% in the CS and non-CS groups, respectively; P=.0002). Conclusion: Inadequate backflow, high serum CK level, positive fluid balance, and advanced-stage ALI were associated with CS. This information may be useful in identification of high-risk patients for CS prevention and in early detection of CS following the revascularization procedure.

Case Series of HIV Infection-Associated Arteriopathy: Diagnosis, Management, and Outcome Over a 5-Year period at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University.

Patients infected with human immunodeficiency virus (HIV) can present with 4 pathology types: drug-induced vasospasm (ergotism), arterial limb ischemia, critical limb ischemia, and aneurysm. Although these problems are common vascular problems, they result in increased morbidity and mortality in HIV-infected patients, especially aneurysm. Patients with these problems tend to be diagnosed with difficulty because of atypical symptoms and signs. Because of lack of data in treatment outcome literature, our report explores and provides information on HIV infection-related arteriopathy. There were 17 patients in our 5-year review. There was no death in patients except the aneurysm type. The survival of aneurysm patients was significantly lower than from other pathologies (P = .003). Our case series showed good short-term outcome, and patients were not at risk for less beneficial surgical procedures.