Antibiotic Consumption and Bloodstream Infections in Patients With Chronic-limb Threatening Ischemia Following Endovascular Therapy in East-west Germany,2019–2020

Abstract

Patients with chronic-limb threatening ischemia (CLTI) and peripheral wounds might be predisposed for systemic infections. The study aimed to describe the rate of systemic infections in patients with CLTI compared with peripheral artery obstructive disease (PAOD) patients without CLTI, both independently of endovascular treatment (EVT) and after EVT. Administrative data of the AOK Baden-Wuerttemberg (AOK BW) from patients with PAOD were analyzed considering bloodstream infection (BSI), 30-day readmission and prescribed antibiotics for ischemic ulcers. The risk of BSI increased 3.9-fold (95% CI: 3.4–4.4) in patients with PAOD Rutherford-Becker category (RBC) 5 and 6 (n = 11,741) compared with PAOD RBC 1-4 (n = 23,482; 6.81% vs 1.67%, P < .01). The risk of Staphylococcus aureus BSI increased 5.6-fold (95% CI: 4.1–7.7) comparing RBC 5 and 6 (1.2%) with RBC 1-4 (0.22%, P < .01). Outpatient antibiotic prescriptions were dominated by aminopenicillins with β-lactamase inhibitors, accounting for 34.9%. Clindamycin, cefuroxime, and fluoroquinolones represented 14.9%, 13.5%, and 12.6% of prescriptions, respectively. Infections were responsible for 7.7% of 30-day readmissions following EVT. Patients with CLTI are at risk of developing BSI, and specifically S. aureus BSI. Infection-related causes in 30-day readmissions following EVT are common. The high use of clindamycin and cefuroxime in outpatients is concerning.