
==== Front
Int Wound J
Int Wound J
10.1111/(ISSN)1742-481X
IWJ
International Wound Journal
1742-4801
1742-481X
Blackwell Publishing Ltd Oxford, UK

10.1111/iwj.70023
IWJ70023
Letter to the Editor
Letter to the Editor
Antimicrobial resistance is not increasing in subsequent cases of ischaemic foot infections, a single‐centre cohort from 2012 to 2021
LETTER TO THE EDITOR
Javanian Mostafa https://orcid.org/0000-0002-2771-4578
1
Barary Mohammad https://orcid.org/0000-0001-8733-9370
2
Ebrahimpour Soheil https://orcid.org/0000-0003-3204-0448
1 drsoheil1503@yahoo.com

1 Infectious Diseases and Tropical Medicine Research Center, Health Research Institute Babol University of Medical Sciences Babol Iran
2 Student Research Committee, School of Medical Education and Learning Technologies Shahid Beheshti University of Medical Sciences Tehran Iran
* Correspondence
Soheil Ebrahimpour, Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
Email: drsoheil1503@yahoo.com

02 9 2024
9 2024
21 9 10.1111/iwj.v21.9 e7002330 7 2024
01 8 2024
© 2024 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

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cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:02.09.2024
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pmc Dear Editor,

We read with keen interest the article titled “Antimicrobial resistance is not increasing in subsequent cases of ischaemic foot infections: a single‐centre cohort from 2012 to 2021” by Salm et al., published in your esteemed journal. 1 This study addresses a significant aspect of infectious disease management by examining the link between antibiotic therapy and antimicrobial resistance (AMR) in recurring episodes of ischemic foot infections (IFI). However, several methodological considerations and limitations warrant further discussion to enhance the study's impact and validity:

METHODOLOGICAL CONSIDERATIONS

Firstly, the study's statistical power is intrinsically tied to the sample size. The relatively small sample size used in this research may undermine the robustness of the findings, leading to an increased margin of error and reduced reliability of the conclusions. 2 Cohort studies require a sufficiently large sample to ensure the precision and generalizability of the results.

Secondly, retrospective cohort studies, such as this one, are prone to various biases. Incomplete recording of medical and laboratory data in patient files poses a significant risk. Moreover, the study did not adjust for critical confounding variables such as patient comorbidities and previous antimicrobial use, which could significantly impact the outcomes. A more rigorous adjustment for these factors is essential to accurately assess the relationship between antibiotic therapy and AMR.

LIMITATIONS IN FOLLOW‐UP

Another notable limitation is the short follow‐up period for monitoring antimicrobial resistance, which was confined to the duration of hospital stays. This approach fails to capture the long‐term dynamics of AMR development and the recurrence of IFI post‐discharge. Including follow‐up data after patients are discharged would provide a more comprehensive understanding of AMR trends over time.

BROADER CONTEXTUALIZATION

The findings of this study are crucial given the current global trends in AMR. However, the methodological limitations outlined above restrict the broader applicability of the results. Addressing these limitations in future research is essential to develop more effective strategies for managing IFI and combating AMR.

In conclusion, despite these limitations, the study by Salm et al. offers valuable insights into AMR patterns in IFI cases. Addressing the highlighted methodological issues would significantly bolster the robustness and applicability of the findings for future research and clinical practice. We urge the authors and the journal to consider these concerns and integrate feasible solutions in subsequent studies.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

RESPONSE FROM AUTHOR

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

The comments raised in the letter to the editor are well written but address common issues in cohort studies. The authors conclude that addressing the outlined methodological limitations in future studies would strengthen the robustness and applicability of the findings for future research, which we fully agree with. And of course we would address their concerns in future research projects. But as research is an iterative process, we think this study is a very good start.

Mit freundlichen Grüßen

Dr. med. Jonas Salm

Assistenzarzt

MSc Epidemiology
==== Refs
REFERENCES

1 Salm J , Ikker F , Noory E , et al. Antimicrobial resistance is not increasing in subsequent cases of ischaemic foot infections, a single‐centre cohort from 2012 to 2021. Int Wound J. 2024;21 (7 ):e14961.38949168
2 Faber J , Fonseca LM . How sample size influences research outcomes. Dental Press J Orthod. 2014;19 (4 ):27‐29.
