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
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
DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
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. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Faber J, Fonseca LM. How sample size influences research outcomes. Dental Press J Orthod. 2014;19(4):27‐29. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.