Abstract
Diabetic foot ulcers (DFUs) lead to nearly 100,000 lower limb amputations annually in the United States. DFUs are colonized by complex microbial communities, and infection is one of the most common reasons for diabetes-related hospitalizations and amputations. In this study, we examined how DFU microbiomes respond to initial sharp debridement and offloading and how the initial composition associates with 4 week healing outcomes. We employed 16S rRNA next generation sequencing to perform microbial profiling on 50 samples collected from 10 patients with vascularized neuropathic DFUs. Debrided wound samples were obtained at initial visit and after one week from two DFU locations, wound bed and wound edge. Samples of the foot skin outside of the wounds were also collected for comparison. We showed that DFU wound beds are colonized by a greater number of distinct bacterial phylotypes compared to the wound edge or skin outside the wound. However, no significant microbiome diversity changes occurred at the wound sites after one week of standard care. Finally, increased initial abundance of Gram-positive anaerobic cocci (GPAC), especially Peptoniphilus (p < 0.05; n = 5 subjects), was associated with impaired healing; thus, GPAC’s abundance could be a predictor of the wound-healing outcome.
Highlights
Diabetes mellitus (DM) affects over 422 million people worldwide and nearly 30 million Americans [1,2,3]
To investigate how the initial debridement influences the composition of wound microbiota, we profiled the microbiome of Diabetic foot ulcers (DFUs) samples collected from patients at initial visit and at follow-up after one week
Among all operational taxonomic units (OTUs) analyzed in this study (525), we found that almost 80% (419) of OTUs were shared between the DFU samples
Summary
Diabetes mellitus (DM) affects over 422 million people worldwide and nearly 30 million Americans [1,2,3]. Diabetic foot ulcers (DFUs) are chronic wounds that develop upon skin injury in patients with long-standing and often poorly-controlled DM. DFUs occur in up to 25% of all patients with DM [4, 5], and even with standard care, one in three DFUs fails to heal [1, 2, 6, 7] preceding 85% of all diabetes-related lower-leg amputations [8]. DFU patients are highly susceptible to rapidly spreading infection that can lead to soft tissue damage and osteomyelitis, lower limb amputation (approximately 100,000 cases annually in the USA), sepsis, and death [1, 2, 6, 7].
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