Abstract
With the increase in the older populations, the number of bedridden older patients is becoming a matter of concern. Skin microbiome and skin physiological functions are known to change according to lifestyle and community; however, such changes in case of movement- and cleaning-restricted bedridden older patients have not yet been revealed. To address this issue, we analyzed skin microbiome and skin physiological functions, including pH, hydration, sebum level, and transepidermal water loss (TEWL), of bedridden older patients, compared with those of ambulatory older and young individuals. For this analysis, we enrolled 19 healthy young and 18 ambulatory older individuals from the community and 31 bedridden older patients from a single, long-term care hospital in Japan. The area of interest was set to the sacral (lower back) skin, where pressure injuries (PIs) and subsequent infection frequently occurs in bedridden older patients. We observed a higher number of gut-related bacteria, fewer commensals, higher skin pH, and lower TEWL on the sacral skin of bedridden older patients than on that of young or ambulatory older individuals. In addition, we observed that 4 of the 31 bedridden older patients developed PIs during the research period; a higher abundance of pathogenic skin bacteria were also observed inside the PI wounds. These findings imply distinct skin microbiome and skin physiological functions in bedridden older patients in comparison with healthy individuals and may suggest the need for more stringent cleaning of the skin of bedridden older patients in light of the closeness of skin and wound microbiome.
Highlights
IntroductionSkin serves as a protectant against external insult (e.g., pressure, shock, ultraviolet light, chemicals, and pathogens), as well as retaining the fluid within the body
Skin serves as a protectant against external insult, as well as retaining the fluid within the body
Six bedridden patients used antibacterial drugs; there were no significant differences in skin microbiome between the users and non-users of antibacterial drugs (PERMANOVA; unweighted UniFrac, P = 0.27; weighted UniFrac, P = 0.84), and all participants were included for further analysis
Summary
Skin serves as a protectant against external insult (e.g., pressure, shock, ultraviolet light, chemicals, and pathogens), as well as retaining the fluid within the body. It is widely recognized that the skin barrier consists of the “wall” of skin cells and of various bacteria [1]. The major skin commensal Cutibacterium (formerly Propionibacterium) acnes is known to produce fatty acids, which in turn keep skin pH mildly acidic and prevent colonization of transient bacteria [2]. Staphylococcus epidermidis is a major source of glycerol on the skin, which is responsible for skin water retention [3]. Depletion of S. epidermidis can cause skin inflammation [4], and several Staphylococcus spp. can produce antimicrobial peptides to prevent colonization of pathogens [5]. Dysbiosis of the skin microbiome can lead to the deterioration of skin physiological and barrier functions
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