Abstract
Decubitus pressure ulcers (PU) are a major complication of immobilised patients. Staphylococcus aureus is one of the most frequently detected microorganisms in PU samples; however, its persistence and role in the evolution of these wounds is unknown. In this study, we analysed S. aureus strains isolated from PU biopsies at inclusion and day 28. Eleven S. aureus (21.1%) were detected in 52 patients at inclusion. Only six PUs (11.5%) continued to harbour this bacterium at day 28. Using a whole genome sequencing approach (Miseq®, Illumina), we confirmed that these six S. aureus samples isolated at D28 were the same strain as that isolated at inclusion, with less than 83 bp difference. Phenotypical studies evaluating the growth profiles (Infinite M Mano, Tecan®) and biofilm formation (Biofilm Ring Test®) did not detect any significant difference in the fitness of the pairs of S. aureus. However, using the Caenorhabditis elegans killing assay, a clear decrease of virulence was observed between strains isolated at D28 compared with those isolated at inclusion, regardless of the clinical evolution of the PU. Moreover, all strains at inclusion were less virulent than a control S. aureus strain, i.e., NSA739. An analysis of polymicrobial communities of PU (by metabarcoding approach), in which S. aureus persisted, demonstrated no impact of Staphylococcus genus on PU evolution. Our study suggested that S. aureus presented a colonising profile on PU with no influence on wound evolution.
Highlights
Pressure ulcers (PU) are a major complication of immobilised patients and, more of spinal cord injury (SCI) patients
Our study demonstrates that S. aureus persistence in PU is not predictive of wound evolution or the development of an infection
Even if a larger scale study should be conducted, our work highlights that S. aureus persistence is a rare event in PU
Summary
Pressure ulcers (PU) are a major complication of immobilised patients and, more of spinal cord injury (SCI) patients. PU annual incidence is estimated at 26%. In this population, and more than 85% of SCI patients will develop at least one PU in their lifetime [1]. PU result from pressure phenomena associated or not with shear forces, and are classified into four clinical stages with two additional stages [2]. In SCI patients, PU are a major public health issue because they increase health care costs by a factor of four and the length of hospitalisation by a factor of six [3]. The occurrence of PU depends on factors related to care (e.g., adapted management of the disability, mobilisation), and intrinsic human factors (e.g., immune status, PU localisation). The wound microbiota play a crucial role in delayed wound healing, and are represented
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