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The Neuropathic Diabetic Foot Ulcer Microbiome Is Associated With Clinical Factors

Nonhealing diabetic foot ulcers (DFUs) are a common and costly complication of diabetes. Microbial burden, or “bioburden,” is believed to underlie delayed healing, although little is known of those clinical factors that may influence microbial load, diversity, and/or pathogenicity. We profiled the m...

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Autores principales: Gardner, Sue E., Hillis, Stephen L., Heilmann, Kris, Segre, Julia A., Grice, Elizabeth A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581190/
https://www.ncbi.nlm.nih.gov/pubmed/23139351
http://dx.doi.org/10.2337/db12-0771
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author Gardner, Sue E.
Hillis, Stephen L.
Heilmann, Kris
Segre, Julia A.
Grice, Elizabeth A.
author_facet Gardner, Sue E.
Hillis, Stephen L.
Heilmann, Kris
Segre, Julia A.
Grice, Elizabeth A.
author_sort Gardner, Sue E.
collection PubMed
description Nonhealing diabetic foot ulcers (DFUs) are a common and costly complication of diabetes. Microbial burden, or “bioburden,” is believed to underlie delayed healing, although little is known of those clinical factors that may influence microbial load, diversity, and/or pathogenicity. We profiled the microbiomes of neuropathic nonischemic DFUs without clinical evidence of infection in 52 individuals using high-throughput sequencing of the bacterial 16S ribosomal RNA gene. Comparatively, wound cultures, the standard diagnostic in the clinic, vastly underrepresent microbial load, microbial diversity, and the presence of potential pathogens. DFU microbiomes were heterogeneous, even in our tightly restricted study population, but partitioned into three clusters distinguished primarily by dominant bacteria and diversity. Ulcer depth was associated with ulcer cluster, positively correlated with abundance of anaerobic bacteria, and negatively correlated with abundance of Staphylococcus. Ulcer duration was positively correlated with bacterial diversity, species richness, and relative abundance of Proteobacteria, but was negatively correlated with relative abundance of Staphylococcus. Finally, poor glycemic control was associated with ulcer cluster, with poorest median glycemic control concentrating to Staphylococcus-rich and Streptococcus-rich ulcer clusters. Analyses of microbial community membership and structure may provide the most useful metrics in prospective studies to delineate problematic bioburden from benign colonization that can then be used to drive clinical treatment.
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spelling pubmed-35811902014-03-01 The Neuropathic Diabetic Foot Ulcer Microbiome Is Associated With Clinical Factors Gardner, Sue E. Hillis, Stephen L. Heilmann, Kris Segre, Julia A. Grice, Elizabeth A. Diabetes Complications Nonhealing diabetic foot ulcers (DFUs) are a common and costly complication of diabetes. Microbial burden, or “bioburden,” is believed to underlie delayed healing, although little is known of those clinical factors that may influence microbial load, diversity, and/or pathogenicity. We profiled the microbiomes of neuropathic nonischemic DFUs without clinical evidence of infection in 52 individuals using high-throughput sequencing of the bacterial 16S ribosomal RNA gene. Comparatively, wound cultures, the standard diagnostic in the clinic, vastly underrepresent microbial load, microbial diversity, and the presence of potential pathogens. DFU microbiomes were heterogeneous, even in our tightly restricted study population, but partitioned into three clusters distinguished primarily by dominant bacteria and diversity. Ulcer depth was associated with ulcer cluster, positively correlated with abundance of anaerobic bacteria, and negatively correlated with abundance of Staphylococcus. Ulcer duration was positively correlated with bacterial diversity, species richness, and relative abundance of Proteobacteria, but was negatively correlated with relative abundance of Staphylococcus. Finally, poor glycemic control was associated with ulcer cluster, with poorest median glycemic control concentrating to Staphylococcus-rich and Streptococcus-rich ulcer clusters. Analyses of microbial community membership and structure may provide the most useful metrics in prospective studies to delineate problematic bioburden from benign colonization that can then be used to drive clinical treatment. American Diabetes Association 2013-03 2013-02-14 /pmc/articles/PMC3581190/ /pubmed/23139351 http://dx.doi.org/10.2337/db12-0771 Text en © 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
spellingShingle Complications
Gardner, Sue E.
Hillis, Stephen L.
Heilmann, Kris
Segre, Julia A.
Grice, Elizabeth A.
The Neuropathic Diabetic Foot Ulcer Microbiome Is Associated With Clinical Factors
title The Neuropathic Diabetic Foot Ulcer Microbiome Is Associated With Clinical Factors
title_full The Neuropathic Diabetic Foot Ulcer Microbiome Is Associated With Clinical Factors
title_fullStr The Neuropathic Diabetic Foot Ulcer Microbiome Is Associated With Clinical Factors
title_full_unstemmed The Neuropathic Diabetic Foot Ulcer Microbiome Is Associated With Clinical Factors
title_short The Neuropathic Diabetic Foot Ulcer Microbiome Is Associated With Clinical Factors
title_sort neuropathic diabetic foot ulcer microbiome is associated with clinical factors
topic Complications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581190/
https://www.ncbi.nlm.nih.gov/pubmed/23139351
http://dx.doi.org/10.2337/db12-0771
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