Temporal Stability in Chronic Wound Microbiota Is Associated With Poor Healing

Michael Loesche; Sue E Gardner; Lindsay Kalan; Joseph Horwinski; Qi Zheng; Brendan P Hodkinson; Amanda S Tyldsley; Carrie L Franciscus; Stephen L Hillis; Samir Mehta; David J Margolis; Elizabeth A Grice

doi:10.1016/j.jid.2016.08.009

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Temporal Stability in Chronic Wound Microbiota Is Associated With Poor Healing

Journal article

Open access

Peer reviewed

Temporal Stability in Chronic Wound Microbiota Is Associated With Poor Healing

Michael Loesche, Sue E Gardner, Lindsay Kalan, Joseph Horwinski, Qi Zheng, Brendan P Hodkinson, Amanda S Tyldsley, Carrie L Franciscus, Stephen L Hillis, Samir Mehta, …

Journal of investigative dermatology, Vol.137(1), pp.237-244

01/2017

DOI: 10.1016/j.jid.2016.08.009

PMCID: PMC5279919

PMID: 27566400

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Abstract

Microbial burden of chronic wounds is believed to play an important role in impaired healing and the development of infection-related complications. However, clinical cultures have little predictive value of wound outcomes, and culture-independent studies have been limited by cross-sectional design and small cohort size. We systematically evaluated the temporal dynamics of the microbiota colonizing diabetic foot ulcers, a common and costly complication of diabetes, and its association with healing and clinical complications. Dirichlet multinomial mixture modeling, Markov chain analysis, and mixed-effect models were used to investigate shifts in the microbiota over time and their associations with healing. Here we show, to our knowledge, previously unreported temporal dynamics of the chronic wound microbiome. Microbiota community instability was associated with faster healing and improved outcomes. Diabetic foot ulcer microbiota were found to exist in one of four community types that experienced frequent and nonrandom transitions. Transition patterns and frequencies were associated with healing time. Exposure to systemic antibiotics destabilized the wound microbiota, rather than altering overall diversity or relative abundance of specific taxa. This study provides evidence that the dynamic wound microbiome is indicative of clinical outcomes and may be a valuable guide for personalized management and treatment of chronic wounds.

Diabetic Foot - physiopathology

Markov Chains

Prognosis

Prospective Studies

Cross-Sectional Studies

Risk Assessment

Humans

Middle Aged

Diabetic Foot - drug therapy

Microbiota - drug effects

Male

Diabetic Foot - microbiology

Disease Progression

Anti-Bacterial Agents - therapeutic use

Female

Aged

Wound Healing - physiology

Chronic Disease

Longitudinal Studies

Cohort Studies

Details

Title: Subtitle: Temporal Stability in Chronic Wound Microbiota Is Associated With Poor Healing
Creators: Michael Loesche - Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Sue E Gardner - University of Iowa, College of Nursing, Iowa City, Iowa, USA. Electronic address: sue-gardner@uiowa.edu
Lindsay Kalan - Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Joseph Horwinski - Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Qi Zheng - Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Brendan P Hodkinson - Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Amanda S Tyldsley - Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Carrie L Franciscus - Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, Iowa, USA
Stephen L Hillis - Departments of Radiology and Biostatistics, University of Iowa, Iowa City, Iowa, USA
Samir Mehta - Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
David J Margolis - Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Departments of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Elizabeth A Grice - Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: egrice@upenn.edu
Resource Type: Journal article
Publication Details: Journal of investigative dermatology, Vol.137(1), pp.237-244
DOI: 10.1016/j.jid.2016.08.009
PMID: 27566400
PMCID: PMC5279919
NLM abbreviation: J Invest Dermatol
ISSN: 0022-202X
eISSN: 1523-1747
Publisher: United States
Grant note: R01 NR009448 / NINR NIH HHS R01 AR066663 / NIAMS NIH HHS P30 AR069589 / NIAMS NIH HHS R01 NR015639 / NINR NIH HHS T32 AR007465 / NIAMS NIH HHS R00 AR060873 / NIAMS NIH HHS
Language: English
Date published: 01/2017
Academic Unit: Radiology; Biostatistics; Nursing
Record Identifier: 9984051728002771

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