Metataxonomic approach to decipher the polymicrobial burden in diabetic foot ulcer and its biofilm mode of infection

Suryaletha, Karthika; John, Joby; Radhakrishnan, Megha Periyappilly; George, Sanil; Thomas, Sabu

doi:10.1111/iwj.12888

Cited by 40 publications

(28 citation statements)

References 36 publications

(33 reference statements)

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“…However, their effectiveness in capturing the entire repertoire of microbes and especially strict anaerobes is highly debated (16). Bacteria are rarely found as monomicrobial entities and, as the wound progresses, the presence of necrotic tissue as well as a poor supply of oxygen and significant biofilm production favors the growth of facultative or obligate anaerobes (5,17). In our NGS study, a steady increase in facultative anaerobes was observed as the wound progressed, with the exception of WG5.…”

Section: Discussionmentioning

confidence: 76%

Microbial Community Distribution and Core Microbiome in Successive Wound Grades of Individuals with Diabetic Foot Ulcers

Jnana

Muthuraman

Varghese

et al. 2020

Appl Environ Microbiol

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Diabetic foot ulcer (DFU) is a major complication of diabetes with high morbidity and mortality rates. The pathogenesis of DFUs is governed by a complex milieu of environmental and host factors. The empirical treatment is initially based on wound severity since culturing and profiling the antibiotic sensitivity of wound-associated microbes is time-consuming. Hence, a thorough and rapid analysis of the microbial landscape is a major requirement toward devising evidence-based interventions. Toward this, 122 wound (100 diabetic and 22 nondiabetic) samples were sampled for their bacterial community structure using both culture-based and next-generation 16S rRNA-based metagenomics approach. Both the approaches showed that the Gram-negative microbes were more abundant in the wound microbiome. The core microbiome consisted of bacterial genera, including Alcaligenes, Pseudomonas, Burkholderia, and Corynebacterium in decreasing order of average relative abundance. Despite the heterogenous nature and extensive sharing of microbes, an inherent community structure was apparent, as revealed by a cluster analysis based on Euclidean distances. Facultative anaerobes (26.5%) were predominant in Wagner grade 5, while strict anaerobes were abundant in Wagner grade 1 (26%). A nonmetric dimensional scaling analysis could not clearly discriminate samples based on HbA1c levels. Sequencing approach revealed the presence of major culturable species even in samples with no bacterial growth in culture-based approach. Our study indicates that (i) the composition of core microbial community varies with wound severity, (ii) polymicrobial species distribution is individual specific, and (iii) antibiotic susceptibility varies with individuals. Our study suggests the need to evolve better-personalized care for better wound management therapies. IMPORTANCE Chronic nonhealing diabetic foot ulcers (DFUs) are a serious complication of diabetes and are further exacerbated by bacterial colonization. The microbial burden in the wound of each individual displays diverse morphological and physiological characteristics with unique patterns of host-pathogen interactions, antibiotic resistance, and virulence. Treatment involves empirical decisions until definitive results on the causative wound pathogens and their antibiotic susceptibility profiles are available. Hence, there is a need for rapid and accurate detection of these polymicrobial communities for effective wound management. Deciphering microbial communities will aid clinicians to tailor their treatment specifically to the microbes prevalent in the DFU at the time of assessment. This may reduce DFUs associated morbidity and mortality while impeding the rise of multidrug-resistant microbes.

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Section: Discussionmentioning

confidence: 76%

Microbial Community Distribution and Core Microbiome in Successive Wound Grades of Individuals with Diabetic Foot Ulcers

Jnana

Muthuraman

Varghese

et al. 2020

Appl Environ Microbiol

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“…Identification of pathogenic bacteria is the first essential step to monitor and control the etiology of DFIs accurately (Sadeghpour Heravi et al, 2019). However, a large portion of bacterial species are not culturable using traditional methods (Suryaletha et al, 2018). While many human disorders have been linked to a shift in the bacterial composition/function (Nowicki et al, 2018), it is still unclear how this fluctuation may influence the development of DFIs.…”

Section: Discussionmentioning

confidence: 99%

Metatranscriptomic Analysis Reveals Active Bacterial Communities in Diabetic Foot Infections

et al. 2020

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Despite the extended view of the composition of diabetic foot infections (DFIs), little is known about which transcriptionally active bacterial communities are pertinent to infection, and if any differences are associated with increased infection severity. We applied a RNA sequencing approach to analyze the composition, function, and pathogenicity of the active bacterial communities in DFIs. Taxonomic profiling of bacterial transcripts revealed the presence of 14 bacterial phyla in DFIs. The abundance of the Spiroplasma, Vibrio, and Mycoplasma were significantly different in different infection severities (P < 0.05). Mild and severe stages of infections were dominated by Staphylococcus aureus and Porphyromonas asaccharolytica, respectively. A total of 132 metabolic pathways were identified of which ribosome and thiamin being among the most highly transcribed pathways. Moreover, a total of 131 antibiotic resistance genes, primarily involved in the multidrug efflux pumps/exporters, were identified. Furthermore, iron acquisition systems (synthesize and regulation of siderophores) and pathways involved in the synthesis and regulation of cell-surface components associated with adhesion, colonization, and movement of bacterial cells were the most common virulence factors. These virulence factors may help bacteria compete for scares resources and survive the host wound proteases. Characterization of transcriptionally active bacterial communities can help to provide an understanding of the role of key pathogens in the development of DFIs. Such information can be clinically useful allowing replacement of DFIs empirical therapy with targeted treatment.

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“…Bacteria in chronic wounds do not exist in a suspended state but colonize the ECM in the form of complex bacterial biofilms. This is often the reason for the emergence of drug-resistant bacteria, such as extended-spectrum β-lactamasepositive Escherichia coli (ESBL E. coli) and methicillin-resistant S. aureus (MRSA) (Suryaletha et al, 2018).…”

Section: Anti-infectionmentioning

confidence: 99%

Functional Biomaterials for Treatment of Chronic Wound

Zhang

Shu

et al. 2020

Front. Bioeng. Biotechnol.

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The increasing number of patients with chronic wounds caused by diseases, such as diabetes, malignant tumors, infections, and vasculopathy, has caused severe economic and social burdens. The main clinical treatments for chronic wounds include the systemic use of antibiotics, changing dressings frequently, operative debridement, and flap repair. These routine therapeutic strategies are characterized by a long course of treatment, substantial trauma, and high costs, and fail to produce satisfactory results. Biomaterial dressings targeting the different stages of the pathophysiology of chronic wounds have become an active research topic in recent years. In this review, after providing an overview of the epidemiology of chronic wounds, and the pathophysiological characteristics of chronic wounds, we highlight the functional biomaterials that can enhance chronic wound healing through debridement, anti-infection and antioxidant effects, immunoregulation, angiogenesis, and extracellular matrix remodeling. It is hoped that functional biomaterials will resolve the treatment dilemma for chronic wounds and improve patient quality of life.

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Metataxonomic approach to decipher the polymicrobial burden in diabetic foot ulcer and its biofilm mode of infection

Cited by 40 publications

References 36 publications

Microbial Community Distribution and Core Microbiome in Successive Wound Grades of Individuals with Diabetic Foot Ulcers

Microbial Community Distribution and Core Microbiome in Successive Wound Grades of Individuals with Diabetic Foot Ulcers

Metatranscriptomic Analysis Reveals Active Bacterial Communities in Diabetic Foot Infections

Functional Biomaterials for Treatment of Chronic Wound

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