The microbiota of traumatic, open fracture wounds is associated with mechanism of injury

Abstract

Open fractures are characterized by disruption of the skin and soft tissue, which allows for microbial contamination and colonization. Preventing infection-related complications of open fractures and other acute wounds remains an evolving challenge due to an incomplete understanding of how microbial colonization and contamination influence healing and outcomes. Culture-independent molecular methods are now widely used to study human-associated microbial communities without introducing culture biases. Using such approaches, the objectives of this study were to (1) define the long-term temporal microbial community dynamics of open fracture wounds and (2) examine microbial community dynamics with respect to clinical and demographic factors. Fifty-two subjects with traumatic open fracture wounds (32 blunt and 20 penetrating injuries) were enrolled prospectively and sampled longitudinally from presentation to the emergency department (ED) and at each subsequent inpatient or outpatient encounter. Specimens were collected from both the wound center and adjacent skin. Culture-independent sequencing of the 16S ribosomal RNA gene was employed to identify and characterize microbiota. Upon presentation to the ED and time points immediately following, sample collection site (wound or adjacent skin) was the most defining feature discriminating microbial profiles. Microbial composition of adjacent skin and wound center converged over time. Mechanism of injury most strongly defined the microbiota after initial convergence. Further analysis controlling for race, gender, and age revealed that mechanism of injury remained a significant discriminating feature throughout the continuum of care. We conclude that the microbial communities associated with open fracture wounds are dynamic in nature until eventual convergence with the adjacent skin community during healing, with mechanism of injury as an important feature affecting both diversity and composition of the microbiota. A more complete understanding of the factors influencing microbial contamination and/or colonization in open fractures is a critical foundation for identifying markers indicative of outcome and deciphering their respective contributions to healing and/or complication.

The Cutaneous Microbiome and Wounds: New Molecular Targets to Promote Wound Healing

“…Similar to burn injury, the wounds created as a result of blunt or penetrating traumas also exhibit changes in skin microbial composition and significant differences in beta diversity compared to controls [ 55 , 56 ]. The microbial composition of open fracture wounds is even associated with mechanism of injury [ 55 ]. The most dominant microbes in open fracture wounds and adjacent skin include Staphylococcus , Corynebacterium , Streptococcus , Acinetobacter , Anaerococcus , Finegoldia , and Pseudomonas .…”

The Cutaneous Wound Innate Immunological Microenvironment

“…Intriguingly, numerous studies have shown that wounding can dramatically alter the cutaneous microbiome [ 51 ]; the disruption of skin can lead to bacteria taking advantage of a new environment, a phenomenon termed quorum sensing. This often leads to a reduction in bacterial diversity in chronic wounds [ 52 ], as well as in acute traumatic fracture wounds [ 53 ]. Furthermore, in acute traumatic fracture wounds, wounded tissue has an initially distinct microbiome from nonwounded tissue, but eventually the two converge over the course of healing [ 53 ], suggesting a dynamic role of the microbiome in the wound resolution process.…”

“…This often leads to a reduction in bacterial diversity in chronic wounds [ 52 ], as well as in acute traumatic fracture wounds [ 53 ]. Furthermore, in acute traumatic fracture wounds, wounded tissue has an initially distinct microbiome from nonwounded tissue, but eventually the two converge over the course of healing [ 53 ], suggesting a dynamic role of the microbiome in the wound resolution process. Significant work has been performed to elucidate how skin flora may either potentiate or impair wound immune responses ( Figure 1 ).…”

Time-Dependent Displacement of Commensal Skin Microbes by Pathogens at the Site of Colorectal Surgery

“…diabetic ulcers. Few studies have chronicled the bacteriology of surgical incisions [28][29][30][31] . In this study, we utilized a high-throughput approach to characterize the skin microbiota of adults undergoing colorectal surgery.…”