Journal
JOURNAL OF INVESTIGATIVE DERMATOLOGY
Volume 137, Issue 1, Pages 237-244Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jid.2016.08.009
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Funding
- National Institutes of Health [NINR R01NR009448, NIAMS R00AR060873, NIAMS R01AR066663, NINR R01NR015639, NIAMS T32AR007465]
- Pennsylvania Department of Health
- NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES [P30AR069589, R01AR066663, T32AR007465, R00AR060873] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF NURSING RESEARCH [R01NR009448, R01NR015639] Funding Source: NIH RePORTER
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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.
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