Next Generation DNA Sequencing of Tissues from Infected Diabetic Foot Ulcers

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Authors: Malone M., Johani K., Jensen S.O., Gosbell I.B., Dickson H.G., Hu H., Vickery K.
Publication: EBioMedicine
Year:  2017
Volume: 21
Start Page: 142


We used next generation DNA sequencing to profile the microbiome of infected Diabetic Foot Ulcers (DFUs). The microbiota was correlated to clinical parameters and treatment outcomes to determine if directed antimicrobial therapy based on conventional microbiological cultures are relevant based on genomic analysis. Patients ≥ 18 years presenting with a new Diabetic Foot Infection (DFI) who had not received topical or oral antimicrobials in the two weeks prior to presentation, were eligible for enrolment. Tissue punch biopsies were obtained from infected DFUs for analysis. Demographics, clinical and laboratory data were collected and correlated against microbiota data. Thirty-nine patients with infected DFUs were recruited over twelve-months. Shorter duration DFUs (< six weeks) all had one dominant bacterial species (n = 5 of 5, 100%, p < 0.001), Staphylococcus aureus in three cases and Streptococcus agalactiae in two. Longer duration DFUs (≥ six weeks) were diversely polymicrobial (p < 0.01) with an average of 63 (range 19–125) bacterial species. Severe DFIs had complex microbiomes and were distinctly dissimilar to less severe infections (p = 0.02), characterised by the presence of low frequency microorganisms. Nineteen patients (49%) during the study period experienced antimicrobial treatment failure, but no overall differences existed in the microbiome of patients who failed therapy and those who experienced treatment success (p = 0.2). Our results confirm that short DFUs have a simpler microbiome consisting of pyogenic cocci but chronic DFUs have a highly polymicrobial microbiome. The duration of a DFU may be useful as a guide to directing antimicrobial therapy.

  • Listing ID: 4924
  • Author/s: Malone M., Johani K., Jensen S.O., Gosbell I.B., Dickson H.G., Hu H., Vickery K.
  • Publication: EBioMedicine
  • Year: 2017
  • Volume: 21
  • Start Page: 142
  • Article Keywords: Acinetobacter, adult, Anaerococcus, antimicrobial therapy, article, bacterium identification, clinical article, community structure, correlation analysis, Corynebacterium, disease duration, disease severity, drug treatment failure, female, Finegoldia, human, human tissue, male, microbial diversity, microbiological examination, pathogen load, Peptoniphilus, priority journal, punch biopsy, sequence analysis, Staphylococcus aureus, Streptococcus, Streptococcus agalactiae, treatment outcome