Exploring the Microbiome of Diabetic Foot Ulcers: A Focus on Cases with a Clinical Worse Outcome

<b>Background/Objectives</b>: We evaluated the diabetic foot ulcer (DFU) microbiome in clinical situations identified as risk factors for a worse outcome and explored the roles of the most abundant microorganisms. <b>Methods</b>: A prospective multicenter cohort of diabetic p...

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Main Authors: Laura Soldevila-Boixader, Anna Carrera-Salinas, Isabel Mur, Laura Morata, Alba Rivera, Jordi Bosch, Abelardo Montero-Saez, Jéssica Martínez Castillejo, Natividad Benito, Sara Martí, Oscar Murillo
Format: Article
Language:English
Published: MDPI AG 2025-07-01
Series:Antibiotics
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Online Access:https://www.mdpi.com/2079-6382/14/7/724
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Summary:<b>Background/Objectives</b>: We evaluated the diabetic foot ulcer (DFU) microbiome in clinical situations identified as risk factors for a worse outcome and explored the roles of the most abundant microorganisms. <b>Methods</b>: A prospective multicenter cohort of diabetic patients with DFU were followed up for 6 months. We obtained a DFU tissue biopsy for microbiome analysis at the baseline visit. Genomic DNA was extracted (QIAamp DNA Mini Kit, Qiagen, Hilden, Germany) and quantified (QuantiFluor dsDNA System, Promega, Madison, WI, USA), with analysis of bacterial communities focusing on relative abundances (RA) and on alpha and beta diversity. <b>Results</b>: Overall, 59 DFUs were analyzed. DFUs of long duration (≥4 weeks) presented a higher RA of Gammaproteobacteria compared with ulcers of short duration (<i>p</i> = 0.02). Non-infected DFUs had a higher proportion of Actinobacteriota phyla than infected DFUs and, particularly, a higher RA of <i>Corynebacterium</i> genera (means ± SD: 0.063 ± 0.14 vs. 0.028 ± 0.13, respectively; <i>p</i> = 0.03). Regarding the pathogenic role of <i>Staphylococcus aureus</i>, DFUs with low <i>S. aureus</i> bacterial loads (<10<sup>6</sup> CFU/mL) compared with those with high loads (≥10<sup>6</sup> CFU/mL) showed a higher <i>Corynebacterium</i> RA (0.045 ± 0.08 vs. 0.003 ± 0.01, respectively; <i>p</i> = 0.01). <b>Conclusions</b>: In clinical situations associated with poor DFU outcomes, we observed a predominance of Gammaproteobacteria in the microbiome of long-duration ulcers and a higher RA of <i>Corynebacterium</i> in non-infected DFUs. An inverse relationship between the predominance of <i>Corynebacterium</i> and the <i>S. aureus</i> bacterial load in DFUs was also noted, which may suggest these commensals have a modulatory role. Further studies should explore the clinical utility of microbiome analysis for DFUs.
ISSN:2079-6382