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
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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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author 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
author_facet 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
author_sort Laura Soldevila-Boixader
collection DOAJ
description <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.
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spelling doaj-art-4b42feab223349f9b91269b95ace35cd2025-08-20T03:36:13ZengMDPI AGAntibiotics2079-63822025-07-0114772410.3390/antibiotics14070724Exploring the Microbiome of Diabetic Foot Ulcers: A Focus on Cases with a Clinical Worse OutcomeLaura Soldevila-Boixader0Anna Carrera-Salinas1Isabel Mur2Laura Morata3Alba Rivera4Jordi Bosch5Abelardo Montero-Saez6Jéssica Martínez Castillejo7Natividad Benito8Sara Martí9Oscar Murillo10Infectious Diseases Unit, Department of Infectious Diseases, Bellvitge University Hospital, The Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona (UB), L’Hospitalet de Llobregat, 08907 Barcelona, SpainDepartment of Microbiology, Bellvitge University Hospital, The Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona (UB), L’Hospitalet de Llobregat, 08907 Barcelona, SpainInternal Medicine, Infectious Diseases Unit, Hospital Moisès Broggi, 08970 Sant Joan Despí, SpainDepartment of Infectious Diseases, Clinic Hospital Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona (UB), 08036 Barcelona, SpainDepartment of Microbiology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), 08041 Barcelona, SpainDepartment of Microbiology, Clinic Hospital, ISGlobal, 08036 Barcelona, SpainInternal Medicine Department, Bellvitge University Hospital, The Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona (UB), L’Hospitalet de Llobregat, 08907 Barcelona, SpainDepartment of Nursery in Orthopedic Surgery, Clinic Hospital, 08036 Barcelona, SpainStudy Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, SpainDepartment of Microbiology, Bellvitge University Hospital, The Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona (UB), L’Hospitalet de Llobregat, 08907 Barcelona, SpainInfectious Diseases Unit, Department of Infectious Diseases, Bellvitge University Hospital, The Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona (UB), L’Hospitalet de Llobregat, 08907 Barcelona, Spain<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.https://www.mdpi.com/2079-6382/14/7/724microbiomechronic diabetic foot ulcersGammaproteobacteria
spellingShingle 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
Exploring the Microbiome of Diabetic Foot Ulcers: A Focus on Cases with a Clinical Worse Outcome
Antibiotics
microbiome
chronic diabetic foot ulcers
Gammaproteobacteria
title Exploring the Microbiome of Diabetic Foot Ulcers: A Focus on Cases with a Clinical Worse Outcome
title_full Exploring the Microbiome of Diabetic Foot Ulcers: A Focus on Cases with a Clinical Worse Outcome
title_fullStr Exploring the Microbiome of Diabetic Foot Ulcers: A Focus on Cases with a Clinical Worse Outcome
title_full_unstemmed Exploring the Microbiome of Diabetic Foot Ulcers: A Focus on Cases with a Clinical Worse Outcome
title_short Exploring the Microbiome of Diabetic Foot Ulcers: A Focus on Cases with a Clinical Worse Outcome
title_sort exploring the microbiome of diabetic foot ulcers a focus on cases with a clinical worse outcome
topic microbiome
chronic diabetic foot ulcers
Gammaproteobacteria
url https://www.mdpi.com/2079-6382/14/7/724
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