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Comparative analysis of the composition and change of the microbiome of diabetic foot ulcers from patients on different therapies

Diabetic foot ulcers (DFUs) are slow healing wounds which arise from co-morbidities associated with diabetes. Often these ulcers become infected leading to gangrene, osteomyelitis and sepsis. Current treatment options include debridement and a topical irrigant which have limited success. Understanding the effects that these treatments have on microbiome of DFUs and on wound healing is poorly understood. This study compared the efficacy of two irrigant solutions (Prontosan and Electrolysed water –E.W.) on their impact on the DFU microbiome, their role in DFU healing and their effect on biofilm viability. Sequential samples taken from 7 patients undergoing treatment with either one of the irrigants, over a 4 week period revealed commonly observed genera present included Staphylococci (96 %), Propionibacterium (96 %) and Finegoldia (89 %). A unique composition and diversity was observed in the microbiome of each individual DFU. Increasing microbial diversity within the DFUs was correlated with an elevated percentage abundance of anaerobic and Gram negative genera whilst inversely correlated with facultative anaerobic and Gram positive genera. No significant reduction in diversity or species richness of the DFU microbiomes was observed after treatment with either irrigant. Both Prontosan and E.W. had similar effects upon S. aureus biofilms reducing viability by 82.013 % and 86.89 % respectively however E.W. efficacy was strain specific. In addition, E.W. was ineffective at preventing biofilm formation in 6/8 (75 %) S. aureus strains. Better understanding of the DFU microbiome and investigations into novel therapies is paramount to aid our ability to improve the quality of life for diabetic patients.