Distinct polymicrobial populations in a chronic foot ulcer with implications for diagnostics and anti-infective therapy
Open accessAbstract
Background: Polymicrobial infections caused by combinations of different bacteria are being detected with an increasing frequency. The evidence of such complex infections is being revealed through the use of novel molecular and culture-independent methods. Considerable progress has been made in the last decade regarding the diagnostic application of such molecular techniques. In particular, 16S rDNA-based sequencing and even metagenomic analyses have been successfully used to study the microbial diversity in ecosystems and human microbiota. Here, we utilized denaturing high-performance liquid chromatography (DHPLC) as a diagnostic tool for identifying different bacterial species in complex clinical samples of a patient with a chronic foot ulcer. Case presentation: A 45-year-old female suffered from a chronic 5x5cm large plantar ulcer located in the posterior calcaneal area with subcutaneous tissue infection and osteomyelitis. The chronic ulcer developed over a period of 8 years. Culture and DHPLC revealed a distinct and location-dependent polymicrobial infection of the ulcer. The analysis of a superficial biopsy revealed a mixture of Staphylococcus aureus,Proteus vulgaris, and Fusobacterium nucleatum, whereas the tissue-deep biopsy harbored a mixture of four different bacterial species, namely Gemella morbillorum,Porphyromonas asaccharolytica,Bacteroides fragilis, and Arcanobacterium haemolyticum. Conclusions: This clinical case highlights the difficulties in assessing polymicrobial infections where a mixture of fastidious, rapid and slow growing bacteria as well as anaerobes exists as structured communities within the tissue architecture of chronic wound infections. The diagnosis of this multilayered polymicrobial infection led to a microbe-adapted antibiotic therapy, targeting the polymicrobial nature of this infection in addition to a standard local wound treatment. However, a complete wound closure could not be achieved due to the long-lasting extensive destruction of tissue.
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If biofilms occur, these microbes change their metabolism and a new ecology is set up with a modified microbiome.
“If this occurs, these microbes change their metabolism11 and a new ecology is set up with a modified microbiome.12,13”
From The Innate Immune System in Acute and Chronic Wounds (2016) · cites this paper as [12]
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- Authors
- Imirzalioglu, C., Sethi, S., Schneider, C., Hain, T., Chakraborty, T., Mayser, P., & Domann, E.
- Affiliations
- Justus-Liebig-Universität Gießen (DE)
- Corresponding author
- Domann, Eugen
- ORCID
- Venue
- BMC Research Notes
- Published
- 2014-03-29
- Volume
- 7
- Issue
- 1
- Pages
- 196-196
- ISSN
- 1756-0500 (ISSN-L)
- PMC
- PMC3974921
- OpenAlex
- W2163974454
- Cited by
- 23
- References
- 45
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 1 · 2015: 1 · 2014: 2
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Research Notes (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University writing server of the Justus Liebig University Giessen (Justus-Liebig-Universität Gießen) (submittedVersion, cc-by)
- Universitätsbibliothek Gießen (cc-by)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Microbiology › Actinomycetales infections and treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Keywords
- co-infection, chronic foot ulcers, osteomyelitis, Staphylococcus aureus, Proteus vulgaris, Fusobacterium nucleatum, Gemella morbillorum, Porphyromonas asaccharolytica, Bacteroides fragilis, Arcanobacterium haemolyticum, anaerobic bacteria, denaturing high-performance liquid chromatography, wound microbiology, targeted antibiotic therapy, chronic wound infection
- MeSH terms
- Anti-Bacterial Agents, Chromatography, High Pressure Liquid, Chronic Disease, Female, Humans, Middle Aged, Osteomyelitis, Foot Ulcer, Gram-Negative Bacterial Infections, Gram-Positive Bacterial Infections, Treatment Failure, Drug Resistance, Multiple, Bacterial, Microbiota
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