Data from: The neuropathic diabetic foot ulcer microbiome is associated with clinical factors.

Nonhealing diabetic foot ulcers (DFUs) are a common and costly complication of diabetes. Microbial burden, or "bioburden," is believed to underlie delayed healing, although little is known of those clinical factors that may influence microbial load, diversity, and/or pathogenicity. We profiled the microbiomes of neuropathic nonischemic DFUs without clinical evidence of infection in 52 individuals using high-throughput sequencing of the bacterial 16S ribosomal RNA gene. Comparatively, wound cultures, the standard diagnostic in the clinic, vastly underrepresent microbial load, microbial diversity, and the presence of potential pathogens. DFU microbiomes were heterogeneous, even in our tightly restricted study population, but partitioned into three clusters distinguished primarily by dominant bacteria and diversity. Ulcer depth was associated with ulcer cluster, positively correlated with abundance of anaerobic bacteria, and negatively correlated with abundance of Staphylococcus. Ulcer duration was positively correlated with bacterial diversity, species richness, and relative abundance of Proteobacteria, but was negatively correlated with relative abundance of Staphylococcus. Finally, poor glycemic control was associated with ulcer cluster, with poorest median glycemic control concentrating to Staphylococcus-rich and Streptococcus-rich ulcer clusters. Analyses of microbial community membership and structure may provide the most useful metrics in prospective studies to delineate problematic bioburden from benign colonization that can then be used to drive clinical treatment.

不愈合糖尿病足溃疡（DFUs）是糖尿病常见且治疗成本高昂的并发症。微生物负荷（microbial burden），或称生物负荷（bioburden），被认为是伤口愈合延迟的核心诱因，但目前对于可能影响微生物负荷、多样性及/或致病性的临床因素仍知之甚少。本研究针对52名无临床感染迹象的神经性非缺血性糖尿病足溃疡患者，通过细菌16S核糖体RNA基因高通量测序对其溃疡微生物组（microbiome）进行了表征分析。相较而言，作为临床标准诊断方法的伤口培养，对微生物负荷、微生物多样性以及潜在病原体存在情况的检出能力严重不足。即便在本研究严格限定的受试人群中，糖尿病足溃疡的微生物组仍呈现异质性，且可根据优势菌属与多样性特征划分为三个聚类群。溃疡深度与溃疡聚类群显著相关：与厌氧菌丰度呈正相关，与葡萄球菌属（Staphylococcus）丰度呈负相关。溃疡病程与细菌多样性、物种丰富度以及变形菌门（Proteobacteria）相对丰度呈正相关，而与葡萄球菌属（Staphylococcus）相对丰度呈负相关。最后，血糖控制不佳与溃疡聚类群相关，其中血糖控制最差的患者群体，其溃疡多集中于富含葡萄球菌属（Staphylococcus）与链球菌属（Streptococcus）的聚类群。在未来的前瞻性研究中，对微生物群落组成与结构的分析或可提供最具价值的量化指标，用于区分病理性生物负荷与良性定植，进而指导临床治疗方案的制定。