Mechanism of Injury is Associated with the Microbiome of Open Fracture Wounds. metagenome

Background: Preventing infection and/or non-union in open fractures remains a challenge. Microbial colonization and/or contamination of the wound may influence healing and outcomes. Using culture-independent molecular methods, we previously demonstrated that microbial communities associated with open fractures are diverse and associated with patient- and injury-level factors. Herein, we expand on these preliminary findings to analyze long-term temporal microbial community dynamics of open fracture wounds and their relationship to injury mechanism.Methods: Fifty-two subjects with traumatic open fractures (32 blunt and 20 penetrating injuries) were enrolled prospectively and sampled longitudinally from presentation to the emergency department (ED) until wound closure. Specimens were collected from both the wound center and adjacent skin. Sequencing of the 16S ribosomal RNA gene was employed to identify and characterize microbiota with respect to mechanism of injury.Results: Upon presentation to the ED and time points immediately following, sample collection site (wound or adjacent skin) was the most defining feature discriminating microbial profiles. Microbial composition of adjacent skin and wound center converged over time. Mechanism of injury most strongly defined the microbiota after initial convergence. Further analysis controlling for race, gender, and age revealed the mechanism of injury remained as the significant discriminating feature of the bacterial communities from samples collected initially at the ED through the continuum of care.Conclusions: The microbial communities associated with open fracture injuries are dynamic in nature, and converge with the adjacent skin microbiome during healing. Mechanism of injury was an important feature affecting diversity and composition of the microbiota.