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Relationship between healing status and microbial dissimilarity in wound and peri-wound skin in pressure injuries
Institution:1. Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;2. Japan Society for the Promotion of Science, Tokyo, Japan;3. Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;4. Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;5. AI Hospital/Macro Signal Dynamics Research and Development Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan;6. Research Center for Implementation Nursing Science Initiative, School of Health Sciences, Fujita Health University, Aichi, Japan;7. Department of Nursing, Sengi Hospital, Ishikawa, Japan;8. School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;1. West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China;2. Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China;3. Mianyang Hospital of Traditional Chinese Medicine, Mianyang, Sichuan, China;4. School of Nursing, Peking University, Beijing, China;1. Koç University, School of Nursing, Davutpasa Street No:4, 34010 Topkapi, Istanbul, Turkey;2. T.C. Istanbul Kültür University, Faculty of Health Science, Nursing Department, Turkey;1. School of Nursing and Midwifery, University of Galway, Galway, Ireland;2. Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland;3. Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western, Switzerland;4. Faculty of Medicine Nursing and Health Sciences, Monash University, Australia;5. Discipline of Podiatric Medicine, School of Health Science, University of Galway, Galway, Ireland;6. Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland;7. CÚRAM, SFI Research Centre for Medical Devices, Ireland;8. Care Directorate, University Hospital Geneva, Switzerland;9. School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland;10. Irish Research Council (IRC), Government of Ireland, Dublin, Ireland;11. Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland;12. Centre for Pain Research, University of Galway, Ireland;1. Wound Care Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China;2. Cangzhou Medical College, Cangzhou, Hebei, China;3. Nursing Department Office, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China;4. Affiliated Hospital of YangZhou University, Nanjing, Jiangsu, China;5. Department of Pathology, Jinglin Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China;6. Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China;1. School of Nursing, University of Milan, ASST GOM Niguarda, Milan, Italy;2. Department Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy;3. Faculty of Medicine and Health, School of Health Sciences, Nursing Science Unit, Swedish Centre for Skin and Wound Research, Örebro University, Sweden;4. Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium;5. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy;1. Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia;2. Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University and Gold Coast University Hospital, Gold Coast Health, Australia;3. The Prince Charles Hospital, Australia;4. School of Nursing & Midwifery, Royal College of Surgeons in Ireland, University of Medicine, and Health Sciences, Ireland;5. Office for Research, Griffith University, Australia;6. School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women''s Hospital, Metro North Health, Australia;7. School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Division of Surgery, Princess Alexandra Hospital, Australia
Abstract:AimWound infection is the most serious cause of delayed healing for patients with pressure injuries. The wound microbiota, which plays a crucial role in delayed healing, forms by bacterial dissemination from the peri-wound skin. To manage the bioburden, wound and peri-wound skin care has been implemented; however, how the microbiota at these sites contribute to delayed healing is unclear. Therefore, we investigated the relationship between healing status and microbial dissimilarity in wound and peri-wound skin.MethodsA prospective cohort study was conducted at a long-term care hospital. The outcome was healing status assessed using the DESIGN-R® tool, a wound assessment tool to monitor the wound healing process. Bacterial DNA was extracted from the wound and peri-wound swabs, and microbiota composition was analyzed using 16S rRNA gene analysis. To evaluate microbial similarity, the weighted UniFrac dissimilarity index between wound and peri-wound microbiota was calculated.ResultsTwenty-two pressure injuries (7 deep and 15 superficial wounds) were included in the study. For deep wounds, the predominant bacteria in wound and peri-wound skin were the same in the healing wounds, whereas they were different in all cases of hard-to-heal wounds. Analysis based on the weighted UniFrac dissimilarity index, there was no significant difference for healing wounds (p = 0.639), while a significant difference was found for hard-to-heal wounds (p = 0.047).ConclusionsDelayed healing is possibly associated with formation of wound microbiota that is different in composition from that of the skin commensal microbiota. This study provides a new perspective for assessing wound bioburden.
Keywords:Hard-to-heal wounds  Microbiome  Wound infection  Critical colonization  16S ribosomal RNA  CFU"}  {"#name":"keyword"  "$":{"id":"kwrd0040"}  "$$":[{"#name":"text"  "_":"colony-forming unit  PCR"}  {"#name":"keyword"  "$":{"id":"kwrd0050"}  "$$":[{"#name":"text"  "_":"polymerase chain reaction  OTU"}  {"#name":"keyword"  "$":{"id":"kwrd0060"}  "$$":[{"#name":"text"  "_":"operational taxonomic unit  PERMANOVA"}  {"#name":"keyword"  "$":{"id":"kwrd0070"}  "$$":[{"#name":"text"  "_":"permutational multivariate analysis of variance
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