Published Studies

Journal of Wound Care

Retrospective Study: To assess the incidence, abundance and species diversity of fungi in chronic wounds, as well as to describe the associations of major fungi populations. Comprehensive molecular diagnostic reports were evaluated from a total of 915 chronic wounds in a retrospective study. Read Study

J Wound Care. 2016;25(2):S16-S22.

Research Article:The study used Fluorescence microscopy and fluorescence in situ hybridization (FISH) to identify potential inflammatory bacterial and viral components of biofilm in atherosclerotic arteries as an investigation into the cause of the chronic inflammation within atherosclerotic plaques of arteries from legs amputated as a complication of diabetic foot ulcers. The results indicate that the presence of biofilms in grossly involved arteries may be an important factor in chronic inflammatory pathways of atherosclerotic progression, in the amputated limbs of patients with diabetic foot ulcers and vascular disease. Read Article

PLoS One. 2008;3(10):e3326.

Research Article: A new bacterial tag encoded FLX amplicon pyrosequencing (bTEFAP) approach was used to investigate the polymicrobial nature of chronic diabetic extremity ulcer infections in 40 patients. The most prevalent bacterial genus associated with diabetic chronic wounds was Corynebacterium spp. Also ubiquitous were obligate anaerobes including Bacteroides, Peptoniphilus, Fingoldia, Anaerococcus, and Peptostreptococcus spp. Other major components of the bacterial communities included commonly cultured genera such as Streptococcus, Serratia, Staphylococcus and Enterococcus spp. We introduce the concept of functional equivalent pathogroups (FEP) as consortia of genotypically distinct bacteria that symbiotically produce a pathogenic community. Together, individual members may synergistically cause disease when in an FEP, giving the biofilm community the factors necessary to maintain chronic biofilm infections. The results suggest that traditional culturing methods may be an extremely biased diagnostic tool, as they select for easily cultured organisms such as Staphylococcus aureus and against difficult to culture bacteria such as anaerobes, which data suggests are ubiquitous in these diabetic extremity ulcer chronic wounds. Read Article

J Wound Care. 2016;25(Sup10):S33-S43.

Research Article: 35 out of 43 (81%) wound microbiota harvested from patients produced similar chronic wounds (producing slough and exudate) in a murine chronic wound model. The top 30 species present in patient wounds were identified by molecular sequencing in the seeded mouse wounds. These results demonstrate that wound microbiota actively disseminates from the chronic wound by forces and mechanisms intrinsic to the wound. Koch's postulates and Hill's criteria for causation together suggest chronic wound microbiota to be the main cause underlying the pathogenesis of chronic wounds. Read Article

Wound Repair and Regeneration. 2008;16(6):805-813.

Research: The study addresses the need for a chronic pathogenic biofilm laboratory model that allows for cooperative growth of three commonly seen organisms: Pseudomonas aeruginosa, Enterococcus faecalis, and Staphylococcus aureus. The study developed a novel media formulation, simple laboratory system, quantitative polymerase chain reaction for monitoring population dynamics, and methods for objectively and subjectively measuring biofilm formation. The 24‐hour model reacts as predicted using known biofilm effectors, lending itself to future work in the development and testing of first‐generation chronic wounds pathogenic biofilm therapeutics. Read Research

BMC Microbiology. 2008;8:43-58.

Research Article: A survey was conducted of major bacterial populations which occur in the pathogenic biofilms of three chronic wound types: diabetic foot ulcers (D), venous leg ulcers (V), and pressure ulcers (P). The study used 3 separate 16S-based molecular amplifications followed by pyrosequencing, shotgun Sanger sequencing, and denaturing gradient gel electrophoresis. The survey study revealed that a wide variety of bacteria with different physiological and phenotypic preferences are common as part of pathogenic biofilm communities in chronic wounds. However, different types of wounds may have different bacterial populations that are prevalent, such as pressure ulcers in which 62% of the populations were identified as obligate anaerobes. Culturing failed to identify major contributing populations, especially strict anaerobes, within the given wound types. Read Article

BMC Microbiology. 2009;9:226-237.

Research Article: A pyrosequencing approach was used to characterize the microbial ecology of 40 venous leg ulcer (VLU) samples. Results show that VLU infections are polymicrobial with no single bacterium colonizing the wounds. The most ubiquitous and predominant organisms include previously uncharacterized bacteroidales, various anaerobes, Staphylococcus, Corynebacterium, and Serratia. Topological analysis of VLU show some notable differences in bacterial populations across the surface of the wounds, highlighting the importance of sampling techniques during diagnostics. Metagenomics provide a preliminary indication that there may be protozoa, fungi and possibly an undescribed virus associated with these wounds. Read Article

BMC Medical Genomics. 2010;3:41-52.

Research Article: Bacterial tag-encoded FLX amplicon pyrosequencing was used to identify the bacterial populations in 49 decubitus ulcers. Decubitus ulcers are shown to be polymicrobial, highly variable (228 genera identified among 49 ulcers) microbial communities dominated by 3 to 10 microorganisms, with obligate anaerobes found in significant proportion. In the decubitus ulcers of diabetics the microbial populations and composition may be significantly different from the communities in non-diabetics. The highly unique profile of each individual wound would require a therapeutic approach tailored to the patient's respective wound microflora and traditional culture is largely inadequate in determining the microbial composition of many chronic wounds. Read Article

J Wound Care. 2010;19(7):272-281.

Study: The study compares healing rates and healing time of two cohorts, one before implementation of molecular diagnostics, one after. Each cohort consisted of ~500 patients with various wound types. The introduction of molecular pathogen diagnostics, with a corresponding precise and targeted therapeutic approach, improved healing rates from 48.5% to 62.4% and reduced healing time by >20% across wound types. Read Study

Journal of Wound Care May 2015, Volume 24, Issue 5

Study: There has been a dramatic rise in the number of chronic wounds globally, which is placing an increased demand on decreasing health-care resources. With significant cuts in health-care budgets, wound care, providers will have to achieve better outcomes quicker and with fewer resources. By using new molecular methods to fully identify wound microbiota, commercially available antimicrobials can be used more efficiently, thereby improving outcomes and decreasing cost. Read Study

PLoS One. 2011;6(11):e27317.

Research Article: Multispecies biofilms consisting of both Gram negative and Gram positive strains, as well as aerobes and anaerobes, were grown in vitro and then transplanted onto the wounds of mice. Wounded mice given multispecies biofilm infections displayed a wound healing impairment over mice infected with a single-species of bacteria. In addition, the bacteria in the polymicrobial wound infections displayed increased antimicrobial tolerance in comparison to those in single species infections. These data suggest that synergistic interactions between different bacterial species in wounds may contribute to healing delays and/or antibiotic tolerance. Read Article