title: Evaluation of the bacterial diversity of pressure ulcers using bTEFAP pyrosequencing.
abstract: BACKGROUND
  Decubitus ulcers, also known as bedsores or pressure ulcers, affect millions of hospitalized patients each year. The microflora of chronic wounds such as ulcers most commonly exist in the biofilm phenotype and have been known to significantly impair normal healing trajectories.
  
  
  METHODS
  Bacterial tag-encoded FLX amplicon pyrosequencing (bTEFAP), a universal bacterial identification method, was used to identify bacterial populations in 49 decubitus ulcers. Diversity estimators were utilized and wound community compositions analyzed in relation to metadata such as Age, race, gender, and comorbidities.
  
  
  RESULTS
  Decubitus ulcers are shown to be polymicrobial in nature with no single bacterium exclusively colonizing the wounds. The microbial community among such ulcers is highly variable. While there are between 3 and 10 primary populations in each wound there can be hundreds of different species present many of which are in trace amounts. There is no clearly significant differences in the microbial ecology of decubitus ulcer in relation to metadata except when considering diabetes. The microbial populations and composition in the decubitus ulcers of diabetics may be significantly different from the communities in non-diabetics.
  
  
  CONCLUSIONS
  Based upon the continued elucidation of chronic wound bioburdens as polymicrobial infections, it is recommended that, in addition to traditional biofilm-based wound care strategies, an antimicrobial/antibiofilm treatment program can be tailored to each patient's respective wound microflora.
authors.affiliation: Research and Testing Laboratory, Lubbock, TX 79407, USA.
authors.forename: Drake M
authors.initials: DM
authors.lastname: Smith
authors.forename: David E
authors.initials: DE
authors.lastname: Snow
authors.forename: Eric
authors.initials: E
authors.lastname: Rees
authors.forename: Ann M
authors.initials: AM
authors.lastname: Zischkau
authors.forename: J Delton
authors.initials: JD
authors.lastname: Hanson
authors.forename: Randall D
authors.initials: RD
authors.lastname: Wolcott
authors.forename: Yan
authors.initials: Y
authors.lastname: Sun
authors.forename: Jennifer
authors.initials: J
authors.lastname: White
authors.forename: Shashi
authors.initials: S
authors.lastname: Kumar
authors.forename: Scot E
authors.initials: SE
authors.lastname: Dowd
mesh_terms: D001419:Bacteria / Q000235:genetics* / Q000302:isolation & purification*; D018407:Bacterial Physiological Phenomena; D044822:Biodiversity; D018441:Biofilms; D002908:Chronic Disease; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D010641:Phenotype; D003668:Pressure Ulcer / Q000382:microbiology*; D025341:Principal Component Analysis; D017422:Sequence Analysis, DNA / Q000379:methods*
chemical_list: D004269:DNA, Bacterial