Distinguishing colonization from infection with Staphylococcus aureus in diabetic foot ulcers with miniaturized oligonucleotide arrays: a French multicenter study.
OBJECTIVE
To extend our previous work on evaluating the use of oligonucleotide arrays to discriminate colonization from infection owing to Staphylococcus aureus in diabetic foot ulcers (DFUs).


METHODS
Patients admitted to 14 French diabetic foot departments for a DFU were screened for entry into the study. At admission, ulcers were classified based on clinical examination according to the Infectious Diseases Society of America system. Only patients with monomicrobial culture for S. aureus were included. In persons with an uninfected ulcer, a second wound bacterial specimen was obtained 1 month later. Using oligonucleotide arrays, S. aureus resistance and virulence genes were determined, and each isolate was affiliated to a clonal complex (CC).


RESULTS
S. aureus was initially isolated from 75 uninfected and 120 infected ulcers; 35 were methicillin resistant. A total of 44 (59%) strains from uninfected DFUs belonged to CC5/CC8 clones vs. 6 (5%) from infected DFUs (P < 0.001). During follow-up, 57 (76%) of uninfected DFUs healed or had a favorable outcome; the strain in 49 (86%) of them belonged to CC5/CC8. Conversely, 18 (24%) had a poor outcome but not a single strain belonged to CC5/CC8 clone. Moreover, lukDE was significantly associated with a favorable outcome of the wound.


CONCLUSIONS
As suggested by our previous study, the use of DNA arrays appears to be a promising technique that might help distinguishing uninfected from infected wounds, predicting ulcer outcome and then contributing to a more adequate use of antibiotics.
National Institute of Health and Medical Research, U1047, Faculty of Medicine, Montpellier 1 University, Montpelier, France.
Albert
A
Sotto
Jean-Louis
JL
Richard
Nourredine
N
Messad
Nicolas
N
Molinari
Nathalie
N
Jourdan
Sophie
S
Schuldiner
Ariane
A
Sultan
Christian
C
Carrière
Bertrand
B
Canivet
Luce
L
Landraud
Gérard
G
Lina
Jean-Philippe
JP
Lavigne
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000235:genetics / Q000382:microbiology*; D005260:Female; D005602:France; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D020411:Oligonucleotide Array Sequence Analysis / Q000379:methods*; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000378:metabolism; D013211:Staphylococcus aureus / Q000235:genetics* / Q000302:isolation & purification*