The microbiome of diabetic foot ulcers : comparison of sampling methods and the effects of debridement

Bacterial burden in diabetic foot ulcers (DFUs) can influence the non-healing of wounds. This study compared methods for sampling DFUs and concluded that the standardised non-invasive Levine swab method provides adequate coverage of DFU microbiomes. Many more bacterial genera were identified using 16s rRNA sequencing compared to traditional culture techniques. The microbiome of DFUs was investigated pre and post debridement, a clinical procedure used to clean the ulcer bed. Post debridement effects of sharp, ultrasound and surgical single session debridements were compared and produced some significant decreases in bacterial abundance and increases in diversity, but a range of pathogens remained in most wounds. Serial debridement was more effective than a single debridement session. Efficacious treatment requires a greater knowledge of the complex changes in microbial communities in DFUs.