Burn Wound Location Influences the Composition of Buccal and Wound Bed Swab Microbiomes

Author(s):
Edward Kelly; Mary Oliver; Bonnie Carney; John Keyloun; Robert Ball; Melissa McLawhorn; justin wright; Regina Lamendella; Lauren Moffatt; Jeffrey Shupp

Background:

Burn wound infections are a common complication affecting burn patients and a significant source of morbidity and mortality. Patients are at risk from many different species known to colonize wound infections. There is limited information regarding the differences in microbial diversity based on burn location. This study aimed to identify the specific microbiome in different burn wound locations.

Hypothesis:

Different burn wound locations will exhibit unique microbiomes.

Methods:

Thirty-one patients with minor (<10% TBSA) and uncomplicated thermal burns anticipated to require a single excision and grafting operation were enrolled. Blood draws, wound biopsies, culture swabs and saliva for oral microbiome (16S rRNA) analysis were collected before and after wound excision, at first dressing takedown, and at first follow-up visit. Data were analyzed using Faith’s Phylogenetic Diversity Metric (Alpha diversity), Permutational multivariate analysis of variance (Beta diversity) and Linear discriminant analysis effect size (LEfSe; Taxa abundance).

Results:

Seven burn wound locations (abdomen, arm, back, chest, foot, hand, leg) were categorized. Buccal swab alpha diversity when all swabs were taken together showed abdomen had lower diversity than arm and back (Kruskal-Wallis, p=0.050 and 0.033). All WB swabs analyzed together showed alpha diversity of arm had higher diversity than leg (Kruskal-Wallis, p=0.048). Buccal swab beta diversity showed differences among back and foot p=.002, abdomen and leg p=.003, abdomen and back p=.005, back and hand p=.005, abdomen and arm p=.01, back and leg p=.014, foot and leg p=.043, arm and back p=.045, and abdomen and hand p=.048. WB swab beta diversity showed differences between arm and hand p= .001, arm and leg p=.001, back and leg p=.002, and back and hand p=.007. LEfSe plots showed enrichment of greater than 15 taxa among the different burn locations. Buccal swabs from abdominal wounds showed enrichment of Staphylococcus, Roseomonas and Proteus, back wounds with Prevotellaand Streptococcus, and chest wounds with Enterobacteriaceae and Serratia (LDA ≥ 4, p≤ 0.05). These findings are consistent with wound swabs from the abdomen, back, and chest.

Conclusions:

Oral and wound microbiomes display unique characteristics based on burn location. Furthermore, when compared to each other, oral and wound swabs from similar burn locations show consistent bacterial profiles. Increasingly targeted therapies are paramount given the continued emergence of antibiotic resistance.