*Burn and Shock Trauma Research Institute, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois†Department of Surgery, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois‡Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois§Center for Biomedical Informatics, Loyola University Chicago, Health Sciences Campus, Maywood, Illinois||Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana¶Departments of Dermatology and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Shock. 2017 Oct;48(4):441-448. doi: 10.1097/SHK.0000000000000874.
The cutaneous microbiome maintains skin barrier function, regulates inflammation, and stimulates wound-healing responses. Burn injury promotes an excessive activation of the cutaneous and systemic immune response directed against commensal and invading pathogens. Skin grafting is the primary method of reconstructing full-thickness burns, and wound infection continues to be a significant complication.
In this study, the cutaneous bacterial microbiome was evaluated and subsequently compared to patient outcomes. Three different full-thickness skin specimens were assessed: control skin from non-burned subjects; burn margin from burn patients; and autologous donor skin from the same cohort of burn patients.
We observed that skin bacterial community structure of burn patients was significantly altered compared with control patients. We determined that the unburned autologous donor skin from burn patients exhibits a microbiome similar to that of the burn margin, rather than unburned controls, and that changes in the cutaneous microbiome statistically correlate with several post-burn complications. We established that Corynebacterium positively correlated with burn wound infection, while Staphylococcus and Propionibacterium negatively correlated with burn wound infection. Both Corynebacterium and Enterococcus negatively correlated with the development of sepsis.
This study identifies distinct differences in the cutaneous microbiome between burn subjects and unburned controls, and ascertains that select bacterial taxa significantly correlate with several comorbid complications of burn injury. These preliminary data suggest that grafting donor skin exhibiting bacterial dysbiosis may augment infection and/or graft failure and sets the foundation for more in-depth and mechanistic analyses in presumably "healthy" donor skin from patients requiring skin grafting procedures.
皮肤微生物组维持皮肤屏障功能、调节炎症、并刺激伤口愈合反应。烧伤会促进皮肤和全身免疫反应过度激活，从而针对共生菌和入侵病原体。植皮是重建全层烧伤的主要方法，而伤口感染仍然是一个严重的并发症。
在这项研究中，评估了皮肤细菌微生物组，随后将其与患者的结果进行了比较。评估了三种不同的全层皮肤标本：非烧伤患者的正常皮肤；烧伤患者的烧伤边缘皮肤；以及来自同一烧伤患者队列的自体供皮区皮肤。
我们观察到烧伤患者的皮肤细菌群落结构与对照组患者相比发生了显著改变。我们确定，来自烧伤患者的未烧伤自体供皮区的微生物组与烧伤边缘皮肤相似，而不是未烧伤的对照组，并且皮肤微生物组的变化与几种烧伤后的并发症具有统计学相关性。我们发现棒状杆菌与烧伤创面感染呈正相关，而葡萄球菌和丙酸杆菌与烧伤创面感染呈负相关。棒状杆菌和肠球菌与脓毒症的发展呈负相关。
这项研究确定了烧伤患者和未烧伤对照组之间皮肤微生物组的明显差异，并确定了某些特定的细菌分类群与烧伤损伤的几种合并症显著相关。这些初步数据表明，移植表现出细菌失调的供皮区可能会增加感染和/或移植物失败的风险，并为更深入和更具机制的分析奠定了基础，这些分析可能针对需要皮肤移植手术的患者的“健康”供皮区。
