Cutaneous Burn Injury Promotes Shifts in the Bacterial Microbiome in Autologous Donor Skin

Abstract

Introduction 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. Methods In this study, the cutaneous bacterial microbiome was evaluated and subsequently compared to patient outcomes. Three different full-thickness skin specimens were assessed: 1.)control skin from non-burned subjects; 2.)burn margin from burn patients; and 3.)autologous donor skin from the same cohort of burn patients. Results We observed that skin bacterial community structure of burn patients was significantly altered compared to 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. Conclusions 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 co-morbid 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.

The Cutaneous Microbiome and Wounds: New Molecular Targets to Promote Wound Healing

“…While the bulk of clinical research on the role of various microbiomes on wound healing has focused on chronic wounds, acute wounds (e.g., burns, blunt traumas, and penetrating traumas) are also of interest. One clinical study demonstrated that cutaneous burns significantly altered microbial skin profiles, and adjacent skin of burn sites exhibited a more similar skin microbiome to that of the burn margin as opposed to that unburned controls [ 53 ]. Burn wounds in these patients revealed an increased abundance of thermophile microbes such as Aeribacillus , Caldalkalibacilus , and Nesterenkonia and decreased abundance of Corynebacterium , both in the wound center and the skin margin.…”

“…Indeed, topical antibiotics have largely aided burn wound outcomes by effectively treating Psuedomonas colonization. However, changes in the cutaneous microbiome were also associated with post burn complications, with Corynebacterium demonstrating a positive correlation with burn wound infection, and Staphylococcus and Propionibacterium demonstrating a negative correlation with post burn infection [ 53 ]. Interestingly, Liu et al also exhibited that skin dysbiosis is an expected consequence of burn injury that persists after healing [ 54 ].…”

Efficacy and safety of platelet-rich plasma in the treatment of severe burns

“…until the wound healed completely. [ 21 , 22 ] Related studies have shown that PRP can significantly repair severe burn wounds, while it is effective in the treatment of tissue infections such as bone infection. [ 23 , 24 ] Therefore, on the 1 hand, the application of PRP in severe burn wounds can repair the wound and reduce the generation of bacteria, on the other hand, it can prevent the invasion and infection of bacteria, thus reducing the occurrence of wound infection.…”

A retrospective cohort study to compare post-injury admissions for infectious diseases in burn patients, non-burn trauma patients and uninjured people

“…Alternatively, changes to the microbiome after injury may also lead to susceptibility to colonisation. Changes to both the skin and intestinal microbiome have both previously been reported after burn injury, and these can increase susceptibility to infection [ 42 , 43 ]. Further work to understand what causes this susceptibility to infectious disease after burn injury will be important to facilitate the use of alternative interventions, either during the acute phase or after recovery to improve recovery and long-term health after burn injury.…”