IADR Abstract Archives
The Oral Cavity: a Potential Reservoir for Diabetic-Foot Ulcer Infections
Objectives: Background: Periodontal disease, a dysbiotic, plaque-triggered, inflammatory disease, is more prevalent and severe in patients with diabetes, for whom oral health is commonly overlooked. Staphylococcal bacteria, highly prevalent in the oro-nasal cavities (ONC) of people with periodontal disease, are the predominant cause of diabetic foot ulcer (DFU) infections (DFUIs). This study compared ONC and DFU staphylococcal populations to determine if the ONC is a reservoir for DFUIs.
Methods: Methods: Participants with type II diabetes with (N=76) and without (N=76) DFUs provided clinical specimens from various anatomical sites (oral cavity, nares, periodontal pockets, finger, toe and DFUs). Staphylococci were recovered on SaSelectTM chromogenic medium (BioRad, Germany). Isolates (N=2185) selected on the basis of distinct colony colours, anatomical sites and individuals were definitively identified by Pastorex latex-agglutination testing (Bio-Rad), S. aureus-/S. epidermidis-specific PCRs, 16S rRNA-sequencing and MALDI-TOF-MS. Close relatedness of S. aureus and S. epidermidis isolates, respectively, was determined using whole-genome multilocus sequence typing (wgMLST).
Results: Results: Oro-nasal S. aureus and S. epidermidis prevalence in non-DFU patients was lower (31/76 [40.7%] and 62/76 [81.5%]), respectively, compared with DFU patients (60/76 [78.9%] and 70/76 [92.1%]), respectively. Staphylococcus aureus was significantly more prevalent on the toe of DFU patients than non-DFUs patients (p>0.04). Identical species were recovered from the ONC and DFUs of 40 DFU patients (S. aureus [28/40, 70%], S. epidermidis [10/40, 25%], S. haemolyticus [2/40, 5%], S. pettenkoferi [1/40, 2.5%], S. saprophyticus [1/40, 2.5%]). Comparative wgMLST analysis identified oro-nasal and ulcer S. aureus and S. epidermidis separated by ≤24 allelic differences (i.e. closely related) in 11/28 (39.3%) and 3/10 (33.3%) participants[BM1] , respectively.
Conclusions: Conclusions: Oro-nasal S. aureus and S. epidermidis prevalence is higher in DFU patients than non-DFU patients. The detection of closely-related oral and ulcer S. aureus and S. epidermidis in patients with DFUs provides evidence for a oro-nasal reservoir for DFUI.
Methods: Methods: Participants with type II diabetes with (N=76) and without (N=76) DFUs provided clinical specimens from various anatomical sites (oral cavity, nares, periodontal pockets, finger, toe and DFUs). Staphylococci were recovered on SaSelectTM chromogenic medium (BioRad, Germany). Isolates (N=2185) selected on the basis of distinct colony colours, anatomical sites and individuals were definitively identified by Pastorex latex-agglutination testing (Bio-Rad), S. aureus-/S. epidermidis-specific PCRs, 16S rRNA-sequencing and MALDI-TOF-MS. Close relatedness of S. aureus and S. epidermidis isolates, respectively, was determined using whole-genome multilocus sequence typing (wgMLST).
Results: Results: Oro-nasal S. aureus and S. epidermidis prevalence in non-DFU patients was lower (31/76 [40.7%] and 62/76 [81.5%]), respectively, compared with DFU patients (60/76 [78.9%] and 70/76 [92.1%]), respectively. Staphylococcus aureus was significantly more prevalent on the toe of DFU patients than non-DFUs patients (p>0.04). Identical species were recovered from the ONC and DFUs of 40 DFU patients (S. aureus [28/40, 70%], S. epidermidis [10/40, 25%], S. haemolyticus [2/40, 5%], S. pettenkoferi [1/40, 2.5%], S. saprophyticus [1/40, 2.5%]). Comparative wgMLST analysis identified oro-nasal and ulcer S. aureus and S. epidermidis separated by ≤24 allelic differences (i.e. closely related) in 11/28 (39.3%) and 3/10 (33.3%) participants[BM1] , respectively.
Conclusions: Conclusions: Oro-nasal S. aureus and S. epidermidis prevalence is higher in DFU patients than non-DFU patients. The detection of closely-related oral and ulcer S. aureus and S. epidermidis in patients with DFUs provides evidence for a oro-nasal reservoir for DFUI.