• 1.

    Bell DP Jr: The role of podiatry in wound management. J Am Col Certif Wound Spec 1 : 78, 2009.

  • 2.

    Moura LIF, Dias AMA & Carvalho E et al.: Recent advances on the development of wound dressings for diabetic foot ulcer treatment: a review. Acta Biomater 9: 7093, 2013.

  • 3.

    National Institute for Health and Care Excellence: Diabetic Foot Problems: Prevention and Management, National Institute for Health and Care Excellence, London, 2015. NICE guideline NG19.

    • Search Google Scholar
    • Export Citation
  • 4.

    Game FL & Jeffcoate WJ: Dressing and diabetic foot ulcers: a current review of the evidence. Plast Reconstr Surg 138 : 158S, 2016.

  • 5.

    Gould L, Abadir P & Brem H et al.: Chronic wound repair and healing in older adults: current status and future research. Wound Repair Regen 23 : 1, 2015.

  • 6.

    Motta GJ, Milne CT & Corbett LQ: Impact of antimicrobial gauze on bacterial colonies in wounds that require packing. Ostomy Wound Manage 50 : 48, 2004.

  • 7.

    Findley K, Oh J & Yang J et al.: Topographic diversity of fungal and bacterial communities in human skin. Nature 498 : 367, 2013.

  • 8.

    Grice EA & Segre JA: The skin microbiome. Nat Rev Microbiol 9 : 244, 2011.

  • 9.

    Grice EA, Kong HH & Conlan S et al.: Topographical and temporal diversity of the human skin microbiome. Science 324 : 1190, 2009.

  • 10.

    Kong HH: Skin microbiome: genomics-based insights into the diversity and role of skin microbes. Trends Mol Med 17 : 320, 2011.

  • 11.

    Costello EK, Lauber CL & Hamady M. et al.: Bacterial community variation in human body habitats across space and time. Science 326 : 1694, 2009.

  • 12.

    Cohen AD, Wolak A & Alkan M et al.: Prevalence and risk factors for tinea pedis in Israeli soldiers. Int J Dermatol 44 : 1002, 2005.

  • 13.

    Hannigan GD & Grice EA: Microbial ecology of the skin in the era of metagenomics and molecular microbiology. Cold Spring Harb Perspect Med 3 : a015362, 2013.

  • 14.

    Fredricks DN: Microbial ecology of human skin health and disease. J Invest Dermatol Symp Proc 6 : 167, 2001.

  • 15.

    Bojar RA & Holland KT: Review: the human cutaneous microflora and factors controlling colonisation. World J Microbiol Biotechnol 18 : 889 2002.

  • 16.

    Aly R, Shirley C & Cunico B et al.: Effect of prolonged occlusion on the microbial flora, pH, carbon dioxide and trans-epidermal water loss on human skin. J Invest Dermatol 71 : 378, 1978.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Hartmann AA: Effect of occlusion on resident flora, skin-moisture and skin pH. Arch Dermatol Res 275 : 251, 1983.

  • 18.

    Faergemann J, Aly R & Wilson DR et al.: Skin occlusion: effect on Pityrosporum orbiculare, skin P CO2, pH, transepidermal water loss and water content. Arch Dermatol Res 275 : 383, 1983.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Waxman BP, Easmon CSF & Dudley HAF: Skin bacteria and OpSite® dressings. Clin Nutr 4 : 29, 1985.

  • 20.

    Marples RR & Kligman AM: Methods of evaluating topical antibacterial agents on human skin. Antimicrob Agents Chemother 5 : 323, 1974.

  • 21.

    Bashir MH, Olson LKM & Walters S-A: Suppression of regrowth of normal skin flora under chlorhexidine gluconate dressings applied to chlorhexidine gluconate prepped skin. Am J Infect Control 40 : 344, 2012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Carty N, Wibaux A & Ward C et al.: Antimicrobial activity of a novel adhesive containing chlorhexidine gluconate (CHG) against resident microflora in human volunteers. J Antimicrob Chemother 69 : 2224, 2014.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Citron DM, Goldstein EJ & Merriam CV et al.: Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol 45 : 2819, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Aravena-Roman M, Spröer C & Sträubler B et al.: Corynebacterium pilbarense sp. nov., a non-lipophilic Corynebacterium isolated from a human ankle aspirate. Int J Syst Evol Microbiol 60 : 1484, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Otsuka Y, Kawamura Y & Koyama T et al.: Corynebacterium resistens sp.: a new multidrug-resistant Coryneform bacterium isolated from human infections. J Clin Microbiol 43 : 3713, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Guest JF, Ayoub N & McIlwraith T et al.: Health economic burden that different wound types impose on the UK's National Health Service. Int Wound J 14 : 322, 2016.

  • 27.

    O'Meara SM, Cullum NA & Majid M et al.: Systematic review of antimicrobial agents used for chronic wounds. Br J Surg 88 : 4, 2001.

  • 28.

    Cullum N, Nelson EA & Flemming K et al.: Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess 5 : 1, 2001.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Bradley M, Cullum N & Nelson EA et al.: Systematic reviews of wound care management: (2). dressings and topical agents used in the healing of chronic wounds. Health Technol Assess 3 : 1, 1999.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    UCI Office of Research. How to consent. Available at: https://www.research.uci.edu/compliance/human-research-protections/researchers/how-to-consent.html. Accessed December 8, 2020.

  • 31.

    Royal Pharmaceutical Society of Great Britain, British Medical Association: British National Formulary, Pharmaceutical Press, Wallingford, England, 2013.

    • Search Google Scholar
    • Export Citation
  • 32.

    Capobianco CM & Zgonis T: Abductor hallucis muscle flap and staged medial column arthrodesis for the chronic ulcerated Charcot foot with concomitant osteomyelitis. Foot Ankle Spec 3 : 269, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Van Schie CHM. A review of the biomechanics of the diabetic foot. Int J Low Extrem Wounds 4 : 160, 2005.

  • 34.

    Public Health England: UK Standards for Microbiology Investigations: Inoculation of Culture Media for Bacteriology , Crown, London, 2013.

    • Search Google Scholar
    • Export Citation
  • 35.

    Ellner PD, Stoessel CJ & Drakeford E et al.: A new culture medium for medical bacteriology. Am J Clin Pathol 45 : 502, 1966.

  • 36.

    Jeffries CD, Holtman DF & Guse DG: Rapid method for determining the activity of microorganisms on nucleic acid. J Bacteriol 73 : 590, 1957.

  • 37.

    Marshall J, Leeming JP & Holland KT: The cutaneous microbiology of normal feet. J Appl Bacteriol 62 : 139, 1987.

  • 38.

    McBride ME, Duncan WC & Knox JM: The environment and the microbial ecology of human skin. Appl Environ Microbiol 33 : 603, 1977.

  • 39.

    Kong HH & Segre JA: Skin microbiome: looking back to move forward. J Invest Dermatol 132 : 933, 2012.

  • 40.

    Grice EA: The skin microbiome: potential for novel diagnostic and therapeutic approaches to cutaneous disease. Semin Cutan Med Surg 33 : 98, 2014.

  • 41.

    Roth RR & James WD: Microbial ecology of the skin. Annu Rev Microbiol 42 : 441, 1988.

  • 42.

    Kwaszewska A, Sobis-Glinkowska M & Szewczyk EM: Cohabitation: relationships of corynebacteria and staphylococci on human skin. Folia Microbiol 59 : 495, 2014.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Chiller K, Selkin BA & Murakawa GJ: Skin microflora and bacterial infections of the skin. J Invest Dermatol Symp Proc 6 : 170, 2001.

  • 44.

    Mishra SK & Agrawal D: Gram-Positive Bacilli: A Concise Manual of Pathogenic Microbiology, John Wiley & Sons, Hoboken, NJ, 2012.

  • 45.

    Byappanahalli MN, Nevers MB & Korajkic A et al.: Enterococci in the environment. Microbiol Mol Biol Rev 76 : 8685, 2012.

  • 46.

    Patel G & Snydman DR: Vancomycin-resistant Entercococcus infections in solid organ transplantation. Am J Transplant 13 : 59, 2013.

  • 47.

    Coykendall AL: Classification and identification of the viridans streptococci. Clin Microbiol Rev 2 : 315, 1989.

  • 48.

    Cazzaniga A, Serralta V & Davis S et al.: The effect of an antimicrobial gauze dressing impregnated with 0.2 percent polyhexamethylene biguanide as a barrier to prevent Pseudomonas aeruginosa wound invasion. Wounds 14 : 169, 2002.

    • Search Google Scholar
    • Export Citation
  • 49.

    Conly JM, Grieves K & Peters B: A prospective, randomized study comparing transparent and dry gauze for central venous catheters. J Infect Dis 159 : 310, 1989.

  • 50.

    Tachi M, Hirabayashi S & Yonehara Y et al.: Comparison of bacteria retaining ability of absorbent wound dressings. Int Wound J 1 : 177, 2004.

  • 51.

    Lipp C, Kirker K & Agostinho A et al.: Testing wound dressings using an in vitro wound model. J Wound Care 19 : 220, 2010.

  • 52.

    Wiegand C, Abel M & Ruth P et al.: In vitro assessment of the antimicrobial activity of wound dressings: influence of the test method selected and impact of the pH. J Mater Sci Mater Med 26 : 5343, 2015.

    • Search Google Scholar
    • Export Citation
  • 53.

    Holland KT, Davis W & Ingham E et al.: A comparison of the in-vitro antibacterial and complement activating effect of ‘OpSite' and ‘Tegaderm' dressings. J Hosp Infect 5 : 323, 1984.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Lee WR, Tobias KM & Bemis DA et al.: In vitro efficacy of a polyhexamethylene biguanide–impregnated gauze dressing against bacteria found in veterinary patients. Vet Surg 33 : 404, 2004.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Beceiro A, Tomás M & Bou G: Antimicrobial resistance and virulence: a successful or deleterious association in the bacterial world? Clin Microbiol Rev 26 : 185, 2013.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 56.

    Gontacharova V, Youn E & Sun Y et al.: A comparison of bacterial composition in diabetic ulcers and contralateral intact skin. Open Microbiol J 4 : 8, 2010.

  • 57.

    Zubair M, Malik A & Ahmad J: Microbiology of diabetic foot ulcer with special reference to ESBL infections. Am J Clin Exp Med 3 : 6, 2015.

  • 58.

    Nayeri F: Occlusive bandaging of wounds with decreased circulation promotes growth of anaerobic bacteria and necrosis: case report. BMC Res Notes 9 : 394, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59.

    Dowd SE, Sun Y & Secor PR et al.: Survey of bacterial diversity in chronic wound using pyrosequencing, DGGE, and full ribosome shotgun sequencing. BMC Microbiol 8 : 43, 2008.

  • 60.

    Smith K, Collier A & Townsend EM et al.: One step closer to understanding the role of bacteria in diabetic foot ulcers: characterising the microbiome of ulcers. BMC Microbiol 16 : 54, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Does the Application of a Semiocclusive Dressing Alter the Microflora of Healthy Intact Skin on the Foot?

Rachel Forss MSc, Zoe Hugman BSc (Hons), Kelly Ridlington BSc (Hons), Marissa Radley BSc (Hons), Emma Henry-Toledo BSc (Hons), and Bill O'Neill MSc
View More View Less
Restricted access

Background

The skin on human feet presents unique environments for the proliferation of potentially pathogenic commensals. This study examined microflora changes on healthy intact skin under a semiocclusive dressing on the medial longitudinal arch of the foot to determine changes in growth, distribution, and frequency of microflora under the dressing.

Methods

Nine human participants wore a low-adherent, absorbent, semiocclusive dressing on the medial longitudinal arch of the left foot for 2 weeks. An identical location on the right foot was swabbed and used as a control. Each foot was swabbed at baseline, week 1, and week 2. The swabs were cultured for 48 hours. Visual identification, Gram staining, DNase test agar, and a latex slide agglutination test were used to identify genera and species.

Results

Microflora growth was categorized as scant (0–10 colony-forming units [CFU]), light (11–50 CFU), moderate (51–100 CFU), or heavy (>100 CFU). Scant and light growth decreased and moderate and heavy growth increased under the dressing compared with the control. Seven different genera of bacteria were identified. Coagulase-negative Staphylococcus spp appeared most frequently, followed by Corynebacterium spp.

Conclusions

Changes in microflora distribution, frequency, and growth were found under the dressing, supporting historical studies. Microflora changes were identified as an increase in bioburden and reduction in diversity. The application of similar methods, using more sophisticated identification and analysis techniques and a variety of dressings, could lead to a better understanding of bacterial and fungal growth under dressings, informing better dressing selection to assist the healing process of wounds and prevent infection.

Department of Podiatry, University of Brighton, Eastbourne, England. Mrs. Forss is also with Centre of Regenerative Medicine and Devices, University of Brighton, Eastbourne, England.

Senior Biomedical Scientist Microbiology, East Sussex Healthcare NHS Trust, Eastbourne, England.

Corresponding author: Rachel Forss, MSc, Department of Podiatry, University of Brighton, 49 Darley Rd, Eastbourne, East Sussex, BN20 7UR England. (E-mail: j.forss@brighton.ac.uk)