Figure 7: The DFU microbiome’s response to intervention predicts healing time.

A) Timeline of each subject where the x-axis denotes the visit and the y-axis denotes individual subject IDs. The color of each visit corresponds to the total number of antibiotic resistance classes detected, with increasing darkness in red indicating increasing number of resistance classes detected. Grey boxes indicate a visit where the sample was either not sequenced, the wound was healed, or no resistance genes were detected. Visit 3, 5, and 7 were not sequenced unless it was the last visit a sample was collected before healing was recorded. Types of antibiotics with multiple classes of resistance (e.g., beta-lactamase class A, B, C etc.) were collapsed into a single class (e.g., beta-lactamases). The letter ‘A’ indicates a visit where antibiotics were administered. B) The proportion of samples with resistance genes detected (x-axis) for different classes of antibiotics (y-axis) at the baseline visit. Circle size corresponds to mean proportion. C) Shannon diversity remains unchanged in samples before, during, or after antibiotic administration in healing (n=9 subjects) and unhealed wounds (n=9 subjects) while debridement significantly reduces Shannon diversity in wounds that heal (n=32 subjects) within 12 weeks post-debridement. P<0.001, with non-parametric Wilcoxon rank-sum test. In wounds unhealed at 12 weeks (n=14 subjects) post-debridement a change in Shannon diversity is not observed. D) The mean proportion of common aerobic genera do not shift after debridement. The mean proportion of anaerobic genera are significantly reduced after debridement in wounds that heal within 12 weeks. P=0.002, with non-parametric Wilcoxon rank-sum test. In wounds unhealed at 12 weeks post-debridement the mean proportion of anaerobic genera does not change.