The Chronic Wound Microbiome: Dynamics and Treatment Response

Chronic ulcers require prolonged care and carry an increased risk of infection and limb loss. Sequencing studies of diabetic foot ulcers, venous leg ulcers, and pressure ulcers have revealed dynamic, patient-specific microbial communities whose composition varies with local tissue conditions and treatment exposure. This review examines changes in microbial burden and community structure during wound-bed and antimicrobial interventions and their relationships with healing. Observed shifts may contribute to therapeutic effects, reflect direct perturbation of the community, or follow tissue recovery. However, most studies are small, heterogeneous, and uncontrolled, limiting causal inference. No published randomized trial has shown that treatment selection informed by sequencing-based microbial profiling improves wound healing. A central translational challenge is to determine whether baseline microbial features reproducibly predict responses to defined interventions. Progress will therefore require prospective longitudinal studies integrating sequencing with quantitative culture, isolate phenotyping, antimicrobial susceptibility testing, biofilm assays, and standardized clinical data. Such studies should establish whether microbiome profiling adds clinically useful information to conventional wound assessment and microbiological testing.