Set Phages to Stun: Reducing the Virulence of Staphylococcus aureus in Diabetic Foot Ulcers

摘要

At least one-quarter of people alive with diabetes will develop a diabetic foot ulcer (DFU), and about half of these will become clinically infected. Once this occurs, 20-30% of infected DFUs lead to lower-extremity amputation, with its dire consequences. Not surprisingly, the direct costs of the treatment of DFUs now exceed those of the five most costly cancers in the U.S.. All DFUs are colonized by microbes. This colonization is comprised of a complex melange of species, with Staphylococcus aureus generally being the most prevalent. However, it is unclear why some wounds harboring this potentially virulent pathogen remain colonized, while others become infected. Defining infection in an open wound has been a persistent problem. While most authorities define it on the presence of local (and less often systemic) signs of inflammatory response, some believe that either the presence of specific species or a high number of colonies is pathogenic. This belief has led many to unnecessarily use antimicrobials to treat clinically noninfected wounds. In this issue of Diabetes, we read with interest the study by Messad et al., which tantalizingly suggests it may be possible to differentiate a "colonizing" from a more microbiologically nefarious phenotype of S. aureus, the "prince of pedal pathogens." Even more promising is that this work may identify an approach to "stun" a pathogenic colony into one that seeks peaceful coexistence.