MLVF dendrogram of different<i>S.</i><i>aureus</i> types isolated from chronic wounds of patients with EB.

<p>The dendrogram was generated using the Dice coefficient with Tolerance 0.6 and optimization 0.5. Clusters of isolates were generated with a cut-off value set to 60%. The MLVF types of individual <i>S. aureus</i> isolates are indicated in the dendrogram together with the number of the patient from which they were collected. Type numbers per patient correspond with the type numbers per patient in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0067272#pone-0067272-g003" target="_blank">Figure 3</a>.</p

Relative numbers of MLVF types detected in the chronic wounds of five EB patients.

<p>A, The percentages of different <i>S. aureus</i> MLVF types detected in individual chronic wounds from patients 1, 62, 63 and 64 at one particular time point are indicated by bar diagrams. Different MLVF types are marked in black, white or grey shading. Note that, for matters of simplicity, the MLVF type numbers were arbitrarily attributed to different <i>S. aureus</i> types isolated from individual patients. Hence, distinct <i>S. aureus</i> types isolated from different patients can have the same type number. B, percentages of different <i>S. aureus</i> MLVF types detected in chronic foot and breast wounds from patient 14. Replica plating of used bandages was performed thrice at two-weekly intervals. Black bars mark the first, white bars the second and grey bars the third time point of sampling.</p

MLVA and spa typing of<i>S. aureus</i> isolates from chronic wounds of EB patients.

a<p>VNTR, Variable Number of Tandem Repeats.</p>b<p>MC, molecular complex.</p><p>Per patient, the isolates with closely related <i>spa</i>-types have been marked by ^I or ^II.</p

Topography of Distinct Staphylococcus aureus Types in Chronic Wounds of Patients with Epidermolysis Bullosa

<p>The opportunistic pathogen Staphylococcus aureus is known to interfere with wound healing and represents a significant risk factor for wound infections and invasive disease. It is generally assumed that one individual is predominantly colonized by one S. aureus type. Nevertheless, patients with the genetic blistering disease epidermolysis bullosa (EB) often carry multiple S. aureus types. We therefore investigated whether different S. aureus types are present in individual wounds of EB patients and, if so, how they are spatially distributed. The staphylococcal topography in chronic wounds was mapped by replica-plating of used bandages and subsequent typing of S. aureus isolates. Individual chronic wounds of five patients contained up to six different S. aureus types. Unexpectedly, distinct S. aureus types formed micro-colonies that were located in close proximity and sometimes even overlapped. While some adjacent S. aureus isolates were closely related, others belonged to distinct molecular complexes. We conclude that the general assumption that one individual is predominantly colonized by one type of S. aureus does not apply to chronic wounds of EB patients. We consider this observation important, not only for EB patients, but also for other patients with chronic wounds in view of the potential risk for severe staphylococcal infections.</p>