Characterization of the microbiome in the infant diapered area: Insights from healthy and damaged skin

Abstract

It has been recognized for nearly a century that human beings are inhabited by a remarkably dense and diverse microbial ecosystem, yet we are only just beginning to understand and appreciate the many roles that these microbes play in human health and development. Establishment of the microbiome begins at birth, but many previous studies on infant skin health have focused on Candida species. Little is known on the full microbial composition across different areas and even less is known on how these communities change during disease/inflammatory states. In this clinical study, infants were recruited during periods of diaper dermatitis (DD) and health to characterize the skin microbiome in these two states. Substantial shifts in the skin microbiome were observed across four sites in the diapered area (genitals, intertriginous, buttocks and perianal), as well as during periods of DD. As DD scores increased, there was a shift in relative abundance that demonstrated higher community percentages of faecal coliforms, such as Enterococcus, and lower percentages of Staphylococcus strains. In high-rash samples, the predominant Staphylococcus species is S aureus, potentially implicating S aureus as a DD aetiological agent. This study provides new information related to the microbiome on infant skin in the diapered area and provides insights into the role of the microbiome in the development of DD.

Keywords: Candida; Staphylococcus; diaper rash; infant; microbiota.

FIGURE 1

Baby diapered area microbiome profile—genus level. Fungal and bacterial relative abundance is demonstrated by region within the diapered area from which the sample was taken' perianal, buttock, genital and intertriginous zones

FIGURE 2

Baby diapered area microbiome profile—species level. Fungal and bacterial relative abundance is demonstrated by region within the diapered area from which the sample was taken' perianal, buttock, genital and intertriginous zones

FIGURE 3

Baby diaper rash microbiome profile—genus level. Fungal and bacterial relative abundance is demonstrated by the level of rash each infant experienced: no rash, low rash or high rash

FIGURE 4

Baby diaper rash microbiome profile—species level. Fungal and bacterial relative abundance is demonstrated by the level of rash each infant experienced: no rash, low rash or high rash

FIGURE 5

Shannon diversity scores for 16s was classified by site (Panel A: Kruskal Wallis chi‐squared = 98.67, P‐value <2.2e‐16), rash severity (Panel B: Kruskal Wallis chi‐squared = 0.583, P‐value = 0.747), and both site and rash (Panel C: Kruskal Wallis chi‐squared = 104.5, P‐value <2.2e‐16). Shannon diversity scores for ITS was classified by site (Panel D: Kruskal Wallis chi‐squared = 6.258, P‐value = 0.099), rash severity (Panel E: Kruskal Wallis chi‐squared = 0.984, P‐value = 0.611), and both site and rash (Panel F: Kruskal Wallis chi‐squared = 19.39, P‐value = 0.036).

FIGURE 6

Bray‐curtis distance by subject for 16s and ITS among site, rash severity and site/rash. 16s Beta diversity was measured using Bray‐Curtis distance by site (Panel A: P‐value =.001), rash severity (Panel B: P‐value =.006) and by site/rash (Panel C: P‐value =.001). ITS Beta diversity was measured using Bray‐Curtis distance by site (Panel D: P‐value =.001), rash severity (Panel E: P‐value =.005) and by site/rash (Panel F: P‐value =.001)