Survey of fungi and yeast in polymicrobial infections in chronic wounds

Abstract

Objective: To assess the incidence, abundance and species diversity of fungi in chronic wounds, as well as to describe the associations of major fungi populations. Method: Comprehensive molecular diagnostic reports were evaluated from a total of 915 chronic wounds in a retrospective study. Results: Of the 915 clinical specimens, 208 (23%) were positive for fungal species. These samples were further compared in a compiled dataset, and sub-classified among the four major chronic wound types (decubitus ulcer, diabetic foot ulcer, non-healing surgical wound, and venous leg ulcer). The most abundant fungi were yeasts in the genus Candida; however, Curvularia, Malessezia, Aureobasidium, Cladosporium, Ulocladium, Engodontium and Trichtophyton were also found to be prevalent components of these polymicrobial infections. A notable bacterial/fungal negative correlation was found to be apparent between Staphylococcus and Candida. There were also significant relationships between both bacterial and fungal genera and patient metadata including gender, diabetes status and cardiovascular comorbidities. Conclusion: This microbial survey shows that fungi are more important wound pathogens and opportunistic pathogens than previously reported, exemplifying the impact of these under-reported pathogens. With the application of modern cost-effective and comprehensive molecular diagnostics, clinicians can now identify and address this significant component of chronic wound bioburden with targeted therapies, thereby improving healing trajectories. Conflict of interest: SED and RW are owners of Pathogenius Diagnostics which is a clinical diagnostic laboratory, SED and RW are owners of Research and Testing Laboratory which develops molecular methods for clinical diagnostics. JK and CEJ are owners of SEMT which licenses lipogels for wound care.