This is a technically daunting article: The takeaways are that 1) fungus species are an important reason for slow wound healing; 2) the focus on using antibiotics to deal with the bacteria in the wound allows the various fungi to grow and expand their ability to slow healing; 3) the fungi that slow healing are ones found on all of our skin; 4) Bacteria and fungi work together to form unique bio-films (fairly tough membranes that slow healing). The upshot is that our deep difficulties in dealing with chronic wounds are partly a result of not dealing with some of the causes of slow healing, and partly that our actions to heal increase other processes that undermine healing. Each chronic wound is a small ecosystem that is resilient in the face of attempts to change it. Very interesting....
Chronic nonhealing wounds have been heralded as a silent epidemic, causing significant morbidity and mortality especially in elderly, diabetic, and obese populations. Polymicrobial biofilms in the wound bed are hypothesized to disrupt the highly coordinated and sequential events of cutaneous healing. Both culture-dependent and -independent studies of the chronic-wound microbiome have almost exclusively focused on bacteria, omitting what we hypothesize are important fungal contributions to impaired healing and the development of complications. Here we show for the first time that fungal communities (the mycobiome) in chronic wounds are predictive of healing time, associated with poor outcomes, and form mixed fungal-bacterial biofilms.