Wound microbiology and associated approaches to wound management

The majority of dermal wounds are colonized with aerobic and anaerobic micr oorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infec tion, others consider the types of microorganisms to be of greater importan ce. However, these and other factors such as microbial synergy, the host im mune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the v alue of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the l aboratory, consideration must be given to the relevance of culturing polymi crobial specimens the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Al though appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the rele vance and use of antibiotics (systemic or topical) and antiseptics (topical ) in the treatment of nonhealing wounds that have no clinical signs of infe ction. In providing a detailed analysis of wound microbiology, together wit h current opinion and controversies regarding wound assessment and treatmen t, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds .