Wound Healing Finally Enters the Age of Molecular Diagnostic Medicine.

BACKGROUND: Many wounds are difficult to heal because of the large, complex community of microbes present within the wound. THE PROBLEM: Classical laboratory culture methods do not provide an accurate picture of the microbial interactions or representation of microorganisms within a wound. There is an inherent bias in diagnosis based upon classical culture stemming from the ability of certain organisms to thrive in culture while others are underrepresented or fail to be identified in culture altogether. Chronic wounds also contain polymicrobial infections existing as a cooperative community that is resistant to antibiotic therapy. BASIC/CLINICAL SCIENCE ADVANCES: New methods in molecular diagnostic medicine allow the identification of nearly all organisms present in a wound irrespective of the ability of these organisms to be grown in culture. Advances in DNA analyses allow absolute identification of microorganisms from very small clinical specimens. These new methods also provide a quantitative representation of all microorganisms contributing to these polymicrobial infections. CLINICAL CARE RELEVANCE: Technological advances in laboratory diagnostics can significantly shorten the time required to heal chronic wounds. Identification of the genetic signatures of organisms present within a wound allows clinicians to identify and treat the primary organisms responsible for nonhealing wounds.
CONCLUSION: Advanced genetic technologies targeting the specific needs of wound care patients are now accessible to all wound care clinicians.