Fungi and bacteria as a pathogenic factor in wound healing in patients after orthopaedic surgeries

Complications of postoperative wound healing delay or limit implementation of rehabilitation therapy. In an attempt to determine the source of the delayed healing we usually focus on searching for bacteria, forgetting, however, to perform mycological tests. Local or systemic reactions to physiotherapeutic procedures may result not only from such disorders as a decreased level of plasma proteins and enzymes, vitamin deficiency, dehydration, reduction of oxygen pressure and diffusion in the wound, high doses of steroids, but also from a secondary bacterial and fungal infection, leading in consequence to deterioration of wound healing. The presence of these microorganisms in the skin adjacent to the wound or in other ontocenoses seems to be of considerable importance, as it may cause impairment of the proper course of rehabilitation. Thus, the aim of the present study was to search for bacteria and fungi in patients with delayed wound healing, subject to rehabilitation following orthopaedic surgeries of the locomotor system.

Mycological investigations were carried out in 24 patients with delayed wound healing after orthopaedic surgery (alloplasty of hip and knee joints, open fracture repositions, lengthening of lower extremities). The material for assessment was taken from the wound, surrounding skin and oral cavity. The results of routinely performed laboratory examinations were used in the bacteriological analysis. The differentiation of strains and fungi was performed on the basis of morphological and biochemical characteristics. Multifocal infections of fungi were looked for in the group of patients studied.

Bacteria were detected in 10 (41.6%) patients. In 7 (29.1%) patients, they occurred in the wound ontocenosis together with fungi. Fungi were found in 19 (79.2%) patients in at least one ontocenosis. Out of the whole sample studied, fungi were isolated from the wound in 9 (37.5%) patients, from the wound-surrounding skin in 10 (41.6%) patients, and from the oral cavity in 17 (70.8%) patients. It should be emphasised that the occurrence of fungi was more frequently observed in two or three ontocenoses (89.4%) simultaneously than in one (10.6%).

In wound ontocenosis of orthopaedic patients with delayed wound healing, fungal infection concomitant with bacterial one should be taken under consideration. Out of all bacteria found in the wound ontocenosis, the most frequent one was Staphylococcus aureus, whereas in fungi the most common species was Candida albicans. In (3/4) of the cases, fungi were observed simultaneously in two or three ontocenoses, which could have influence on endogenic expansion, making treatment difficult and delaying initiation of physical exercises.