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The wound microbiota: microbial mechanisms of impaired wound healing and infection

Nature Reviews Microbiology (2024)Cite this article

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Abstract

The skin barrier protects the human body from invasion by exogenous and pathogenic microorganisms. A breach in this barrier exposes the underlying tissue to microbial contamination, which can lead to infection, delayed healing, and further loss of tissue and organ integrity. Delayed wound healing and chronic wounds are associated with comorbidities, including diabetes, advanced age, immunosuppression and autoimmune disease. The wound microbiota can influence each stage of the multi-factorial repair process and influence the likelihood of an infection. Pathogens that commonly infect wounds, such as Staphylococcus aureus and Pseudomonas aeruginosa, express specialized virulence factors that facilitate adherence and invasion. Biofilm formation and other polymicrobial interactions contribute to host immunity evasion and resistance to antimicrobial therapies. Anaerobic organisms, fungal and viral pathogens, and emerging drug-resistant microorganisms present unique challenges for diagnosis and therapy. In this Review, we explore the current understanding of how microorganisms present in wounds impact the process of skin repair and lead to infection through their actions on the host and the other microbial wound inhabitants.

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Fig. 1: Development of acute and chronic wounds.
Fig. 2: The wound infection ‘continuum’.
Fig. 3: Factors that contribute to wound infections.

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Acknowledgements

We thank current and former members of the Grice lab for critical discussion. E.A.G. was supported by the following grants from the National Institutes of Health: R01NR015639, R01AR079856, R01AI143790. A.M.-V. was supported by the Penn Dermatology Research T32 Training Grant (NIH/NIAMS T32AR007465). A.U. was supported by the Prevent Cancer Foundation Awesome Games Done Quick fellowship and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (1K99AR081404). This work is dedicated to the aunts of the authors, especially Punita Jolly (A.U.) and Ethel Doehrmann (E.A.G.), for their unconditional love, support, and kindness and their inspiring examples to be our best selves even in the worst of times.

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  1. Departments of Dermatology and Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Aayushi Uberoi, Amelia McCready-Vangi & Elizabeth A. Grice

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Uberoi, A., McCready-Vangi, A. & Grice, E.A. The wound microbiota: microbial mechanisms of impaired wound healing and infection. Nat Rev Microbiol (2024). https://doi.org/10.1038/s41579-024-01035-z

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