Biofilms are found in the majority of chronic wounds and pose a critical health threat, causing nearly 80% of refractory nosocomial infections. They also have a damaging virulence mechanism, which induces resistance to antimicrobials and evasion from the host’s immune system. Over 90% of chronic...
By the WoundSource Editors
Antifungal cream is a broad term used to describe a range of products containing antifungal agents that are topically applied to the skin to control and manage fungal infections. These products may be formulated with a moisture barrier to protect and condition the skin. Antifungal creams are used both as a palliative treatment for existing fungal infections and as a prophylactic measure in cases where there is a risk of fungal infection.
Although bacteria cause most infections in chronic wounds, research indicates that the role of fungal infections is not insignificant.1 For this reason, antifungal creams play a critical role in reducing the bioburden of chronic and non-healing wounds.2 Antifungal cream is important when it comes to the treatment of burn patients because fungal colonization is a prevalent feature of burn wounds.3
Indications for Antifungal Creams
Although open wounds provide ideal conditions for the colonization of bacteria and fungi, some wounds are at greater risk of fungal infections than others. The following conditions may present indications for antifungal creams to be applied as part of a care regimen:
- Burn wounds: Compared with other hospitalized patients, burn patients are at high risk for developing fungal infections, with incidences reported between 6.3% and 15%.4
- Chronic wounds: Up to 23% of chronic wounds have been found to contain fungi, which prevent and discourage healing by stalling the wound in the inflammatory phase and potentially contributing to the development of biofilms.5
- Diabetic foot ulcers: In some studies, 80% of diabetic foot ulcers displaying biofilm have a microbiome component primarily made up of commensal and pathogenic yeasts.6
- Surgical wound infections: Fungi may cause nosocomial infections in surgical patients, in addition to polymicrobial infections or fungemia.7
- Chemotherapy patients and cancer patients: Patients receiving chemotherapy are immunocompromised, which increases susceptibility to fungal infections.
- Immunosuppressed patients: Patients with suppressed immune systems are at high risk of systemic fungal infections, many of which are opportunistic and begin on compromised skin surfaces.8
- Patients with peripheral arterial disease: Onychomycosis is a warning sign for peripheral arterial disease.9
- Skin grafts: Fungal infections in skin graft sites can inhibit the success of the graft by preventing it from growing or expanding.10
Considerations in Antifungal Wound Treatment
Patients with wounds for which antifungal creams are indicated should have bacterial cultures collected to determine the polymicrobial composition of the wound bed. The appropriate type of antimicrobial treatment will vary based on the microorganisms present.
Prophylactic treatment with antifungal cream may be appropriate in cases where moist peristomal skin is at high risk of fungal infection.11
The relationship of fungal infections to chronic and non-healing wounds is still being revealed by ongoing study. Although antifungal creams are the first line of defense against topical fungal infections in a vast array of wounds, they are only one part of an antifungal strategy in wound care.
1. Moore EC, Padiglione AA, Wasiak J, Paul E, Cleland H. Candida in burns: risk factors and outcomes. J Burn Care Res. 2010;31(2):257-263.
2. Felton T, Troke PF, Hope WW. Tissue penetration of antifungal agents. Clin Microbiol Rev. 2014;27:68-88.
3. Jarvis WR. Epidemiology of nosocomial fungal infections, with emphasis on Candida species. Clin Infect Dis. 1995;20(6):1526-1530.
4. Struck MF, Gille J. Fungal infections in burns: a comprehensive review. Ann Burns Fire Disasters. 2013;26(3):147-153.
5. Dowd SE, Delton Hanson J, Rees E, et al. Survey of fungi and yeast in polymicrobial infections in chronic wounds. J Wound Care. 2011;20:40-47. doi: 10.12968/jowc.2011.20.1.40.
6. Kalan L, Loesche M, Hodkinson BP, et al. Redefining the chronic-wound microbiome: fungal communities are prevalent, dynamic, and associated with delayed healing. mBio. 2016;7(5):e01058-16. doi: 10.1128/mBio.01058-16.
7. Kaya D, Agartan C, Yucel M. Fungal agents as a cause of surgical wound infections: an overview of host factors. Wounds. 2007;19:218-222.
8. Jerez Puebla JE.. Fungal infections. in immunosuppressed patients. In: Metodiev K, ed. Immunodeficiency. IntechOpen; 2012. doi: 10.5772/51512. https://www.intechopen.com/books/immunodeficiency/fungal-infections-in-i.... Accessed March 4, 2020.
9. Gupta AK, Gupta MA, Summerbell RC, et al. The epidemiology of onychomycosis: possible role of smoking and peripheral arterial disease. J Eur Acad Dermatol Venereol. 2000;14:466-469.
10. Becker WK, Cioffi WG Jr, McManus AT, et al. Fungal burn wound infection. A 10-year experience. Arch Surg. 1991;126:44-48.
11. Alvey B, Beck DE. Peristomal dermatology. Clin Colon Rectal Surg. 2008;21(1):41-44.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.