Antibiotic Misuse in Wound Care: Can Bacterial Localization through Fluorescence Imaging Help?

Abstract

(1) Background: Systemic antibiotic use in chronic wounds is alarmingly high worldwide. Between 53% to 71% of patients are prescribed at least one course per chronic wound. Systemic antibiotic use should follow antibiotic stewardship guidelines and ought to be reserved for situations where their use is deemed supported by clinical indications. Unfortunately, in the field of wound care, indiscriminate and often inadequate use of systemic antibiotics is leading to both patient complications and worsening antibiotic resistance rates. Implementing novel tools that help clinicians prevent misuse or objectively determine the true need for systemic antibiotics is essential to reduce prescribing rates. (2) Methods: We present a compendium of available systemic antibiotic prescription rates in chronic wounds. The impact of various strategies used to improve these rates, as well as preliminary data on the impact of implementing fluorescence imaging technology to finesse wound status diagnosis, are presented. (3) Results: Interventions including feedback from wound care surveillance and treatment data registries as well as better diagnostic strategies can ameliorate antibiotic misuse. (4) Conclusions: Interventions that mitigate unnecessary antibiotic use are needed. Effective strategies include those that raise awareness of antibiotic overprescribing and those that enhance diagnosis of infection, such as fluorescence imaging.

Lights, fluorescence, action—Influencing wound treatment plans including debridement of bacteria and biofilms

“…), such that we could not determine the impact of FL‐imaging on topical antimicrobial prescribing, specifically. We also observed a significant increase in the prescribing of systemic antibiotics, contrary to several longitudinal studies reporting that FL‐imaging reduces systemic antibiotic use by up to 33% 32,33,46 . This discrepancy is likely driven by study parameters.…”

“…Antimicrobial stewardship has long been a challenge in the context of polymicrobial, non‐healing complicated wounds that may require multiple courses of broad‐spectrum antibiotics over their lifetime. Judicious use of antibiotics is necessary to combat their pervasive overuse (53%‐71% of chronic wounds will be prescribed a systemic antibiotic at some point in their care 46 ), and this begins with maximising the efficacy of local, topical strategies before resorting to systemic measures. We found that FL‐imaging prompted a significant increase in the application of topical therapies, however, these were bucketed into a single category that included topical antimicrobials, but also non‐antimicrobial creams/ointments (eg, analgesic, enzymatic, etc.…”

“…We also observed a significant increase in the prescribing of systemic antibiotics, contrary to several longitudinal studies reporting that FL-imaging reduces systemic antibiotic use by up to 33%. 32,33,46 This discrepancy is likely driven by study parameters. First, this is a single-timepoint snapshot of these clinical practices and systemic prescribing trends over time could differ greatly.…”

Skin Pigmentation Impacts the Clinical Diagnosis of Wound Infection: Imaging of Bacterial Burden to Overcome Diagnostic Limitations

“…For instance, a 2022 RCT showed that adding FL-imaging to standard clinical assessment doubled 12-week DFU healing rates [ 53 ]. Furthermore, Price et al [ 54 ] reported increased DFU healing rates (+23%) alongside decreased systemic antibiotic prescribing (−33%), suggestive of decreased infections, and Caputo et al report that antimicrobial prescribing decisions changed at the bedside in 41% of the visits with the use of FL-imaging [ 55 ]. Therefore, FL-imaging also has a role to play in improving outcomes across all skin types and colors.…”

Multifunctional antibacterial hydrogels for chronic wound management

“…Hence, systemic antibiotics, whether administered orally or intravenously, might be less effective owing to poor wound blood supply, thus contributing to the development of antibiotic resistance. 17,18 Therefore, a safe and effective delivery system for antibacterial drugs is crucial to reduce drug resistance and enhance therapeutic efficacy. The distinctive threedimensional mesh structure of hydrogels can help slow the release of drugs and enable their localisation at the wound site, leading to sustained therapeutic outcomes.…”