Bacteria and Antibiotics in Wound Healing

Caldwell, Michael D.

doi:10.1016/j.suc.2020.05.007

Cited by 91 publications

(72 citation statements)

References 115 publications

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“…It is known that increased microbial load is a key predictor of nonhealing wounds. 7,8 Proliferation of bacteria resulting in moderate-to-heavy loads (>10 4 colony-forming units [CFU]/g) delays healing [9][10][11] and increases the risk of wound complications, including infection, sepsis, and amputation. [12][13][14] Guidelines advise that early diagnosis of high bacterial burden is essential to prevent the wound from progression to local or systemic infection.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Point-of-Care Fluorescence Imaging for the Detection of Bacterial Burden in Wounds: Results from the 350-Patient Fluorescence Imaging Assessment and Guidance Trial

Baer²,

Briggs

et al. 2021

Advances in Wound Care

182

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Objective: High bacterial load contributes to chronicity of wounds and is diagnosed based on assessment of clinical signs and symptoms (CSS) of infection, but these characteristics are poor predictors of bacterial burden. Point-of-care fluorescence imaging (FL) MolecuLight i:X can improve identification of wounds with high bacterial burden (>10 4 colony-forming unit [CFU]/g). FL detects bacteria, whether planktonic or in biofilm, but does not distinguish between the two. In this study, diagnostic accuracy of FL was compared to CSS during routine wound assessment. Postassessment, clinicians were surveyed to assess impact of FL on treatment plan. Approach: A prospective multicenter controlled study was conducted by 20 study clinicians from 14 outpatient advanced wound care centers across the United States. Wounds underwent assessment for CSS followed by FL. Biopsies were collected to confirm total bacterial load. Three hundred fifty patients completed the study (138 diabetic foot ulcers, 106 venous leg ulcers, 60 surgical sites, 22 pressure ulcers, and 24 others). Results: Around 287/350 wounds (82%) had bacterial loads >10 4 CFU/g, and CSS missed detection of 85% of these wounds. FL significantly increased detection of bacteria (>10 4 CFU/g) by fourfold, and this was consistent across wound types ( p < 0.001). Specificity of CSS+FL remained comparably high to CSS ( p = 1.0). FL information modified treatment plans (69% of wounds), influenced wound bed preparation (85%), and improved overall patient care (90%) as reported by study clinicians. Innovation: This novel noncontact, handheld FL device provides immediate, objective information on presence, location, and load of bacteria at point of care. Conclusion: Use of FL facilitates adherence to clinical guidelines recommending prompt detection and removal of bacterial burden to reduce wound infection and facilitate healing.

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Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Point-of-Care Fluorescence Imaging for the Detection of Bacterial Burden in Wounds: Results from the 350-Patient Fluorescence Imaging Assessment and Guidance Trial

Baer²,

Briggs

et al. 2021

Advances in Wound Care

182

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“…It is well established that bacterial proliferation in wounds contributes to infection and delayed wound healing [1][2][3][4]. The chronic wound microenvironment is ideal for bioburden and usually contains multiple bacterial species [5].…”

Section: Introductionmentioning

confidence: 99%

Rapid Diagnosis of Pseudomonas aeruginosa in Wounds with Point-Of-Care Fluorescence Imaing

2021

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Pseudomonas aeruginosa (PA) is a common bacterial pathogen in chronic wounds known for its propensity to form biofilms and evade conventional treatment methods. Early detection of PA in wounds is critical to the mitigation of more severe wound outcomes. Point-of-care bacterial fluorescence imaging illuminates wounds with safe, violet light, triggering the production of cyan fluorescence from PA. A prospective single blind clinical study was conducted to determine the positive predictive value (PPV) of cyan fluorescence for the detection of PA in wounds. Bacterial fluorescence using the MolecuLight i:X imaging device revealed cyan fluorescence signal in 28 chronic wounds, including venous leg ulcers, surgical wounds, diabetic foot ulcers and other wound types. To correlate the cyan signal to the presence of PA, wound regions positive for cyan fluorescence were sampled via curettage. A semi-quantitative culture analysis of curettage samples confirmed the presence of PA in 26/28 wounds, resulting in a PPV of 92.9%. The bacterial load of PA from cyan-positive regions ranged from light to heavy. Less than 20% of wounds that were positive for PA exhibited the classic symptoms of PA infection. These findings suggest that cyan detected on fluorescence images can be used to reliably predict bacteria, specifically PA at the point-of-care.

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“…The point at which bacterial loads tip from colonization to local infection is a matter of some debate. While the literature is varied, most studies suggest loads of between 10 4 CFU/g and 10 5 CFU/g [10,[15][16][17]. For example, a study by Breidenbach and Trager demonstrated that a critical bacterial load threshold of 10 4 CFU/g must be attained to cause infection in complicated lower-limb wounds [18].…”

mentioning

confidence: 99%

Diagnosing Burn Wounds Infection: The Practice Gap & Advances with MolecuLight Bacterial Imaging

Farhan

Jeffery

2021

Diagnostics

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Burn injuries constitute a critical economic burden on healthcare infrastructures worldwide. They are often associated with high mortality rates due to severe complications. Infection is the most common complication, highlighting the importance of prompt and precise diagnosis in order to prevent detrimental consequences and to optimize patient outcomes. Here we examine the current standard of care for diagnosing infection in both burn and chronic wounds followed by an investigation into the research surrounding a relatively new technique for bacterial detection, fluorescence imaging. With five years of published research on bacterial fluorescence imaging (MolecuLight i:X device), we have summarized and analysed the validity of the procedure and compared it to the current standard of care; clinical assessment and microbiological analysis. We highlight the benefits that could be obtained through the use of this technology as well as the limitations and the feasibility of incorporating this novel procedure into the standard of care.

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Bacteria and Antibiotics in Wound Healing

Cited by 91 publications

References 115 publications

Diagnostic Accuracy of Point-of-Care Fluorescence Imaging for the Detection of Bacterial Burden in Wounds: Results from the 350-Patient Fluorescence Imaging Assessment and Guidance Trial

Diagnostic Accuracy of Point-of-Care Fluorescence Imaging for the Detection of Bacterial Burden in Wounds: Results from the 350-Patient Fluorescence Imaging Assessment and Guidance Trial

Rapid Diagnosis of Pseudomonas aeruginosa in Wounds with Point-Of-Care Fluorescence Imaing

Diagnosing Burn Wounds Infection: The Practice Gap & Advances with MolecuLight Bacterial Imaging

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