Uncovering the high prevalence of bacterial burden in surgical site wounds with point‐of‐care fluorescence imaging

Sandy‐Hodgetts, Kylie; Andersen, Charles A.; Al-Jalodi, Omar; Serena, Laura; Teimouri, Christina; Serena, Thomas E

doi:10.1111/iwj.13737

Cited by 22 publications

(22 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The current study highlights FL-imaging as an objective solution to address this diagnostic gap by visualising high bacterial loads synchronously across the entire wound/periwound. Consistent with other trials, 24,25,37,[39][40][41] the data herein show a high PPV of FL-imaging and sensitivity well above that of the CSS of infection. Advancing on past works, we also demonstrate that the sensitivity of FL-imaging increases proportionally with bacterial load, while the sensitivity of CSS does not.…”

Section: Discussionsupporting

confidence: 91%

“…Similarly, Gardner et al 21 reported that the signs and symptoms in the IDSA classification were no better than chance at predicting DFUs with high bacterial loads (defined as >10 6 CFU/g in that study). Other clinical trials have reported similar findings across DFUs, VLUs, pressure injuries, and surgical sites 24,37 . In contrast, delayed wound healing was observed in a large proportion of DFUs in this study, with its frequency increasing as bacterial load thresholds increased from 10 6 to 10 8 CFU/g (41.7%–57.7%).…”

Section: Discussionsupporting

confidence: 80%

“…Other clinical trials have reported similar findings across DFUs, VLUs, pressure injuries, and surgical sites. 24 , 37 In contrast, delayed wound healing was observed in a large proportion of DFUs in this study, with its frequency increasing as bacterial load thresholds increased from 10 6 to 10 8 CFU/g (41.7%–57.7%). There are many factors aside from bacterial presence which contribute to delayed wound healing.…”

Section: Discussionmentioning

confidence: 51%

See 2 more Smart Citations

Point‐of‐care fluorescence imaging reveals extent of bacterial load in diabetic foot ulcers

Armstrong

Edmonds

Serena

2023

International Wound Journal

Self Cite

View full text Add to dashboard Cite

Elevated levels of bacteria, including biofilm, increase the risk of chronic wound infection and inhibit healing. Addressing asymptomatic high bacterial loads is challenged by a lack of clinical terminology and diagnostic tools. This post-hoc multicenter clinical trial analysis of 138 diabetic foot ulcers investigates fluorescence (FL)-imaging role in detecting biofilm-encased and planktonic bacteria in wounds at high loads. The sensitivity and specificity of clinical assessment and FL-imaging were compared across bacterial loads of concern (10 4 -10 9 CFU/g). Quantitative tissue culture confirmed the total loads. Bacterial presence was confirmed in 131/138 ulcers. Of these, 93.9% had loads >10 4 CFU/g. In those wounds, symptoms of infection were largely absent and did not correlate with, or increase proportionately with, bacterial loads at any threshold. FL-imaging increased sensitivity for the detection of bacteria across loads 10 4 -10 9 (P < .0001), peaking at 92.6% for >10 8 CFU/g. Imaging further showed that 84.2% of ulcers contained high loads in the periwound region.New terminology, chronic inhibitory bacterial load (CIBL), describes frequently asymptomatic, high bacterial loads in diabetic ulcers and periwound tissues, which require clinical intervention to prevent sequelae of infection. We anticipate this will spark a paradigm shift in assessment and management, enabling earlier intervention along the bacterial-infection continuum and supporting improved wound outcomes.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 51%

See 1 more Smart Citation

Point‐of‐care fluorescence imaging reveals extent of bacterial load in diabetic foot ulcers

Armstrong

Edmonds

Serena

2023

International Wound Journal

Self Cite

View full text Add to dashboard Cite

show abstract

“…18,19 It is possible to perform swab and biopsy in the most specific point, by identifying the area with pathological fluorescence. 20 Fluorescence Imaging showed higher sensitivity of bacterial detection compared to CSS in a recent case series of 58 surgical site wounds 21 or to the Levine technique in diabetic foot ulcers case series. 22 Moelleken et al reported an average decrease of 29% of bacteria fluorescence after a single mechanical debridement in a case series of 25 venous leg ulcers.…”

Section: Discussionmentioning

confidence: 93%

The Role of Autoflorescence Imaging Device in the Evaluation of Bacteria Burden Control

Janowska

Davini

Iannone

et al. 2022

The International Journal of Lower Extremity Wounds

View full text Add to dashboard Cite

MolecuLight i:X is a autofluorescence, portable device that allows an assessment of wound area, perimeter, width and length and an evaluation in real time of wound surface bacteria (>104 CFU/g). Primary objective of our study was to evaluate the reduction of bacterial load associated to 3 different therapeutic approaches: dressings and multicomponent bandages (Group1), sharp debridement, dressings and multicomponent bandages (Group 2), and 10 patients treated with zinc oxide bandage (Group 3). Secondary objective was NRS pain scale, Wound Bed Score (WBS) and Quality of Life (QoL) assessment. Despite the improvement of bacterial load, WBS, Qol and NRS was evident in all 3 groups, the analysis of our results demonstrates that the application of zinc oxide bandage, directly in contact with the wound bed and/or the perilesional skin, resulted in a higher improvement and a significant reduction of WBS and bacterial load. Fluorescence imaging can help the specialist in a more targeted assessment and management of infection. Sharp debridement and antiseptic dressings are classically used to reduced bacteria burden. Zinc oxide directly on the wound is an interesting cost-effective option to control different types of bacteria.

show abstract

“…This trial was designed to measure the diagnostic accuracy and utility of this technology in the management of chronic wounds. The primary outcomes of the FLAAG trial demonstrated that the imaging procedure provided accurate, real-time mapping of areas of high bacterial loads greater than 10 4 CFU/g in and around wounds, with a sensitivity 4 to 11-fold greater than CSS alone (standard of care diagnosis) ( Rennie et al., 2017 ; Le L et al., 2021 ; Sandy-Hodgetts K et al., 2021 ). In this study, we are leveraging the information collected during the FLAAG trial from a subset of 78 wounds from which two biopsies were taken.…”

Section: Introductionmentioning

confidence: 99%

Use of fluorescence imaging to optimize location of tissue sampling in hard-to-heal wounds

Serena

Snyder

Bowler³

2023

Front. Cell. Infect. Microbiol.

Self Cite

View full text Add to dashboard Cite

IntroductionWound microflora in hard-to-heal wounds is invariably complex and diverse. Determining the interfering organisms(s) is therefore challenging. Tissue sampling, particularly in large wounds, is subjective and, when performed, might involve swabbing or biopsy of several locations. Fluorescence (FL) imaging of bacterial loads is a rapid, non-invasive method to objectively locate microbial hotspots (loads >104 CFU/gr). When sampling is deemed clinically necessary, imaging may indicate an optimal site for tissue biopsy. This study aimed to investigate the microbiology of wound tissue incisional biopsies taken from sites identified by FL imaging compared with sites selected by clinical judgment.MethodsA post hoc analysis of the 350-patient FLAAG wound trial was conducted; 78 wounds were included in the present study. All 78 wounds were biopsied at two sites: one at the center of the wound per standard of care (SoC) and one site guided by FL-imaging findings, allowing for comparison of total bacterial load (TBL) and species present.ResultsThe comparison between the two biopsy sites revealed that clinical uncertainty was higher as wound surface area increased. The sensitivity of a FL-informed biopsy was 98.7% for accurately finding any bacterial loads >104 CFU/g, compared to 87.2% for SoC (p=0.0059; McNemar test). Regarding species detected, FL-informed biopsies detected an average of 3 bacterial species per biopsy versus 2.2 species with SoC (p < 0.001; t-test). Microbial hotspots with a higher number of pathogens also included the CDC’s pathogens of interest.Conclusions & perspectiveFL imaging provides a more accurate and relevant microbiological profile that guides optimal wound sampling compared to clinical judgment. This is particularly interesting in large, complex wounds, as evidenced in the wounds studied in this post hoc analysis. In addition, fluorescence imaging enables earlier bacterial detection and intervention, guiding early and appropriate wound hygiene and potentially reducing the need for antibiotic use. When indicated, this diagnostic partnership with antibiotic stewardship initiatives is key to ameliorating the continuing threat of antibiotic resistance.

show abstract

Uncovering the high prevalence of bacterial burden in surgical site wounds with point‐of‐care fluorescence imaging

Cited by 22 publications

References 42 publications

Point‐of‐care fluorescence imaging reveals extent of bacterial load in diabetic foot ulcers

Point‐of‐care fluorescence imaging reveals extent of bacterial load in diabetic foot ulcers

The Role of Autoflorescence Imaging Device in the Evaluation of Bacteria Burden Control

Use of fluorescence imaging to optimize location of tissue sampling in hard-to-heal wounds

Contact Info

Product

Resources

About