Utility of MolecuLight i:X for Managing Bacterial Burden in Pediatric Burns

Abstract

Pediatric burn injuries are vulnerable to severe complications, most often infection, making prompt and precise diagnosis of bacterial bioburden vital to preventing detrimental consequences and optimizing patients’ outcomes. Currently, burn wounds are assessed for infection via examining the clinical signs and symptoms of infection, which can be confirmed by swab culture analysis. While the former approach is subjective and experience-dependant, the latter technique is susceptible to missing subsurface, biofilm-associated colonization, and any peripheral bacterial burden, and also delays confirmation by up to 5 days. The MolecuLight i:X is a handheld, noncontact fluorescence imaging device, which can reveal real-time information about clinically significant levels of bacteria and their biodistribution in surface and subsurface burn wound tissues. We conducted a single-center observational study to assess the device efficacy in identifying critical bacterial levels in pediatric burn wounds and to test the children’s compliance and the overall feasibility of the device integration into the current diagnostic practice. Ten patients with 16 wounds were recruited and assessed for the presence or absence of clinical signs and symptoms of infection and the presence or absence of bacterial fluorescence on images, with swabs taken to confirm findings. Results demonstrate the device’s ability to visualize clinically significant bacterial burden and to localize distribution of pathogens. All clinicians agreed on the high compliance with the device and high feasibility of incorporating the device into routine wound assessments. The results of this study may pave the way toward including bacterial fluorescence imaging into the standard diagnostic algorithm for pediatric burn population.

Use of a bacterial fluorescence imaging system to target wound debridement and accelerate healing: a pilot study

“…In 10 of the 11 wounds assessed, bacterial fluorescence was detected (at loads >10 4 CFU/g) despite absence of CSS. These findings are in line with recent studies, [24][25][26] and confirm the ability of fluorescence imaging to detect presence of bacteria (at loads >10 4 CFU/g), in wounds asymptomatic for CSS. It is plausible that at 10 4 CFU/g, symptoms of infection may not manifest; but even at bacterial loads (>10 6 CFU/g) known to indicate infection, 8 fluorescence imaging has been shown to detect 50% more wounds than CSS assessment.…”

“…In a clinical trial of 50 hard-to-heal (chronic) wounds, Raizman et al reported fluorescence indicative of bacteria in the periwound of 89% of wounds 20 and Farhan et al detected bacteria in the peripheries of 88% of wounds. 25 However, we show here for the first time that the presence of periwound bacterial loads is associated with delayed healing and fluorescenceguided debridement of these regions to eliminate fluorescent signature from bacteria was associated with a shift of wounds onto a healing trajectory. Larger studies are warranted to better understand the potential detriment of bioburden harboured in periwound tissues, but these findings suggest that fluorescence imaging of hard-to-heal wounds can be used to enhance detection and targeted removal of bioburden in this region of the wound that is typically overlooked during routine assessment.…”

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

“…In line with preclinical studies, numerous observational studies and clinical trials have detected cyan fluorescence in wounds positive for PA ( Figure 1 c,d) [ 27 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Wound biopsies [ 27 , 46 ], curettage samples [ 45 ] or swabs [ 47 , 48 , 49 , 50 , 51 ] were collected for microbiological analysis to confirm the presence and amount of PA detected from cyan positive regions. In multiple instances, cyan fluorescence indicative of PA was detected in wounds otherwise lacking the typical signs of PA infection [ 27 , 44 , 46 ].…”

“…In an egg-based infection model, real-time fluorescence imaging detected cyan fluorescence indicative of PA, and this was used to assess the efficacy of antimicrobial treatments against PA [43]. In line with preclinical studies, numerous observational studies and clinical trials have detected cyan fluorescence in wounds positive for PA ( Figure 1c,d) [27,[44][45][46][47][48][49][50][51]. Wound biopsies [27,46], curettage samples [45] or swabs [47][48][49][50][51] were collected for microbiological analysis to confirm the presence and amount of PA detected from cyan positive regions.…”

Prospective clinical study on the efficacy of bacterial removal with mechanical debridement in and around chronic leg ulcers assessed with fluorescence imaging

“…Similarly, in a study of paediatric burns, contactless, painless, and immediate bacterial detection was possible using this fluorescence imaging device. In this patient population, rapid and effective wound disinfection is important to prevent septic progression . These user‐friendly aspects can also be confirmed by our clinical applications.…”