Visual analysis of chronic wounds and its correlation with biofilm

Abstract

To evaluate the biofilm using visual indicators that were clinically observable to see if any significant method of clinically detecting or predicting the presence of a biofilm can be developed. Material and methods:The prospective study was conducted from late 2019 to 2021 in the Department of Surgery at Chatrapati Shivaji Subharti Hospital, a tertiary care super speciality institute of Swami Vivekanand Subharti University among patients with chronic wounds admitted in the department through surgery outpatient department/Emergency/transferred from other departments formed the study group. Samples were subjected for aerobic bacterial culture on blood agar, chocolate agar and MacConkey agar plates. The isolated bacterial pathogen was identified using standard bacteriological procedures which included colony morphology, gram stain and battery biochemical tests both for Gram positive and negative bacteria as per Gram stain. Efficacy of visual score was calculated using diagnostic tests (Sensitivity, Specificity, Diagnostic Accuracy) considering biofilm assessment by culture method as gold standard. Results: Visual score viz. 0 (None), ≤5 (Not Sure), 6-8 (Probable) and ≥9 (Predicted) was reported in 0%, 8%, 31% and 61% of the subjects respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of visual score considering culture method as gold standard was 94.74%, 83.72%, 99.10%, 45.57% and 94.19% respectively. Conclusion:We concluded from our findings that clinical algorithm (visual score) may serve as a nearly signal to alert clinicians that the wound has diverted off its normal healing path. Detection of early (young) biofilms enable intervention before recalcitrance and/or infection become a problem.