Put Deteriorating Wounds on the Path to Healing – Visualize Asymptomatic Bioburden with the MolecuLight i:XTM

Case Study - Courtesy of David Russell, MD, Leeds General Infirmary, Leeds, UK

Bacterial colonization in chronic wounds can significantly delay or entirely prevent wound healing1. Therefore, detection of significant bacterial burden in a wound typically mandates a change in treatment plan towards one which targets bioburden. Real-time detection of bioburden currently relies on subjective, qualitative visual assessment of clinical signs and symptoms (e.g. pain, exudate, crusting, swelling, erythema, foul odour, friable granulation tissue, and heat). Yet high levels of bacteria often occur in the absence of signs and symptoms, even some cases of wound infection1-3. Without real-time confirmation of the presence and spatial distribution of bacterial burden within and around a wound, clinicians are at risk of making inappropriate and ineffective treatment decisions.

This diabetic foot ulcer patient had significant wound deterioration (3-fold area increase over 4 weeks) despite aggressive offloading, good vascularity, and no clinical signs or symptoms of infection. After routine debridement the wound was imaged for bacterial fluorescence using The MolecuLight i:X Imaging Device. Despite clinician confidence that the wound did not harbor significant bioburden, images revealed prominent bacterial (red) fluorescence which persisted after additional cleaning. The presence of red-fluorescing bacteria prompted the clinician to switch to a honey-based antimicrobial dressing. After two weeks, bacterial fluorescence was no longer visible and wound area had decreased by 45%.

Standard Imaging ModeTM

Figure 1
Figure 2

Fluorescence Imaging ModeTM

Figure 3: MolecuLight i:X image revealed significant bioburden (red) after debridement.
Figure 4: No bacterial (red) fluorescence observed after 2 weeks, 45% decrease in wound size.
Figure 4: No bacterial (red) fluorescence
observed after 2 weeks, 45% decrease in
wound size.


References
[1] Edwards R, Harding KG. Bacteria and wound healing. Curr Opin Infect Dis. 2004;17(2):91–96.
[2] Gardner SE, Frantz RA, Doebbeling BN. The validity of the clinical signs and symptoms used to identify localized chronic wound infection. Wound Repair Regen. 2001;9(3):178–186.
[3] Serena TE, Hanft JR, Snyder R. The lack of reliability of clinical examination in the diagnosis of wound infection: preliminary communication. Int J Low Extrem Wounds. 2008;7(1):32–35.