Presented at Wounds Canada Spring Conference, May 12-13 2017; Kamloops BC by Rosemary Hill
Authors: Rosemary Hill BSN CWOCN CETN (C) and Joshua Douglas, Vancouver Coastal Health, CANADA
The urgent need to eliminate unnecessary use of systemic antibiotics in wound care has been hampered by a lack of real-time information confirming a wound’s bioburden. We describe utility of a novel, hand-held bacterial fluorescence imaging device1 for visualization of pathogenic bacteria in real-time and for guiding antimicrobial stewardship practices. It is noted that the recently published Wound Infection in Clinical Practice (2016) state that “prompt diagnosis and treatment of infection promotes wound healing and minimises the impact on the individual, their carer and health care system.”2
Six patients with diverse wounds were imaged at the bedside as part of routine wound assessments. Wounds positive for red fluorescence were considered to have clinically significant bacterial loads and swabs from regions of red fluorescence were taken to confirm.
Wound images revealed pronounced bacterial fluorescence in four patients, three of whom were about to be discharged, leading to prescription of short duration systemic antibiotics and additional patient monitoring. Swabs from each of these wounds later confirmed heavy growth of one or more pathogenic bacterial species. Follow up images demonstrated effectiveness of antibiotics, and in some instances led to reduced antibiotic courses and duration. In the remaining two patients, real-time images showing no bacterial fluorescence prevented use of systemic antibiotics, which otherwise would have been prescribed. Follow up images remained clear of bacterial fluorescence and both wounds healed successfully.
Real-time, point-of-care visualization of fluorescing bacteria facilitated evidence-based deployment of systemic antibiotics and also prevented their unnecessary use. These cases highlight the potential for this imaging device to provide invaluable, real-time information regarding the pathogenic state of a wound that can guide appropriate use of antibiotics and facilitate antimicrobial stewardship.
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- Swanson, T. et al. International Wound Infection Institute (IWII) Wound Infection in clinical practice. Wounds International 2016