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Evidence Category:
Detection of Bacterial Burden

Detection of Bacterial Burden

MolecuLight significantly improved the detection of high bacterial load in each group of skin tones, peaking in the high group at 12-fold over CSS alone

MolecuLight is poised to provide a more objective and equitable indicator of wound bacteria

pH values on wound bed confirm non-invasive correlation between fluorescence & bacterial burden

MolecuLight i:X is able to objectively detect the bacterial proliferation in chronic wounds

MolecuLight also guides the correct assessment in the absence of clinical signs of infection and the presence of subclinical bacteria burden

Clinical signs and symptoms (CSS) assessment has poor sensitivity (6.8%) for detecting high bacterial loads in surgical wounds

Point-of-care fluorescence imaging for high bacterial loads improved sensitivity by 5.7-fold compared with CSS alone

Advanced image interpretation training, including hands-on experience, further increases sensitivity of fluorescence imaging up to 11.3-fold vs. CSS alone

Early awareness and management of bacterial burden & biofilm is essential to wound healing

Tissue biopsy & quantitative culture aren’t widely practiced and semi-quantitative analysis is unreliable

MolecuLight fluorescence imaging offers great potential to detect elevated bacterial burden in wounds

Delphi method was employed to establish consensus guidelines describing fluorescence imaging (MolecuLight i:X) use

96% reported that imaging-informed treatment plans led to improved wound healing

Guidelines provided will help to standardize use of fluorescence imaging among wound care providers

This review summarizes clinical evidence from the last 5 years evaluating the diagnostic accuracy and impact of adding fluorescence imaging to standard of care wound assessment

Several studies reported vast improvements in detection of bacterial burden in burn wounds with the addition of fluorescence imaging to standard of care

Incorporation of fluorescence imaging into patient care can change the trajectory of wound healing, leading to interventions that placed non-healing wounds on a healing trajectory

UPPER and LOWER CSS checklists were developed to distinguish between local & systemic infection

Addition of fluorescence imaging led to more judicious application of antimicrobials & more thorough wound bed preparation

95% sensitivity when fluorescence imaging was added over signs and symptoms alone (p<0.01)

69% of wounds had changes in treatment plans due to using the MolecuLight i:X

85% of wounds with wound bed preparation & high bacterial burden (>104 CFU/g) were impacted by information provided by the i:X

53% of wounds involving antimicrobial stewardship & high bacterial burden (>104 CFU/g) were impacted by information provided by the i:X

The Fluorescence imaging procedure was used to inform advanced wound therapies

Three cases are described in which fluorescence images provided information at the point-of-care

This information was used to guide use of antibiofilm agents, NPWT, and preparation of the wound bed for grafting

This case series describes the utility of fluorescence imaging for detection of bacterial burden in an adult burn center

Fluorescence imaging informed decision making on dressings, antimicrobials and antibiotics used at point of care

Swabs confirmed accuracy of imaging results (positive or negative) in all 10 cases

Wounds were assessed for CSS & fluorescence images were then acquired to determine presence of moderate-to-heavy bacterial loads

Sensitivity of fluorescence imaging was 3-fold higher than CSS (72% vs 22%; p=0.002)

Fluorescence imaging information resulted in treatment plan modifications in 73% of study wounds

Fluorescence images for identifying bacterial loads of concern was 100% vs 63% sensitivity of CSS

Fluorescence images for identifying bacterial loads of concern was 92% compared to 82% accuracy of CSS

Fluorescence correctly identified all 8 wounds that were positive for significant bacterial growth on cultures

A pre-clinical mouse wound model demonstrating the safety and feasibility of the fluorescence imaging procedure to visualize elevated bacterial burden in wounds

After treatment with antibiotics, bacterial fluorescence signal correlated with quantitative changes in wound bacterial load