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Evidence Category:
Detection of Bacterial Burden

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


Pseudomonas aeruginosa, a common bacterial pathogen in chronic wounds, is challenging to detect by standard assessment of clinical signs and symptoms

Cyan detected on MolecuLight i:X fluorescence images, can be used to reliably predict Pseudomonas aeruginosa at the point-of-care, with a PPV of 93% (confirmed by microbiological analysis)


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


The PPV of red fluorescence on MolecuLight i:X images was 100%, regardless of sampling method, analysis technique, or study site

Fluorescence guidance, in combination with subsurface sampling techniques, could eliminate the risk of false negative wound sampling

Fluorescence imaging information could influence treatment decisions at the point of care


Fluorescence imaging of diabetic foot ulcers had superior accuracy (78%) in detecting the presence of clinically significant bacteria than standard practice (Levine swabbing, 52%; p=0.048)

Higher bacterial loads were detected from wound regions positive for bacterial fluorescence compared to regions sampled based on CSS alone


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