Effective strategies include those that raise awareness of antibiotic overprescribing and those that enhance diagnosis of infection, such as fluorescence imaging (MolecuLight)
Detection of Bacterial Burden
MolecuLight i:X helpful targeting for bacterial cultures as well as in judging therapeutic necessity for intractable skin ulcers.
MolecuLight Improved Sensitivity 8.3-Fold for Detecting Bacterial Burden in DFUs over CSS alone
Fluorescence imaging showed that 84.2% of DFUs contained high bacterial loads in the periwound
Authors introduce new terminology, chronic inhibitory bacterial load (CIBL)
MolecuLight successfully used to detect location & load of elevated bacterial load prior to delivery of non-thermal gas plasma in DFU patients
Detection of Bacterial Burden
Quick detection of elevated bacterial burden enabled instant implementation of wound hygiene, skin disinfection, appropriate dressing choice and curative treatment was possible
High diagnostic accuracy to detect elevated bacterial loads in perineal wounds
The sensitivity was 83%, specificity was 90%, and the PPV was 92%
The use of MolecuLight to identify elevated bacterial loads in venous leg ulcers was confirmed and validated by pathology
Effectiveness of Alprep Pad® for cleaning and debridement of DFUs was studied
MolecuLight i:X was used to establish the presence of bioburden in the wound bed, wound edge and periwound skin
Wound size was measured using the MolecuLight device
First RCT using MolecuLight i:X technology
Addition of MolecuLight to standard treatment doubled 12-week healing rates of DFUs (204%) and improved wound closure
Fluorescence imaging aids antimicrobial stewardship by supporting evidence-based decision-making at the point of care
Also increased communication, enhanced efficiency, and improved continuity of care between wound care providers and hospital sites
1st study to describe healing outcomes of dehisced perineal wounds & factors associated with delayed healing
The presence of fluorescence significantly reduced the odds of wound healing in ≤ 4 weeks by 76%
Fluorescence imaging can help the specialist in a more targeted assessment and management of infection
Detection of Bacterial Burden
Fluorescent imaging excluded infection at the initial visit, and debridement was avoided
MolecuLight-assisted assessment of wound bacterial burden was helpful point-of-care tool in the clinician's armamentarium to diagnose pyoderma gangrenosum accurately
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
Debridement/Wound Hygiene
MolecuLight used in clinical trial of sodium hypochlorite to test its efficacy in reducing bacterial burden and promoting healing
Used to assess the presence of elevated burden in patients pre- and post-treatment
Initial findings: Sodium hypochlorite is efficacious in reducing bacterial burden and promoting healing
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
Using novel debridement tool, fluorescence imaging demonstrated a reduction in bacterial load in 69% of cases, with complete resolution in 19% of wounds.
Advantage of utilizing point-of-care fluorescence imaging for improving bacterial detection and optimizing treatment strategies with wound sepsis in stage 4 pelvic pressure injuries.
Detection of Bacterial Burden
MolecuLight i:X recommended, as review of NICE guidance in new JoWC publication "Wound healing: what is the NICE guidance from the UK?" for the assessment of fluorescent bacteria 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
Detection of Bacterial Burden
Hand trauma wounds were inspected for CSS and underwent fluorescence imaging for detection of bacterial burden
Fluorescence signals correlated with CSS and swab results in 97% of wounds
Fluorescence imaging can guide surgical debridement by providing real-time information on wounds' infected areas
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
In a clinical trial with 412 punch biopsies, only one resulted in an adverse event (abscess)
Fluorescence images revealed presence of bacteria at site of biopsy prior to abscess development
Bacterial load was confirmed as 106 CFU/g from the biopsy
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
Detection of Bacterial Burden
Fluorescence imaging was used to monitor elevated bacterial loads during burn reconstruction
Weekly fluorescence imaging led to detection of elevated bacterial loads in the dermal template at the point-of-care
This resulted in debridement
88% of wounds where bacterial fluorescence was detected in peripheries (in regions not typically swabbed)
100% of pediatric patients were compliant with the MolecuLight imaging procedure
93% of clinicians who reported highest practicality of incorporating MolecuLight i:X into routine diagnostic practice
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
95% Sensitivity for detecting bacteria in fluorescence images
95% Positive Predictive Value (PPV) of fluorescence images
100% Negative Predictive Value (NPV) of fluorescence images
This peer-reviewed tutorial describes how to interpret the various fluorescence signals detected from wound tissues and bacteria using the fluorescence imaging procedure
Methods to minimize imaging artifacts and misinterpretation are described
Detection of Bacterial Burden
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
Detection of Bacterial Burden
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
