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Raizman R. Fluorescence imaging guided dressing change frequency during negative pressure wound therapy: a case series. J Wound Care 2020; 28:S28-S37. [PMID: 31509488 DOI: 10.12968/jowc.2019.28.sup9.s28] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Knowledge of wound bioburden can guide selection of therapies, for example, the use of negative pressure wound therapy (NPWT) devices with instillation in a heavily contaminated wound. Wound and periwound bacteria can be visualised in real-time using a novel, non-contact, handheld fluorescence imaging device that emits a safe violet light. This device was used to monitor bacterial burden in patients undergoing NPWT. METHODS Diverse wounds undergoing NPWT were imaged for bacterial (red or cyan) fluorescence as part of routine wound assessments. RESULTS We assessed 11 wounds undergoing NPWT. Bacterial fluorescence was detected under sealed, optically-transparent (routine) adhesive before dressing changes, on foam dressings, within the wound bed, and on periwound tissues. Bacterial visualisation in real-time helped to guide: (1) bioburden-based, personalised treatment regimens, (2) clinician selection of NPWT, with or without instillation of wound cleansers, and (3) the extent and location of wound cleaning during dressing changes. The ability to visualise bacteria before removal of dressings led to expedited dressing changes when heavy bioburden was detected and postponement of dressing changes for 24 hours when red fluorescence was not observed, avoiding unnecessary disturbance of the wound bed. CONCLUSION Fluorescence imaging of bacteria prompted and helped guide the timing of dressing changes, the extent of wound cleaning, and selection of the appropriate and most cost-effective NPWT (standard versus instillation). These results highlight the capability of bacterial fluorescence imaging to provide invaluable real-time information on a wound's bioburden, contributing to clinician treatment decisions in cases where bacterial contamination could impede wound healing.
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Affiliation(s)
- Rose Raizman
- Adjunct Lecturer, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Department of Professional Practice, Scarborough Health Network
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52
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Pijpe A, Ozdemir Y, Sinnige JC, Kwa KAA, Middelkoop E, Meij-de Vries A. Detection of bacteria in burn wounds with a novel handheld autofluorescence wound imaging device: a pilot study. J Wound Care 2020; 28:548-554. [PMID: 31393796 DOI: 10.12968/jowc.2019.28.8.548] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the detection of bacteria in burn wounds between an bacterial fluorescence imaging device MolecuLight i:X, (Canada), and standard microbiological swabs. METHODS Wounds were swabbed three times on one occasion; once with a standard swab, once with a high-fluorescent area swab, indicating a bacterial load >104 colony-forming units (CFU)/gram and a finally with a non-fluorescent (nF) area swab. Proportion agreement of the microbiological results was calculated and the accuracy of the device to detect relevant bacteria was assessed. RESULTS A total of 14 patients with 20 wounds participated in the study. Median post-burn day at sampling time was 21 days. Of the 20 wounds, nine had a positive swab result in either of the three swabs, and 11 showed a highfluorescent area. Overall, positive and negative proportion agreement between standard swab and high-fluorescent swab sample results were 100%. Sensitivity, specificity, positive and negative predictive values of presence of high-fluorescence were 78%, 64%, 64%, and 78%, respectively. For Pseudomonas aeruginosa detection, these results were 100%, 70%, 44% and 100%, respectively. CONCLUSION The diagnostic accuracy of the bacterial fluorescence imaging device to detect relevant bacteria in burn wounds was moderate and the reliability was equal to standard swabbing. Further research in larger sample sizes and on the relevance of minimal bacterial load and its potential to help with Pseudomonas aeruginosa management is needed.
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Affiliation(s)
- Anouk Pijpe
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands
| | - Yildiz Ozdemir
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands
| | - Jan C Sinnige
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands.,Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Kelly A A Kwa
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands.,Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Middelkoop
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands.,Association of Dutch Burn Centers, Beverwijk, the Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Annebeth Meij-de Vries
- Burn Center, Red Cross Hospital, PO Box 1074, 1940 EB, Beverwijk, the Netherlands.,Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
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Jones LM, Dunham D, Rennie MY, Kirman J, Lopez AJ, Keim KC, Little W, Gomez A, Bourke J, Ng H, DaCosta RS, Smith AC. In vitro detection of porphyrin-producing wound bacteria with real-time fluorescence imaging. Future Microbiol 2020; 15:319-332. [PMID: 32101035 DOI: 10.2217/fmb-2019-0279] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: Fluorescence imaging can visualize polymicrobial populations in chronic and acute wounds based on porphyrin fluorescence. We investigated the fluorescent properties of specific wound pathogens and the fluorescence detected from bacteria in biofilm. Methods: Utilizing Remel Porphyrin Test Agar, 32 bacterial and four yeast species were examined for red fluorescence under 405 nm violet light illumination. Polymicrobial biofilms, supplemented with δ-aminolevulinic acid, were investigated similarly. Results: A total of 28/32 bacteria, 1/4 yeast species and polymicrobial biofilms produced red fluorescence, in agreement with their known porphyrin production abilities. Conclusion: These results identify common wound pathogens capable of producing porphyrin-specific fluorescence and support clinical observations using fluorescence imaging to detect pathogenic bacteria in chronic wounds.
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Affiliation(s)
| | | | | | | | - Andrea J Lopez
- Department of Honors Studies, Texas Tech University, Lubbock, TX 79409, USA
| | - Klara C Keim
- Department of Honors Studies, Texas Tech University, Lubbock, TX 79409, USA
| | - William Little
- Department of Honors Studies, Texas Tech University, Lubbock, TX 79409, USA
| | - Andre Gomez
- Department of Honors Studies, Texas Tech University, Lubbock, TX 79409, USA
| | - Jessica Bourke
- Department of Microbiology, University Health Network/Sinai Health System, Toronto, ON, M5G 1X5, Canada
| | - Herman Ng
- Department of Microbiology, University Health Network/Sinai Health System, Toronto, ON, M5G 1X5, Canada
| | - Ralph S DaCosta
- MolecuLight Inc., Toronto, ON M5G 1T6, Canada.,Princess Margaret Cancer Center, University Health Network, Toronto, ON, M5G 2C1, Canada
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54
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Serena TE, Harrell K, Serena L, Yaakov RA. Real-time bacterial fluorescence imaging accurately identifies wounds with moderate-to-heavy bacterial burden. J Wound Care 2019; 28:346-357. [PMID: 31166857 DOI: 10.12968/jowc.2019.28.6.346] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Clinical evaluation of signs and symptoms (CSS) of infection is imperative to the diagnostic process. However, patients with heavily colonised and infected wounds are often asymptomatic, leading to poor diagnostic accuracy. Point-of-care fluorescence imaging rapidly provides information on the presence and location of bacteria. This clinical trial (#NCT03540004) aimed to evaluate diagnostic accuracy when bacterial fluorescence imaging was used in combination with CSS for identifying wounds with moderate-to-heavy bacterial loads. METHODS Wounds were assessed by study clinicians using NERDS and STONEES CSS criteria to determine the presence or absence of moderate-to-heavy bacterial loads, after which the clinician prescribed and reported a detailed treatment plan. Only then were fluorescence images of the wound acquired, bacterial fluorescence determined to be present or absent and treatment plan adjusted if necessary. RESULTS We examined 17 VLUs/2 DFUs. Compared with CSS alone, use of bacterial fluorescence imaging in combination with CSS significantly improved sensitivity (22% versus 72%) and accuracy (26% versus 74%) for identifying wounds with moderate-to-heavy bacterial loads (≥104 CFU/g, p=0.002). Clinicians reported added value of fluorescence images in >90% of study wounds, including identification of wounds incorrectly diagnosed by CSS (47% of study wounds) and treatment plan modifications guided by fluorescence (73% of study wounds). Modifications included image-guided cleaning, treatment selection, debridement and antimicrobial stewardship. CONCLUSION Findings from this pilot study suggest that when used in combination with CSS, bacterial fluorescence may: (1) improve the diagnostic accuracy of identifying patients with wounds containing moderate-to-heavy bacterial loads and (2) guide more timely and appropriate treatment decisions at the point-of-care.
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Affiliation(s)
| | | | - Laura Serena
- SerenaGroup Research Foundation, Cambridge, MA US
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55
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Welling MM, Hensbergen AW, Bunschoten A, Velders AH, Scheper H, Smits WK, Roestenberg M, van Leeuwen FWB. Fluorescent imaging of bacterial infections and recent advances made with multimodal radiopharmaceuticals. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00322-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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56
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Atkin L, Bućko Z, Montero EC, Cutting K, Moffatt C, Probst A, Romanelli M, Schultz GS, Tettelbach W. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 2019; 23:S1-S50. [DOI: 10.12968/jowc.2019.28.sup3a.s1] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant. Mid Yorkshire NHS Trust/University of Huddersfield, England
| | - Zofia Bućko
- Head of Non-Healing Wounds Department, Centrum Medycznym HCP, Poznań, Poland
| | - Elena Conde Montero
- Specialist in Dermatology. Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Keith Cutting
- Clinical Research Consultant, Hertfordshire, Honorary, Tissue Viability Specialist, First Community Health and Care, Surrey, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, University of Nottingham, and Nurse Consultant, Derby Hospitals NHS Foundation Trust Lymphoedema Service, England
| | - Astrid Probst
- Advanced Nurse Practitioner Wound Care, Klinikum am Steinenberg/Ermstalklinik, Reutlingen, Germany
| | - Marco Romanelli
- President WUWHS, Associate Professor of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gregory S Schultz
- Researcher, Professor of Obstetrics and Gynaecology, University of Florida, Gainesville, Florida, US
| | - William Tettelbach
- Associate Chief Medical Officer, MiMedx, Georgia. Adjunct Assistant Professor, Duke University School of Medicine, Durham, North Carolina. Medical Director of Wound Care and Infection Prevention, Landmark Hospital, Salt Lake City, Utah, US
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57
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Rennie MY, Dunham D, Lindvere-Teene L, Raizman R, Hill R, Linden R. Understanding Real-Time Fluorescence Signals from Bacteria and Wound Tissues Observed with the MolecuLight i:X TM. Diagnostics (Basel) 2019; 9:E22. [PMID: 30813551 PMCID: PMC6468690 DOI: 10.3390/diagnostics9010022] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/16/2022] Open
Abstract
The persistent presence of pathogenic bacteria is one of the main obstacles to wound healing. Detection of wound bacteria relies on sampling methods, which delay confirmation by several days. However, a novel handheld fluorescence imaging device has recently enabled real-time detection of bacteria in wounds based on their intrinsic fluorescence characteristics, which differ from those of background tissues. This device illuminates the wound with violet (405 nm) light, causing tissues and bacteria to produce endogenous, characteristic fluorescence signals that are filtered and displayed on the device screen in real-time. The resulting images allow for rapid assessment and documentation of the presence, location, and extent of fluorescent bacteria at moderate-to-heavy loads. This information has been shown to assist in wound assessment and guide patient-specific treatment plans. However, proper image interpretation is essential to assessing this information. To properly identify regions of bacterial fluorescence, users must understand: (1) Fluorescence signals from tissues (e.g., wound tissues, tendon, bone) and fluids (e.g., blood, pus); (2) fluorescence signals from bacteria (red or cyan); (3) the rationale for varying hues of both tissue and bacterial fluorescence; (4) image artifacts that can occur; and (5) some potentially confounding signals from non-biological materials (e.g., fluorescent cleansing solutions). Therefore, this tutorial provides clinicians with a rationale for identifying common wound fluorescence characteristics. Clinical examples are intended to help clinicians with image interpretation-with a focus on image artifacts and potential confounders of image interpretation-and suggestions of how to overcome such challenges when imaging wounds in clinical practice.
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Affiliation(s)
| | | | | | - Rose Raizman
- Department of Professional Practice, Scarborough and Rouge Hospital, Toronto, ON M1E 4B9, Canada.
| | - Rosemary Hill
- Department of Ambulatory Care, Lions Gate Hospital, Vancouver Coastal Health, North Vancouver, BC V7L 2L7, Canada.
| | - Ron Linden
- Judy Dan Research and Treatment Centre, North York, ON M2R 1N5, Canada.
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Woodmansey EJ, Roberts CD. Appropriate use of dressings containing nanocrystalline silver to support antimicrobial stewardship in wounds. Int Wound J 2018; 15:1025-1032. [PMID: 30117675 PMCID: PMC7949668 DOI: 10.1111/iwj.12969] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/18/2018] [Accepted: 06/24/2018] [Indexed: 12/16/2022] Open
Abstract
Antimicrobial resistance is an ever-increasing global concern, with the era of untreatable infection becoming a reality. Wound care is no exception, with increasing issues of antibiotic-resistant infections across different wound types and care settings. Antibiotic resistance and stewardship have been the priority for most strategic interventions so far; however, in wound care, alternative or supplementary strategies using antiseptics should be considered. Antiseptics such as silver can provide effective cidal activity across a broad range of wound pathogens, assuming they are used at the correct level for an appropriate duration. Evidence summarised in this manuscript suggests that effective antiseptics, such as nanocrystalline silver, have an increasing body of evidence in support of their use to minimise transmission of antibiotic-resistant organisms as part of institutional infection control procedures and, in addition, through appropriate early use and stewardship on local wound infections, in conjunction with local procedures, to minimise the need for systemic antibiotic therapy. Engagement, alignment, and collaboration between wound care professionals and wider related teams and governments on antimicrobial stewardship, and the potential role of antiseptics within this, will help to generate further evidence for such interventions in the fight against antimicrobial-resistant infections in wound care.
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Affiliation(s)
- Emma J. Woodmansey
- Clinical Scientific and Medical AffairsSmith & Nephew Advanced Wound ManagementHullUK
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59
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Ousey K, Chadwick P, Jawień A, Tariq G, Nair HKR, Lázaro-Martínez JL, Sandy-Hodgetts K, Alves P, Wu S, Moore Z, Pokorná A, Polak A, Armstrong D, Sanada H, Hong JP, Atkin L, Santamaria N, Tehan P, Lobmann R, Fronzo C, Webb R. Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives. J Wound Care 2018; 27:S1-S52. [DOI: 10.12968/jowc.2018.27.sup5.s1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Arkadiusz Jawień
- Collegium Medicum, University of Nicolaus Copernicus, Bydgoszcz, Poland
| | - Gulnaz Tariq
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | | | | | - Paulo Alves
- Institute of Health Sciences, Catholic University of Portugal, Portugal
| | - Stephanie Wu
- Dr William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, United States
| | - Zena Moore
- Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | | | - Anna Polak
- Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | - David Armstrong
- Keck School of Medicine of University of Southern California, United States
| | | | - Joon Pio Hong
- Asan Medical Centre, University of Ulsan, South Korea
| | | | - Nick Santamaria
- University of Melbourne and Royal Melbourne Hospital, New South Wales, Australia
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60
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Blumenthal E, Jeffery S. Autofluorescence Imaging for Evaluating Debridement in Military and Trauma Wounds. Mil Med 2018; 183:429-432. [DOI: 10.1093/milmed/usx145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/22/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Emily Blumenthal
- University College London, Division of Surgery & Interventional Science, Gower Street, Bloomsbury, London, WC1E 6BT, UK
| | - Steven Jeffery
- Birmingham Burn Centre, The Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK
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Blackshaw EL, Jeffery SL. Efficacy of an imaging device at identifying the presence of bacteria in wounds at a plastic surgery outpatients clinic. J Wound Care 2018; 27:20-26. [DOI: 10.12968/jowc.2018.27.1.20] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Steven L.A. Jeffery
- Consultant Plastic Surgeon; University of Birmingham, Birmingham, UK; Queen Elizabeth Hospital, Birmingham, UK
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