Real-Time Autofluorescence Imaging to Diagnose LVAD Driveline Infections

Abstract

A 64-year-old man experienced a driveline infection that was treated with serial debridements and antibiotics. When the wound clinically appeared ready for closure, a handheld fluorescence imaging device still revealed a margin of red fluorescence around the wound edges consistent with a subclinical infection. Therefore, a wider margin was made and additional specimens for wound culture were taken, which demonstrated a vancomycin-resistant enterococcal infection. The autofluorescence signals of common bacteria can be detected with a fluorescence camera in subclinical wound infections without clinical signs. Here we describe the first use of this technology to diagnose ventricular assist device driveline infections after left ventricular assist device implantation.

Fluorescence imaging guided dressing change frequency during negative pressure wound therapy: a case series

“…These 10 cases cannot be used to generalise findings, but they do serve to demonstrate the clinical usefulness of handheld fluorescence imaging in wound care, supporting previous studies. [16][17][18][20][21][22][23][24][25] These cases also demonstrate, for the first time, how fluorescence imaging of wounds can be used in conjunction with NPWT to guide treatment decisions including timing of dressing changes, treatment selection, and wound cleaning specifically targeted to regions of bioburden.…”

“…[16][17][18][19] The clinical use of the bacterial fluorescence imaging device has previously been established for chronic wounds, 16,18,20,21 burn and trauma wounds 22,23 and surgical wounds. 24,25 However, its specific usage in conjunction with NPWT has not been described. This case series reports the use of bacterial fluorescence imaging in conjunction with routine wound assessments for clinical signs and symptoms of infection.…”

Over 870 days of successful antibiotic suppression therapy for VRE‐infected left ventricular assist device

“…This is the first report of successful antimicrobial suppression for a VRE pump pocket infection, and vancomycin‐resistant Enterococcus spp are rarely reported as the causes of LVAD infections 5‐7 . This comes as a surprise given that one retrospective study found a high percentage (34.1%) of LVAD recipients to be colonized with multidrug‐resistant bacteria, and VRE was amongst the most commonly identified 6 .…”

“…This is the first report of successful antimicrobial suppression for a VRE pump pocket infection, and vancomycin-resistant Enterococcus spp are rarely reported as the causes of LVAD infections. [5][6][7] This comes as a surprise given that one retrospective study found a high percentage (34.1%) of LVAD recipients to be colonized with multidrug-resistant bacteria, and VRE was amongst the most commonly identified. 6 The importance of these infections is reflected by a separate study which supported VRE infections as notable causes of morbidity and mortality in the posttransplant setting for patients with prior LVAD infections.…”

Visualisierung von Bakterien auf Verbrennungswunden und Spalthauttransplantaten nach der MEEK/MESH-Technik – Eine Pilotstudie mit ersten Erfahrungen der klinischen Wundbeurteilung durch Autofluoreszenz

“…Die Bildgebung der Autofluoreszenz von Wunden stellt dabei eine sichere nicht invasive Methode zur Vi- Es erlaubt eine Differenzierung der Wundfläche mit Visualisierung der Bakterienbesiedlung durch farbliche Darstellung. Bisherige Untersuchungen konnten die Vorteile der Autofluoreszenz sowohl bei der Wundheilung im Tiermodell [25] als auch bei subklinischen Infektionen am Menschen aufzeigen [26]. Die konventionelle Definition von Bakterienart und -dichte mittels mikrobiologischen Untersuchungen (Biopsie, Abstrich) erlaubt eine antibiotische Resistenzbestimmung bzw.…”