Use of a bacterial fluorescence imaging system to target wound debridement and accelerate healing: a pilot study

Abstract

Objective: Optimal wound-bed preparation consists of regular debridement to remove devitalised tissues, reduce bacterial load, and to establish an environment that promotes healing. However, lack of diagnostic information at point-of-care limits effectiveness of debridement. Method: This observational case series investigated use of point-of-care fluorescence imaging to detect bacteria (loads >104CFU/g) and guide wound bed preparation. Lower extremity hard-to-heal wounds were imaged over a 12-week period for bacterial fluorescence and wound area. Results: A total of 11 wounds were included in the study. Bacterial fluorescence was present in 10 wounds and persisted, on average, for 3.7 weeks over the course of the study. The presence of red or cyan fluorescent signatures from bacteria correlated with an average increase in wound area of 6.5% per week, indicating stalled or delayed wound healing. Fluorescence imaging information assisted in determining the location and extent of wound debridement, and the selection of dressings and/or antimicrobials. Elimination of bacterial fluorescence signature with targeted debridement and other treatments correlated with an average reduction in wound area of 27.7% per week (p<0.05), indicative of a healing trajectory. Conclusion: These results demonstrate that use of fluorescence imaging as part of routine wound care enhances assessment and treatment selection, thus facilitating improved wound healing.

Diagnostic Accuracy of Point-of-Care Fluorescence Imaging for the Detection of Bacterial Burden in Wounds: Results from the 350-Patient Fluorescence Imaging Assessment and Guidance Trial

“…The inclusion of FL as part of routine wound assessment provided information on bacterial burden that led to additional improvements in care: Guided wound bed preparation in ≥90% of wounds in this and other studies. 35 , 52 Information on location of bacterial burden at point of care has been shown to be highly impactful for debridement, 52 , 53 selection of appropriate cleanser, 30 and general wound bed preparation before application of advanced therapies. 30 Advanced therapies such as cellular and tissue-based products and skin grafts often fail when high bacterial loads are present.…”

“…Evidence from small longitudinal observational studies demonstrate accelerated wound area reduction with use of FL. 32 , 53 Due to the limited (1.5 mm) depth of excitation 36 and inability to detect non-porphyrin-producing bacteria, including species from the Streptococcus , Enterococcus , and Finegoldia generas (which account for an estimated 12% of the most prevalent wound pathogens 23 and rarely occur monomicrobially 69 ), it is recommended that FL be used in combination with CSS.…”

“…This represents a paradigm shift in wound assessment, in which clinicians now have immediate information on bacterial burden to guide treatment selection and inform the frequency of reassessment to determine the efficacy of selected treatments at point of care. 34 , 53 The point-of-care information provided by FL facilitates a rapid switch to a more effective bacterial-targeting agent ( e.g ., cleanser and bandage). 34 , 70 Study results, collected across 14 study sites from 20 clinicians of varying skill levels, indicate the widespread utility of FL to inform wound assessment, wound bed preparation, and overall treatment planning.…”

Rapid Diagnosis of Pseudomonas aeruginosa in Wounds with Point-Of-Care Fluorescence Imaing

“…Whether PA would ever express solely porphyrins, not pyoverdines, in a wound environment has, to our knowledge, not been studied. If this were to occur then red fluorescence would presumably be used to guide bacterial removal treatments, as it does for other pathogens [ 27 , 45 , 67 ]. Given the association between pyoverdine production and PA virulence [ 36 , 37 , 38 , 39 ], detection of wounds in which PA is expressing this virulence factor has large clinical relevance.…”

Diagnosing Burn Wounds Infection: The Practice Gap & Advances with MolecuLight Bacterial Imaging

“…Studies have specifically shown that fluorescence imaging can change treatment plans, in one study in as many as 73% of cases [ 7 , 36 ]. Even more encouraging is that the use of fluorescence imaging to inform the location and extent of debridement to target bacterial habitation in recalcitrant wounds has been shown to increase healing rates [ 71 ], which is the ultimate goal for most wound care. Other groups illustrated that the overall 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 [ 72 ] or healed more wounds altogether [ 73 ].…”