Practice Innovations
The presence of high bacterial loads in chronic wounds increases the risk of complications, such as infection and hospitalization, and inhibits healing processes. Healing outcomes are shown to improve when more bacteria are removed through hygiene, biofilm disruption, more frequent debridement, and more aggressive debridement methods. Point-of-care fluorescence imaging information on wound bacterial location(s) and load can inform treatment decisions, including the need for more extensive or expansive debridement. This retrospective study evaluates the prevalence of elevated bacterial presence in wounds across 36 states and the impact of that location and load information on treatment plans in a real-world setting.
Methods:
Retrospective analysis was performed on single time-point data from 1000 chronic wounds (DFUs, VLUs, PIs, surgical wounds, burns, and others) assessed by clinicians (including MD, DPM, DO, PT, & NP) at 211 facilities across 36 states. These data represent real-world scenarios as no exclusion criteria were applied. Clinicians described the proposed treatment plans before and after fluorescence imaging of each wound for bacteria (loads >104 CFU/g); signs and symptoms of infection, fluorescence imaging findings, and treatment plan changes were recorded, when applicable.
Results:
After observing the illumination of high levels of bacteria in wounds via fluorescence imaging, clinicians changed their treatment plans for 528 wounds (53%). Fluorescence indicating bacterial loads was observed in 711 wounds (72%): most common Gram-positive and Gram-negative species (red fluorescence; 55%), Pseudomonas aeruginosa (cyan fluorescence; 7%), or both (10%). Owing to fluorescence imaging findings, clinicians added targeted and/or more extensive debridement to the treatment plans for 311 wounds (31%). Further, 61 wounds were sampled as a direct result of fluorescence image findings; no sampling was planned for any wounds pre-fluorescence imaging.
Discussion:
These real-world findings of bacterial load prevalence in chronic wounds, and of the high percentage of treatment plan changes post-imaging (53%), mirror clinical trial findings on this technology [1]. These data, from a range of wound types, clinician skill sets, and spanning 36 states, suggest that incorporation of fluorescence imaging is likely to improve bacterial-infection management through treatment adjustments including hygiene/debridement, dressing selection, sampling, and other treatments impacted by the presence of bacterial loads.
Trademarked Items: *MolecuLight
References: [1] Le, L. et al. 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. Adv Wound Care (New Rochelle) 10, 123-136, doi:10.1089/wound.2020.1272 (2021).