scholarly journals Routine Fluorescence Imaging to Detect Wound Bacteria Reduces Antibiotic Use and Antimicrobial Dressing Expenditure While Improving Healing Rates: Retrospective Analysis of 229 Foot Ulcers

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 927
Author(s):  
Nadine Price
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Foot Ulcers ◽  
Routine Practice ◽  
Bacterial Burden ◽  
Imaging Device ◽  
Antibiotics Use ◽  
Point Of Care Detection

Foot ulcers and their bacterial burden produce a significant strain on the National Healthcare System (NHS). Subjectivity of wound infection assessment makes appropriate dressing selection challenging. To aid point-of-care detection of bacterial burden, a fluorescence imaging device (MolecuLight i:X) was introduced to the Whipps Cross Hospital Podiatry clinic. This retrospective pre/post-analysis evaluated how implementation of fluorescence imaging impacted (1) antimicrobial dressings and antibiotics use and (2) wound healing rates. Over a 2-year period 229 lower extremity wounds were treated. Wound-related outcomes and antimicrobial dressing costs were quantified over 1-year before (2018/2019) and after (2019/2020) incorporating fluorescence imaging into routine practice. The period of fluorescence imaging saw a 27% increase in the number of wounds seen, yet annual antimicrobial dressing expenditure decreased by 33%. Implementation of fluorescence imaging was also associated with a 49% decrease in prescription of antimicrobial dressings, a 33% decrease in antibiotic prescriptions, and a 23% increase in wound healing rates within 12-weeks (48% vs. 39%), likely due to earlier bacterial detection and improved wound hygiene. This increased healing rate is projected to decrease annual wound costs by 10% (£762 per patient). Routine bacterial imaging appears to diminish clinical and economic burden to patients and the NHS.

scholarly journals Guidelines for Point-of-Care Fluorescence Imaging for Detection of Wound Bacterial Burden Based on Delphi Consensus

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1219
Author(s):  
Alisha R. Oropallo ◽  
Charles Andersen ◽  
Raymond Abdo ◽  
Jenny Hurlow ◽  
Martha Kelso ◽  
...  
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Nurse Practitioners ◽  
Point Of Care ◽  
Clinical Signs ◽  
Care Providers ◽  
Bacterial Burden ◽  
Term Care ◽  
Assessment Protocol ◽  
Treatment Plans

Excessive levels of bacteria impede wound healing and can lead to infectious complications. Unfortunately, clinical signs and symptoms of elevated bacterial burden are often unreliable. As a result, point--of--care fluorescence imaging, used to detect critical bacterial burden in wounds, is becoming widely recognized and adopted by clinicians across the globe as an accepted and added component of wound assessment protocol. A Delphi method was employed to establish consensus guidelines describing fluorescence imaging use. A multidisciplinary panel of 32 wound experts (56% MD, 22% podiatrist, 12.5% nurses/nurse practitioners) representing multiple sites of service (e.g., hospital outpatient, inpatient, private office, long-term care) completed two rounds of online questionnaires. The Delphi included key topics, including competencies required to perform imaging, clinical indications for imaging (e.g., signs/symptoms present, procedures warranting imaging), frequency of imaging, and a clinical workflow algorithm. Describing their clinical experiences of imaging impact, >80% reported changes in treatment plans, 96% reported that imaging-informed treatment plans led to improved wound healing, 78% reported reduced rates of amputations, and 83% reported reduced rates of microbiological sampling. The guidelines provided here will help to standardize use of fluorescence imaging among wound care providers and enhance the quality of patient care.

Utility of MolecuLight i:X for Managing Bacterial Burden in Pediatric Burns

2019 ◽  
Author(s):  
Nawras Farhan ◽  
Steven Jeffery
Keyword(s):  
Fluorescence Imaging ◽  
Clinical Signs ◽  
Diagnostic Algorithm ◽  
Signs And Symptoms ◽  
Bacterial Burden ◽  
Burn Wound ◽  
Imaging Device ◽  
Burn Wounds ◽  
Clinical Signs And Symptoms ◽  
Clinically Significant

Abstract Pediatric burn injuries are vulnerable to severe complications, most often infection, making prompt and precise diagnosis of bacterial bioburden vital to preventing detrimental consequences and optimizing patients’ outcomes. Currently, burn wounds are assessed for infection via examining the clinical signs and symptoms of infection, which can be confirmed by swab culture analysis. While the former approach is subjective and experience-dependant, the latter technique is susceptible to missing subsurface, biofilm-associated colonization, and any peripheral bacterial burden, and also delays confirmation by up to 5 days. The MolecuLight i:X is a handheld, noncontact fluorescence imaging device, which can reveal real-time information about clinically significant levels of bacteria and their biodistribution in surface and subsurface burn wound tissues. We conducted a single-center observational study to assess the device efficacy in identifying critical bacterial levels in pediatric burn wounds and to test the children’s compliance and the overall feasibility of the device integration into the current diagnostic practice. Ten patients with 16 wounds were recruited and assessed for the presence or absence of clinical signs and symptoms of infection and the presence or absence of bacterial fluorescence on images, with swabs taken to confirm findings. Results demonstrate the device’s ability to visualize clinically significant bacterial burden and to localize distribution of pathogens. All clinicians agreed on the high compliance with the device and high feasibility of incorporating the device into routine wound assessments. The results of this study may pave the way toward including bacterial fluorescence imaging into the standard diagnostic algorithm for pediatric burn population.

scholarly journals Detection of bacterial fluorescence from in vivo wound biofilms using a point‐of‐care fluorescence imaging device

2021 ◽  
Author(s):  
Andrea J. Lopez ◽  
Laura M. Jones ◽  
Landrye Reynolds ◽  
Rachel C. Diaz ◽  
Isaiah K. George ◽  
...  
Keyword(s):  
Fluorescence Imaging ◽  
Point Of Care ◽  
Imaging Device ◽  
Wound Biofilms

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

2020 ◽  
Vol 29 (Sup7) ◽  
pp. S44-S52 ◽  
Author(s):  
Windy Cole ◽  
Stacey Coe
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Imaging System ◽  
Wound Care ◽  
Point Of Care ◽  
Bacterial Load ◽  
Case Series ◽  
Wound Area ◽  
Wound Debridement ◽  
Wound Bed Preparation

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.

scholarly journals Utility of a real-time fluorescence imaging device in guiding antibiotic treatment in superficial skin infections

2021 ◽  
Vol 0 ◽  
pp. 1-6
Author(s):  
Bhavika M. Shah ◽  
Devina Ganvir ◽  
Yugal K. Sharma ◽  
Shahzad Beg Mirza ◽  
R. N. Misra ◽  
...  
Keyword(s):  
Real Time ◽  
Fluorescence Imaging ◽  
Point Of Care ◽  
Fluorescent Imaging ◽  
Skin Infections ◽  
Imaging Device ◽  
Superficial Skin ◽  
Microbiological Testing ◽  
Infective Etiology

The prescription of antibiotics empirically without confirmation of an infective etiology is on the rise. Administration of appropriate antibiotics can be guided by real-time fluorescence imaging using a point-of-care device. These composite images show the presence, type and the burden of infection. The time saved by this method over microbiological testing, especially in resource-poor settings, can lead to a paradigm shift in treatment by facilitating prompt and adequate antimicrobial therapy, surgical debridement as well as follow-up. Thumbnail sketches of a series of four cases highlighting different scenarios in which a fluorescent imaging device utilizing artificial intelligence and machine learning was found useful is presented in this report.

scholarly journals Uncovering the high prevalence of bacterial burden in surgical site wounds with point‐of‐care fluorescence imaging

2021 ◽  
Author(s):  
Kylie Sandy‐Hodgetts ◽  
Charles A. Andersen ◽  
Omar Al‐Jalodi ◽  
Laura Serena ◽  
Christina Teimouri ◽  
...  
Keyword(s):  
Fluorescence Imaging ◽  
Point Of Care ◽  
Bacterial Burden ◽  
High Prevalence

Testing for resistance: Point-of-care testing as a communicational tool in antibiotic prescribing

2018 ◽  
Vol 14 (3) ◽  
pp. 229-240
Author(s):  
Johanna Lindell
Keyword(s):  
Point Of Care ◽  
Rapid Test ◽  
Antibiotic Use ◽  
Treatment Recommendation ◽  
Antibiotic Prescribing ◽  
Communicative Practices ◽  
Effective Strategies ◽  
Reactive Protein ◽  
Point Of Care Test ◽  
Test Result

As antibiotic resistance becomes a growing health emergency, effective strategies are needed to reduce inappropriate antibiotic use. In this article, one such strategy – communicative practices associated with the C-reactive protein point-of care test – is investigated. Building on a collection of 31 videorecorded consultations from Danish primary care, and using conversation analysis, this study finds that the rapid test can be used throughout the consultation to incrementally build the case for a nonantibiotic treatment recommendation, both when the test result is forecast and reported. The study also finds that the format of reports of elevated results differs from that of ‘normal’ results, resulting in a subtle shift of authority from doctor to test.

Assessment of parental knowledge, attitude and practice towards antibiotic use in children

2020 ◽  
Vol 10 (2) ◽  
pp. 25-41
Author(s):  
Thejaswini Karanth ◽  
Someswar Deb ◽  
Lal Ruatpuii Zadeng ◽  
Rajeswari Ramasamy ◽  
Teena Nazeem ◽  
...  
Keyword(s):  
Parental Knowledge ◽  
Antibiotic Use ◽  
Case Report Form ◽  
Standard Case ◽  
Attitude And Practice ◽  
Validated Questionnaire ◽  
Antibiotics Use ◽  
The Impact ◽  
Knowledge Attitude And Practice

Objective to assess the impact of pharmacist assisted counselling in improving Parental Knowledge, Attitude and Practice [KAP] towards antibiotic use in children. A Prospective, Educational Interventional Study was conducted in 200 subjects, from the randomly chosen communities in Bangalore. The investigators did door to door visit. The primary demographics data of parents and their children were collected using standard Case Report Form (CRF), and the baseline towards antibiotic use in Children was obtained from parents using validated Questionnaire. In the presence of both parents, only one was supposed to answer the Questionnaire. Pharmacist assisted parent centred interventional counselling was provided with the help of Patient Information Leaflet1s (PIL). Follow-up and post interventional KAP assessment were done after two months from the baseline measurement. The changes in parental KAP towards antibiotics use in children were being assessed by comparing the Pretest and Posttest responses using statistical analysis. The knowledge of parents towards antibiotic use in children was medium to good in the baseline KAP assessment; however, in the majority of the participating parents it was not satisfactory in attitude and practice domains. A statistically significant improvement was seen in the KAP of parents towards antibiotic use in children after the pharmacist assisted interventional counselling. Thus, Investigators could bring excellent changes in the knowledge part; whereas the result for changes in the Attitude and Practice was good to medium respectively.

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