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

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.

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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

Advances in Wound Care ◽

10.1089/wound.2020.1272 ◽

2020 ◽

Cited By ~ 2

Author(s):

Lam Le ◽

Marc Baer ◽

Patrick Briggs ◽

Neal Bullock ◽

Windy Cole ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Fluorescence Imaging ◽

Point Of Care ◽

Bacterial Burden

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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 ◽

10.3390/diagnostics10110927 ◽

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.

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Rapid point-of-care (POC) testing for Hepatitis C antibodies in a very high prevalence setting: persons injecting drugs in Tallinn, Estonia

Harm Reduction Journal ◽

10.1186/s12954-021-00485-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Anneli Uusküla ◽

Ave Talu ◽

Jürgen Rannap ◽

David M. Barnes ◽

Don Des Jarlais

Keyword(s):

Hepatitis C ◽

Point Of Care ◽

Antibody Test ◽

Hcv Rna ◽

Test Results ◽

Blood Draw ◽

Persons Who Inject Drugs ◽

Oral Swab ◽

High Prevalence ◽

Hcv Antibody

Abstract Background Between December 2018 and January of 2019, we evaluated the accuracy of the point-of-care Hepatitis C (HCV) antibody test (POC; OraQuick HCV) used at a community-based needle and syringe exchange program serving persons who inject drugs in Tallinn, Estonia. Methods We compared the results of screening for HCV antibodies by OraQuick (oral swab) and enzyme immunoassay (EIA; blood draw) and assessed test results implications in a high prevalence setting. Findings Of the 100 participants, 88 (88%) had reactive POC test results, and 93 were HCV antibody positive on EIA testing. Sensitivity, specificity and negative predictive value (NPV) for the POC assay with EIA as the relevant reference test were as follows: 94.6% (95% CI 90.0–99.2%), 100% and 58.3% (95% CI 30.4–86.2%). Of the 12 testing, HCV-negative with the POC only 7 (58.3%) were true negatives. Conclusions Oral swab rapid testing HCV screening in this nonclinical setting was sensitive and specific but had unacceptably low NPV. In high prevalence settings, POC tests with high sensitivity and that directly measure HCV RNA may be warranted.

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Point-of-care Ratiometric Fluorescence Imaging of Tissue for the Diagnosis of Ovarian Cancer

Theranostics ◽

10.7150/thno.35322 ◽

2019 ◽

Vol 9 (16) ◽

pp. 4597-4607 ◽

Cited By ~ 5

Author(s):

Xiaobo Zhou ◽

Yawei Liu ◽

Qiyu Liu ◽

Luzhe Yan ◽

Meng Xue ◽

...

Keyword(s):

Ovarian Cancer ◽

Fluorescence Imaging ◽

Point Of Care ◽

Ratiometric Fluorescence

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

Journal of Burn Care & Research ◽

10.1093/jbcr/irz167 ◽

2019 ◽

Cited By ~ 1

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.

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Could point-of-care testing be effective for reducing the prevalence of trichomoniasis in remote Aboriginal communities?

Sexual Health ◽

10.1071/sh14035 ◽

2014 ◽

Vol 11 (4) ◽

pp. 370

Author(s):

Ben B. Hui ◽

James Ward ◽

Louise Causer ◽

Rebecca J. Guy ◽

Matthew G. Law ◽

...

Keyword(s):

Mathematical Modelling ◽

Older Women ◽

Point Of Care ◽

Indigenous Communities ◽

Treatment Programs ◽

Point Of Care Testing ◽

Aboriginal Communities ◽

Sexually Transmissible Infections ◽

High Prevalence ◽

The Impact

High prevalence of trichomoniasis is reported for many remote Indigenous communities despite intensive screening and treatment programs. Mathematical modelling has previously been used to show that point-of-care (POC) testing for gonorrhoea and chlamydia has the potential to increase the impact of screening in reducing the prevalence of these sexually transmissible infections. The study was extended to estimate the impact of a rapid POC test for trichomoniasis. The results suggest that POC testing in place of conventional testing will also provide additional reductions in trichomoniasis prevalence. However, more emphasis should be placed on testing for trichomoniasis in older women due to the high prevalence observed in this group.

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Rapid tests in the diagnostics of sexually transmitted infections

Journal of obstetrics and women s diseases ◽

10.17816/jowd64134-43 ◽

2015 ◽

Vol 64 (1) ◽

pp. 34-43

Author(s):

Olga Sergeyevna Ryzhkova

Keyword(s):

Sexually Transmitted Infections ◽

Point Of Care ◽

High Specificity ◽

Molecular Diagnostic ◽

Sexually Transmitted ◽

Highly Sensitive ◽

High Prevalence ◽

Microfluidic Biosensor ◽

Rapid Tests ◽

Diagnostic Technologies

High prevalence of sexually transmitted infections (STIs) and their substantial adverse effect on reproductive health of people necessitate the development of accurate and rapid tests for their diagnostics, in particular those that can be used at point-of-care (POC). The majority of current immunological POC-tests have high specificity; however, their sensitivity is mainly suboptimal. The future of POC-diagnostics of STIs - highly sensitive and specific, robust and affordable - is seen in the development and implementation of molecular diagnostic technologies (amplification, microfluidic, biosensor).

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SARS-CoV-2 antigen and antibody prevalence among UK staff working with cancer patients during the COVID-19 pandemic.

10.1101/2020.09.18.20197590 ◽

2020 ◽

Author(s):

David M Favara ◽

Karen McAdam ◽

Anthony Cooke ◽

Alex Bordessa-Kelly ◽

Ieva Budriunaite ◽

...

Keyword(s):

Cancer Patients ◽

Point Of Care ◽

Nasopharyngeal Swab ◽

Antibody Testing ◽

Antibody Prevalence ◽

Prevalence Trends ◽

Department Staff ◽

High Prevalence ◽

Staff Group ◽

Polymerase Chain

Background International guidelines for testing potentially immunosuppressed cancer patients receiving non-surgical anticancer therapies for SARS-CoV-2 (COVID-19) are currently lacking. The value of routinely testing staff treating cancer patients is not known. Methods: Patient-facing oncology department staff at work during the COVID-19 pandemic consented to have a nasopharyngeal swab SARS-CoV-2 antigen test by polymerase chain reaction (PCR) and blood tests for SARS-CoV-2 antibody using a laboratory Luminex-based assay and a rapid point-of-care (POC) assay on 2 occasions 28 days apart in June and July 2020. Results 434 participants were recruited: nurses (58.3%), doctors (21.2%), radiographers (10.4%) and administrators (10.1%). 82% were female; median age 40-years (range 19-66). 26.3% reported prior symptoms suggestive of SARS-CoV-2 infection and 1.4% tested PCR-positive prior to June 2020. All were PCR-negative at both study day 1 and 28. 18.4% were SARS-CoV-2 sero-positive on day 1 by Luminex, of whom 42.5% also tested positive by POC. 47.5% of Luminex sero-positives had antibodies to both nucleocapsid (N) and surface (S) antigens. Nurses (21.3%) and doctors (17.4%) had higher prevalence trends of Luminex sero-positivity compared with administrators (13.6%) and radiographers (8.9%) (p=0.2). 38% of sero-positive participants reported previous symptoms suggestive of SARS-CoV-2 infection, a 1.9-fold higher odds than sero-negative participants (p=0.01). 400 participants re-tested on day 28: 13.3% were Luminex sero-positive of whom 92.5% were previously positive and 7.5% newly positive. Nurses (16.5%) had the highest seroprevalence trend amongst staff groups (p=0.07). 32.5% of day 1 sero-positives became sero-negative by day 28: the majority being previously reactive to the N-antigen only (p<0.0001). Conclusion The high prevalence of SARS-CoV-2 IgG sero-positivity in oncology nurses, and the high decline of positivity over 4 weeks supports regular antigen and antibody testing in this staff group for SARS-CoV-2 as part of routine patient care prior to availability of a vaccine.

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Evaluation of iron intake in preschool children in a setting with high anemia burden

International Health ◽

10.1093/inthealth/ihz106 ◽

2020 ◽

Author(s):

Maria G Dunn ◽

Ryan M Close ◽

Steven G McKee ◽

Ramona Cordero ◽

Ingrid F Japa ◽

...

Keyword(s):

Point Of Care ◽

Cross Sectional Study ◽

Deficiency Anemia ◽

Iron Intake ◽

Cross Sectional ◽

Targeted Interventions ◽

Resource Limited ◽

High Prevalence ◽

Study Team ◽

Daily Allowance

Abstract Background Iron deficiency anemia affects millions of children worldwide. Iron intake assessments can inform targeted interventions. Methods This cross-sectional study describes diet and hemoglobin levels of children 1–5 y of age in a resource-limited setting in the Dominican Republic. The study team performed meal observations and measurements, dietary questionnaires, and point-of-care hemoglobin testing. Results Iron intake and bioavailability were low, with liberal estimates indicating that not more than 40% of subjects consumed the recommended daily allowance for iron. Forty of 80 children had anemia, with 23% demonstrating moderate or severe anemia. Conclusions Poor observed iron intake likely contributes to the high prevalence of anemia in this population.

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