Imaging Beyond the Wound Bed: Leveraging Fluorescence Imaging of Non-Biologicals to Enhance Bacterial-Infection Management

Introduction: Chronic wounds frequently harbor asymptomatic bacterial load, which our group monitors with point-of-care fluorescence imaging*. Bacterial presence is not limited to the wound bed or periwound – bacteria frequently contaminate non-biological elements in contact with the wound (e.g., socks) or migrate underneath the wound bed via sinus tracts or tunnels. Bacteria in all forms and locations must be removed to put stalled wounds back on a healing trajectory and prevent escalation to overt infection and infection-associated complications.Methods:A 5-patient case series demonstrating a comprehensive approach to localized bacterial management used routinely in our practice, enabled by fluorescence imaging of non-biological elements. Each patient underwent non-contact bacterial fluorescence imaging* of their wound and any non-biological elements in contact with their wound, including dressings, wicks, socks, insoles/orthotics, and shoes. In cases where tunneling or undermining was suspected, the wound was probed with a sterile cotton-swab which was then scanned for bacterial fluorescence (i.e., C-swab test).Results: Bacterial signals from fluorescence scans were frequently detected on wound dressings and wicks, in diabetic shoes and socks, and on diabetic insoles/orthotics. Most patients were unaware of the extent of bacterial contamination on these items, and so we used the fluorescence images to educate them on the importance of regularly cleaning or changing these items. Deep bacterial presence in sinus tracts/tunnels was revealed using the C-swab test, prompting additional irrigation, debridement, wick selection, dressings, and on occasion, antibiotics. Negative C-swab tests helped avoid unnecessary interventions.Discussion: Fluorescence imaging was highly successful in alerting to bacterial presence on wound-associated non-biological items and in wound tunnels/sinus tracts via the C-swab test. This real-time information on covert bacterial presence enhanced treatment and proved to be a useful educational tool for our patients.References: