Addressing Pressure Ulcer Bacteria: Impact of Fluorescence Imaging on Assessment and Treatment

Pressure ulcers (PUs) occur in up to 15% of inpatients1 and 37-53% of long-term care (LTC) residents2 and are plagued by infection. Many clinical signs and symptoms of infection (CSS) in PUs have little predictive value in diagnosing infection3, making care planning a challenge. We have therefore added non-invasive, point-of-care fluorescence imaging* (FL) to our standard of care assessment to detect the presence, load ( >104 CFU/g) and location of bacteria in wounds4,5. The impact of FL on care planning of PUs as part of a multicenter, prospective controlled clinical trial is reported here.

350 chronic wounds (22 PUs) across 14 clinical sites were assessed for CSS per guidelines6 and underwent FL by 20 clinicians to identify wounds with high bacterial burden. Quantitative analysis of wound biopsies confirmed total bacterial load (TBL). Clinicians were surveyed on the impact of FL information on wound assessment and treatment. A sub-analysis was performed to evaluate the impact of FL on PU care.

9% (2/22) PUs were identified as positive for bacteria based on CSS, while FL identified 68% (15/22) of PUs as positive for bacteria. Median bacterial load of all PUs was 1.0 x 106 CFU/g (range: 3.1 x 104 – 7.4 x 108 CFU/g). The most common bacterial species detected was Staphylococcus aureus. FL information changed clinician’s wound assessment in 59% (13/22) of PUs. Downstream aspects of wound care influenced by FL include guiding wound bed preparation (85% of PUs), sampling location (45%), debridement (48%), and informing treatment selection (55%).  

These findings demonstrate the utility of FL to enhance assessment, wound bed preparation and treatment selection of PUs. Use of FL in inpatient and LTC settings may facilitate more accurate diagnosis and more appropriate care planning of infected PUs.

Trademarked Items (if applicable): MolecuLight i:X

References (if applicable): 1. Nussbaum et al. Pharmacoeconomics Outcomes Res. (2018)
2. Davis et al. Wound Management and Prevention (2001)
3. Reddy et al. JAMA (2012)
4. Rennie et al. J Wound Care (2017)
5. Serena et al. J Wound Care (2019)
6. IWII Wound Infection Checklist (2016)