References
Detection of bacteria in burn wounds with a novel handheld autofluorescence wound imaging device: a pilot study
Abstract
Objective:
To compare the detection of bacteria in burn wounds between an bacterial fluorescence imaging device MolecuLight i:X, (Canada), and standard microbiological swabs.
Methods:
Wounds were swabbed three times on one occasion; once with a standard swab, once with a high-fluorescent area swab, indicating a bacterial load >104 colony-forming units (CFU)/gram and a finally with a non-fluorescent (nF) area swab. Proportion agreement of the microbiological results was calculated and the accuracy of the device to detect relevant bacteria was assessed.
Results:
A total of 14 patients with 20 wounds participated in the study. Median post-burn day at sampling time was 21 days. Of the 20 wounds, nine had a positive swab result in either of the three swabs, and 11 showed a highfluorescent area. Overall, positive and negative proportion agreement between standard swab and high-fluorescent swab sample results were 100%. Sensitivity, specificity, positive and negative predictive values of presence of high-fluorescence were 78%, 64%, 64%, and 78%, respectively. For Pseudomonas aeruginosa detection, these results were 100%, 70%, 44% and 100%, respectively.
Conclusion:
The diagnostic accuracy of the bacterial fluorescence imaging device to detect relevant bacteria in burn wounds was moderate and the reliability was equal to standard swabbing. Further research in larger sample sizes and on the relevance of minimal bacterial load and its potential to help with Pseudomonas aeruginosa management is needed.
Colonisation and infection are major challenges in burn wound management. Due to the compromised barrier function of skin and altered humoral and cellular immunity in patients with burn wounds, the burn site is prone to bacterial growth.1,2,3 Colonisation and infection can disturb the healing process; it can infect viable tissue,1 cause septicaemia,2,4 reduce graft take,3,5 delay wound healing and prolong hospital admission.6
Practice in burn centres includes taking microbiological swab samples of burn wounds on a regular basis to detect colonisation and early infection.7,8 Prophylactic systemic antibiotics is not recommended.9 Initial treatment aims to prevent colonisation and infection and enhance wound healing by the application of silver-containing dressings and topical antimicrobials such as nitrofurazone and fusidic acid cream10 and is adjusted according to the microbiological test results. Thus, burn wound management is highly reliant on early detection of bacteria. However, swab sampling is subjective, results of swabbing tests generally take a few days and it is unknown to what extent clinically relevant bacteria are missed by the standard swabbing technique.
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