DaCosta RS, Kulbatski I, Lindvere-Teene L Point-of-care autofluorescence imaging for real-time sampling and treatment guidance of bioburden in chronic wounds: first-in-human results. PloS one. 2015; 10:(3)

Guest JF, Ayoub N, McIlwraith T Health economic burden that different wound types impose on the UK's National Health Service. Int Wound J. 2017; 14:(2)322-330

Guest JF, Vowden K, Vowden P. The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. J Wound Care. 2017; 26:(6)292-303

Edwards R, Harding KG. Bacteria and wound healing. Curr Opin Infect Dis. 2004; 17:(2)91-96

Broughton G, Janis JE, Attinger CE. The basic science of wound healing. Plast Reconstr Surg. 2006; 117:12s-34s

Reddy M, Gill SS, Wu W Does this patient have an infection of a chronic wound?. JAMA. 2012; 307:(6)605-611

McGuckin M, Goldman R, Bolton L, Salcido R. The clinical relevance of microbiology in acute and chronic wounds. Adv Skin Wound Care. 2003; 16:(1)12-23

Copeland-Halperin LR, Kaminsky AJ, Bluefeld N, Miraliakbari R. Sample procurement for cultures of infected wounds: a systematic review. J Wound Care. 2016; 25:(4)4-6

Rondas AA, Schols JM, Halfens RJ, Stobberingh EE. Swab versus biopsy for the diagnosis of chronic infected wounds. Adv Skin Wound Care. 2013; 26:(5)211-219

Fenech M, Abela R, Chetcuti Zammit S Wound swab use and misuse at a regional general hospital. J Wound Care. 2014; 23:(12)634-642

Orenstein A, Klein D, Kopolovic J The use of porphyrins for eradication of Staphylococcus aureus in burn wound infections. FEMS Immunol Med Microbiol. 1997; 19:(4)307-314

Baird FJ, Wadsworth MP, Hill JE. Evaluation and optimization of multiple fluorophore analysis of a Pseudomonas aeruginosa biofilm. J Microbiol Methods. 2012; 90:(3)192-196

MolecuLight i:X imaging device user manual: MolecuLight Inc. 2016. (accessed 4 June 2019)

Blackshaw EL, Jeffery SLA. Efficacy of an imaging device at identifying the presence of bacteria in wounds at a plastic surgery outpatients clinic. J Wound Care. 2018; 27:(1)20-26

Wu YC, Smith M, Chu A Handheld fluorescence imaging device detects subclinical wound infection in an asymptomatic patient with chronic diabetic foot ulcer: a case report. Int Wound J. 2016; 13:(4)449-453

Aerden D, Bosmans I, Vanmierlo B Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab. J Wound Care. 2013; 22:(2)85-89

Blumenthal E, Jeffery S. The use of the MolecuLight i:X in managing burns: a pilot study. J Burn Care Res. 2018; 39:(1)154-161

Blumenthal E, Jeffery S. Autofluorescence imaging for evaluating debridement in military and trauma wounds. Mil Med. 2018; 183:429-432

Percival SL, Thomas J, Linton S The antimicrobial efficacy of silver on antibioticresistant bacteria isolated from burn wounds. Int Wound J. 2012; 9:(5)488-493

Biofilm-based efficacy of a bacterial fluorescence imaging device in an outpatient wound care clinic: a pilot study

02 September 2019
Volume 3 · Issue 4


Subsurface bacterial burden can be missed during standard wound examination protocols. The real-time bacterial fluorescence imaging device, MolecuLight i:X, visualises the presence of potentially harmful levels of bacteria through endogenous autofluorescence, without the need for contrast agents or contact with the patient. The intended use of the imaging device is to assist with the management of patients with wounds by enabling real-time visualisation of potentially harmful bacteria. The aim of this study was to establish the accuracy of the wound imaging device at detecting pathogenic bacteria in wounds.

A single-centre, prospective observational study was conducted in Cork University Hospital in an outpatient plastic surgery wound care clinic. Patients had their wounds photographed under white and autofluorescent light with the imaging device. Auto-fluorescent images were compared with the microbiological swab results. A total of 33 patients and 43 swabs were included, of which 95.3% (n=41) were positive for bacteria growth. Staphylococcus aureus was the most common bacterial species identified. The imaging device had a sensitivity of 100% and specificity of 78% at identifying pathological bacteria presence in wounds on fluorescent light imaging. The positive predictive value (PPV) was 95.4%. The negative predictive value (NPV) was 100%. It demonstrated a sensitivity and specificity of 100% at detecting the presence of Pseudomonas spp.

The imaging device used could be a safe, effective, accurate and easy-to-use autofluorescent device to improve the assessment of wounds in the outpatient clinic setting. In conjunction with best clinical practice, the device can be used to guide clinicians use of antibiotics and specialised dressings.

Acute and chronic wounds are a major burden to patients worldwide.1 The cost per annum of treating patients with non-healing wounds is increasing. However a growing volume of evidence demonstrates that strategies focusing on accurate diagnosis and improving wound healing rates is of benefit to patients and economically.2 The UK's National Health Service (NHS) annually manages an estimated 2.2 million patients with a wound, approximately 4.5% of the adult population.3

Wound infection is detrimental to wound healing, and the diagnosis of infection is controversial as it can vary between clinicians.4 Current practice in the outpatient setting for diagnosing wound infections is limited to clinical assessment of signs and symptoms of localised infection such as pain, heat, oedema, erythema, malodour, delayed healing and purulent exudate.5 However, wound healing may also be delayed in the absence of typical clinical features of infection. Subsurface bacterial burden can be missed during standard wound examination protocols and can be led by the clinician's level of experience of diagnosing wound infection.6 This can lead to wound chronicity and patient morbidity.

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month