Point-of-care fluorescence imaging predicts the presence of pathogenic bacteria in wounds: a clinical study
Point-of-care fluorescence imaging predicts the presence of pathogenic bacteria in wounds: a clinical study
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DOI：
10.12968/jowc.2017.26.8.452
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发表时间：
2017-08-01
影响因子：
1.9
通讯作者：
Linden, R.
中科院分区：
文献类型：
--
作者：
Rennie, M. Y.;Lindvere-Teene, L.;Linden, R.
目的：慢性创面中的细菌是肉眼看不见的，会导致创面延迟愈合。护理点细菌荧光成像用405 nm的光照射伤口，引发细菌产生红色荧光，并实现实时细菌定位。前瞻性、单盲临床试验(临床试验。GOV#NCT02682069，#NCT03091361)，确定这种红色荧光对慢性创面细菌检测的阳性预测值(PPV)。分别采用活组织检查或刮宫的方法对红色荧光阳性区域进行采样，将红色荧光信号与细菌的存在进行相关性分析，并分别采用金标准定量聚合酶链式反应(QPCR)和半定量培养法进行分析。结果：共获得60个小腿慢性创面的图像。从红色荧光区域获得的伤口组织活检的定量PCR分析产生了100%的PPV。这些区域的细菌总数为>；=104cfu/g。对红色荧光区域的刮除刮片进行半定量培养分析，PPV为100%，主要为中等或重度细菌生长。共检出9种不同的细菌，均为慢性创面常见病原菌。结论：细菌荧光图像引导下的刮除或活检采样可积极预测创面细菌存在的潜在有害程度，完全消除了假阴性采样的风险。伤口的荧光成像为临床医生提供了关于伤口细菌负荷的实时信息，洞察可以影响护理点的治疗决定。
Objective: Bacteria in chronic wounds are invisible to the naked eye and can lead to delayed wound healing. Point-of-care bacterial fluorescence imaging illuminates a wound with 405nm light, triggering bacteria to produce red fluorescence and enabling real-time bacterial localisation. Prospective, single-blind clinical trials (clinicaltrials. gov #NCT02682069, #NCT03091361) were conducted to determine the positive predictive value (PPV) of this red fluorescence for detecting bacteria in chronic wounds.Method: Lower limb chronic wounds were imaged for bacterial fluorescence using the MolecuLight i:X imaging device. Regions positive for red fluorescence were discretely sampled using either biopsy or curettage to correlate red fluorescence signals to bacterial presence and analysed via gold standard quantitative polymerase chain reaction (qPCR) or via semi-quantitative culture analysis respectively.Results: A total of 60 lower limb chronic wounds were imaged. Quantitative PCR analysis of wound tissue biopsies obtained from regions of red fluorescence yielded a PPV of 100%. Total bacterial load in these areas was >= 104 CFU/g. Semi-quantitative culture analysis of curettage scrapings from regions of red fluorescence yielded a PPV of 100%, with predominately moderate or heavy bacterial growth. There were nine distinct bacterial species detected, all common pathogens in chronic wounds. Staphylococcus aureus was the most prevalent species.Conclusion: Bacterial fluorescence image-guided curettage or biopsy sampling positively predicts bacterial presence in wounds at potentially harmful levels, entirely eliminating the risk of false negative sampling. Fluorescence imaging of wounds offers clinicians real-time information on a wound's bacterial burden, insight which can influence treatment decisions at the point-of care.