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Diagnostics
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The Rise of Diagnostics in the Treatment of Chronic Wounds
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The Rise of Diagnostics in the Treatment of Chronic Wounds

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 April 2021) | Viewed by 33173

Special Issue Editor

Dr. Thomas E. Serena

E-Mail Website
Guest Editor
SerenaGroup Research Foundation, Cambridge, MA, USA
Interests: chronic wound; diabetic foot ulcer; venous leg ulcer; bacterial burden; pressure ulcer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The specialty of chronic wound care, “woundology,” developed in the absence of diagnostics. The recent rise in diagnostic imaging techniques and biomarker detection will revolutionize the practice of wound care. Point-of-care techniques that identify bacterial virulence factors are under study. In addition, fluorescence imaging can detect bacterial load at the bedside. Devices that rapidly evaluate tissue oxygenation and perfusion will also play a role in the evaluating the chronic wound. This issue presents new research and reviews the evidence for diagnostics in the burgeoning field of wound healing.

Dr. Thomas E. Serena
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (5 papers)

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Research

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12 pages, 24703 KiB  
Article
Are Semi-Quantitative Clinical Cultures Inadequate? Comparison to Quantitative Analysis of 1053 Bacterial Isolates from 350 Wounds
by Thomas E. Serena, Philip G. Bowler, Gregory S. Schultz, Anna D’souza and Monique Y. Rennie
Diagnostics 2021, 11(7), 1239; https://doi.org/10.3390/diagnostics11071239 - 12 Jul 2021
Cited by 15 | Viewed by 7017
Abstract
Early awareness and management of bacterial burden and biofilm is essential to wound healing. Semi-quantitative analysis of swab or biopsy samples is a relatively simple method for measuring wound microbial load. The accuracy of semi-quantitative culture analysis was compared to ‘gold standard’ quantitative [...] Read more.
Early awareness and management of bacterial burden and biofilm is essential to wound healing. Semi-quantitative analysis of swab or biopsy samples is a relatively simple method for measuring wound microbial load. The accuracy of semi-quantitative culture analysis was compared to ‘gold standard’ quantitative culture analysis using 428 tissue biopsies from 350 chronic wounds. Semi-quantitative results, obtained by serial dilution of biopsy homogenates streaked onto culture plates divided into 4 quadrants representing occasional, light, moderate, and heavy growth, were compared to total bacterial load quantified as colony-forming units per gram (CFU/g). Light growth, typically considered an insignificant finding, averaged a clinically significant 2.5 × 105 CFU/g (SE = 6.3 × 104 CFU/g). Occasional growth (range: 102–106 CFU/g) and light growth (103–107 CFU/g) corresponded to quantitative values that spanned a 5-log range; moderate and heavy growth corresponded to a range of 4-log and 6-log, respectively, with a high degree of overlap in range of CFU/g per category. Since tissue biopsy and quantitative culture cannot be widely practiced and semi-quantitative analysis is unreliable, other clinically relevant approaches are required to determine wound bioburden and guide best management practices. Fluorescence imaging is a point-of-care technology that offers great potential in this field. Full article
(This article belongs to the Special Issue The Rise of Diagnostics in the Treatment of Chronic Wounds)
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14 pages, 2953 KiB  
Article
Rapid Diagnosis of Pseudomonas aeruginosa in Wounds with Point-Of-Care Fluorescence Imaing
by Rose Raizman, William Little and Allie Clinton Smith
Diagnostics 2021, 11(2), 280; https://doi.org/10.3390/diagnostics11020280 - 11 Feb 2021
Cited by 35 | Viewed by 7755
Abstract
Pseudomonas aeruginosa (PA) is a common bacterial pathogen in chronic wounds known for its propensity to form biofilms and evade conventional treatment methods. Early detection of PA in wounds is critical to the mitigation of more severe wound outcomes. Point-of-care bacterial fluorescence imaging [...] Read more.
Pseudomonas aeruginosa (PA) is a common bacterial pathogen in chronic wounds known for its propensity to form biofilms and evade conventional treatment methods. Early detection of PA in wounds is critical to the mitigation of more severe wound outcomes. Point-of-care bacterial fluorescence imaging illuminates wounds with safe, violet light, triggering the production of cyan fluorescence from PA. A prospective single blind clinical study was conducted to determine the positive predictive value (PPV) of cyan fluorescence for the detection of PA in wounds. Bacterial fluorescence using the MolecuLight i:X imaging device revealed cyan fluorescence signal in 28 chronic wounds, including venous leg ulcers, surgical wounds, diabetic foot ulcers and other wound types. To correlate the cyan signal to the presence of PA, wound regions positive for cyan fluorescence were sampled via curettage. A semi-quantitative culture analysis of curettage samples confirmed the presence of PA in 26/28 wounds, resulting in a PPV of 92.9%. The bacterial load of PA from cyan-positive regions ranged from light to heavy. Less than 20% of wounds that were positive for PA exhibited the classic symptoms of PA infection. These findings suggest that cyan detected on fluorescence images can be used to reliably predict bacteria, specifically PA at the point-of-care. Full article
(This article belongs to the Special Issue The Rise of Diagnostics in the Treatment of Chronic Wounds)
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11 pages, 1382 KiB  
Article
Routine Fluorescence Imaging to Detect Wound Bacteria Reduces Antibiotic Use and Antimicrobial Dressing Expenditure While Improving Healing Rates: Retrospective Analysis of 229 Foot Ulcers
by Nadine Price
Diagnostics 2020, 10(11), 927; https://doi.org/10.3390/diagnostics10110927 - 10 Nov 2020
Cited by 22 | Viewed by 5002
Abstract
Foot ulcers and their bacterial burden produce a significant strain on the National Healthcare System (NHS). Subjectivity of wound infection assessment makes appropriate dressing selection challenging. To aid point-of-care detection of bacterial burden, a fluorescence imaging device (MolecuLight i:X) was introduced to the [...] Read more.
Foot ulcers and their bacterial burden produce a significant strain on the National Healthcare System (NHS). Subjectivity of wound infection assessment makes appropriate dressing selection challenging. To aid point-of-care detection of bacterial burden, a fluorescence imaging device (MolecuLight i:X) was introduced to the Whipps Cross Hospital Podiatry clinic. This retrospective pre/post-analysis evaluated how implementation of fluorescence imaging impacted (1) antimicrobial dressings and antibiotics use and (2) wound healing rates. Over a 2-year period 229 lower extremity wounds were treated. Wound-related outcomes and antimicrobial dressing costs were quantified over 1-year before (2018/2019) and after (2019/2020) incorporating fluorescence imaging into routine practice. The period of fluorescence imaging saw a 27% increase in the number of wounds seen, yet annual antimicrobial dressing expenditure decreased by 33%. Implementation of fluorescence imaging was also associated with a 49% decrease in prescription of antimicrobial dressings, a 33% decrease in antibiotic prescriptions, and a 23% increase in wound healing rates within 12-weeks (48% vs. 39%), likely due to earlier bacterial detection and improved wound hygiene. This increased healing rate is projected to decrease annual wound costs by 10% (£762 per patient). Routine bacterial imaging appears to diminish clinical and economic burden to patients and the NHS. Full article
(This article belongs to the Special Issue The Rise of Diagnostics in the Treatment of Chronic Wounds)
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Review

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18 pages, 27649 KiB  
Review
Diagnosing Burn Wounds Infection: The Practice Gap & Advances with MolecuLight Bacterial Imaging
by Nawras Farhan and Steven Jeffery
Diagnostics 2021, 11(2), 268; https://doi.org/10.3390/diagnostics11020268 - 09 Feb 2021
Cited by 20 | Viewed by 7449
Abstract
Burn injuries constitute a critical economic burden on healthcare infrastructures worldwide. They are often associated with high mortality rates due to severe complications. Infection is the most common complication, highlighting the importance of prompt and precise diagnosis in order to prevent detrimental consequences [...] Read more.
Burn injuries constitute a critical economic burden on healthcare infrastructures worldwide. They are often associated with high mortality rates due to severe complications. Infection is the most common complication, highlighting the importance of prompt and precise diagnosis in order to prevent detrimental consequences and to optimize patient outcomes. Here we examine the current standard of care for diagnosing infection in both burn and chronic wounds followed by an investigation into the research surrounding a relatively new technique for bacterial detection, fluorescence imaging. With five years of published research on bacterial fluorescence imaging (MolecuLight i:X device), we have summarized and analysed the validity of the procedure and compared it to the current standard of care; clinical assessment and microbiological analysis. We highlight the benefits that could be obtained through the use of this technology as well as the limitations and the feasibility of incorporating this novel procedure into the standard of care. Full article
(This article belongs to the Special Issue The Rise of Diagnostics in the Treatment of Chronic Wounds)
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Other

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9 pages, 2186 KiB  
Case Report
Bacterial Autofluorescence Digital Imaging Guides Treatment in Stage 4 Pelvic Pressure Injuries: A Preliminary Case Series
by James B. Stiehl
Diagnostics 2021, 11(5), 839; https://doi.org/10.3390/diagnostics11050839 - 07 May 2021
Cited by 3 | Viewed by 4222
Abstract
Pelvic pressure injuries in long-term care facilities are at high risk for undetected infection and complications from bacterial contamination and stalling of wound healing. Contemporary wound healing methods must address this problem with mechanical debridement, wound irrigation, and balanced dressings that reduce bacterial [...] Read more.
Pelvic pressure injuries in long-term care facilities are at high risk for undetected infection and complications from bacterial contamination and stalling of wound healing. Contemporary wound healing methods must address this problem with mechanical debridement, wound irrigation, and balanced dressings that reduce bacterial burden to enable the normal healing process. This study evaluated the impact of bacterial autofluorescence imaging to indicate wound bacterial contamination and guide treatment for severe stage 4 pelvic pressure injuries. A handheld digital imaging system was used to perform bacterial autofluorescence imaging in darkness on five elderly, high-risk, long-term care patients with advanced stage 4 pelvic pressure injuries who were being treated for significant bacterial contamination. The prescient findings of bacterial autofluorescence imaging instigated treatment strategies and enabled close monitoring of the treatment efficacy to ameliorate the bacterial contamination. Wound sepsis recurrence, adequate wound cleansing, and diagnosis of underlying periprosthetic total joint infection were confirmed with autofluorescence imaging showing regions of high bacterial load. By providing objective information at the point of care, imaging improved understanding of the bacterial infections and guided treatment strategies. Full article
(This article belongs to the Special Issue The Rise of Diagnostics in the Treatment of Chronic Wounds)
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