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Point-of-care autofluorescence imaging for real-time sampling and treatment guidance of bioburden in chronic wounds: first-in-human results.


ABSTRACT:

Background

Traditionally, chronic wound infection is diagnosed by visual inspection under white light and microbiological sampling, which are subjective and suboptimal, respectively, thereby delaying diagnosis and treatment. To address this, we developed a novel handheld, fluorescence imaging device (PRODIGI) that enables non-contact, real-time, high-resolution visualization and differentiation of key pathogenic bacteria through their endogenous autofluorescence, as well as connective tissues in wounds.

Methods and findings

This was a two-part Phase I, single center, non-randomized trial of chronic wound patients (male and female, ?18 years; UHN REB #09-0015-A for part 1; UHN REB #12-5003 for part 2; clinicaltrials.gov Identifier: NCT01378728 for part 1 and NCT01651845 for part 2). Part 1 (28 patients; 54% diabetic foot ulcers, 46% non-diabetic wounds) established the feasibility of autofluorescence imaging to accurately guide wound sampling, validated against blinded, gold standard swab-based microbiology. Part 2 (12 patients; 83.3% diabetic foot ulcers, 16.7% non-diabetic wounds) established the feasibility of autofluorescence imaging to guide wound treatment and quantitatively assess treatment response. We showed that PRODIGI can be used to guide and improve microbiological sampling and debridement of wounds in situ, enabling diagnosis, treatment guidance and response assessment in patients with chronic wounds. PRODIGI is safe, easy to use and integrates into the clinical workflow. Clinically significant bacterial burden can be detected in seconds, quantitatively tracked over days-to-months and their biodistribution mapped within the wound bed, periphery, and other remote areas.

Conclusions

PRODIGI represents a technological advancement in wound sampling and treatment guidance for clinical wound care at the point-of-care.

Trial registration

ClinicalTrials.gov NCT01651845; ClinicalTrials.gov NCT01378728.

SUBMITTER: DaCosta RS 

PROVIDER: S-EPMC4366392 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Publications

Point-of-care autofluorescence imaging for real-time sampling and treatment guidance of bioburden in chronic wounds: first-in-human results.

DaCosta Ralph S RS   Kulbatski Iris I   Lindvere-Teene Liis L   Starr Danielle D   Blackmore Kristina K   Silver Jason I JI   Opoku Julie J   Wu Yichao Charlie YC   Medeiros Philip J PJ   Xu Wei W   Xu Lizhen L   Wilson Brian C BC   Rosen Cheryl C   Linden Ron R  

PloS one 20150319 3


<h4>Background</h4>Traditionally, chronic wound infection is diagnosed by visual inspection under white light and microbiological sampling, which are subjective and suboptimal, respectively, thereby delaying diagnosis and treatment. To address this, we developed a novel handheld, fluorescence imaging device (PRODIGI) that enables non-contact, real-time, high-resolution visualization and differentiation of key pathogenic bacteria through their endogenous autofluorescence, as well as connective ti  ...[more]

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