Lion's Gate Hospital, Vancouver Coastal Health, North Vancouver, British Columbia, Canada.
Queen's University, Kingston, Ontario, Canada.
Wounds. 2020 Nov;32(11):299-308.
The UPPER/LOWER infection checklists look for signs and symptoms of local/superficial infection (UPPER) and deep infection (LOWER) to assist clinicians in identifying and distinguishing between these infection levels, facilitating appropriate treatment. The presence of 3 or more UPPER or LOWER criteria is indicative of infection.
This study evaluated the utility of incorporating real-time bacterial fluorescence imaging into the UPPER/LOWER checklists to enhance identification of infection in wounds.
This prospective, multisite study assessed 43 chronic wounds. Infection was identified in 27 wounds (62.8%) according to the UPPER/LOWER checklist criteria; 3 wounds were positive for both UPPER and LOWER infection, 1 wound was positive for LOWER infection only, and 23 wounds were positive for UPPER infection only. Fluorescence images were taken to detect wounds with high bacterial loads (> 104 CFU/g), indicated by the presence of red or cyan fluorescence.
Red or cyan fluorescence from bacteria was observed in 88% of wounds (n = 38); all wounds positive for UPPER/LOWER were also positive for bacterial fluorescence. In 18 (41.9%) of the 43 wounds, fluorescence information added a third check to the UPPER/LOWER threshold, turning a negative diagnosis into a positive diagnosis of infection. Bacterial load was detected in 22/27 wounds swabbed, 17 of which exhibited heavy growth; in all wounds with detectable bacterial load, fluorescence signal was observed (positive predictive value = 100%, negative predictive value = 83%). Using microbiology as ground truth, inclusion of fluorescence information as an additional item in the checklists increased the sensitivity of the UPPER/LOWER checklist from 82% to 95%.
These results suggest that the UPPER/LOWER checklist and fluorescence imaging work in a complementary manner to effectively identify wounds with high bacterial burden at the point-of-care.
UPPER/LOWER 感染检查表旨在寻找局部/浅表感染（UPPER）和深部感染（LOWER）的迹象和症状，以帮助临床医生识别和区分这两种感染级别，从而提供适当的治疗。出现 3 个或更多 UPPER 或 LOWER 标准表明存在感染。
本研究评估了将实时细菌荧光成像纳入 UPPER/LOWER 检查表中以增强对伤口感染识别的效用。
本前瞻性、多中心研究评估了 43 例慢性伤口。根据 UPPER/LOWER 检查表标准，27 个伤口被确定为感染（62.8%）；3 个伤口 UPPER 和 LOWER 均呈阳性，1 个伤口仅呈 LOWER 感染阳性，23 个伤口仅呈 UPPER 感染阳性。荧光图像用于检测细菌负荷较高（>104 CFU/g）的伤口，表现为红色或青色荧光。
观察到 88%（n=38）的伤口存在来自细菌的红色或青色荧光；所有 UPPER/LOWER 阳性的伤口也呈细菌荧光阳性。在 43 个伤口中，18 个（41.9%）的荧光信息为 UPPER/LOWER 阈值增加了第三个检查，将阴性诊断转变为感染的阳性诊断。在 27 个进行拭子取样的伤口中，有 22 个检测到细菌负荷，其中 17 个显示重度生长；在所有可检测到细菌负荷的伤口中，均观察到荧光信号（阳性预测值=100%，阴性预测值=83%）。使用微生物学作为金标准，将荧光信息作为检查表中的附加项目纳入，可将 UPPER/LOWER 检查表的灵敏度从 82%提高到 95%。
这些结果表明，UPPER/LOWER 检查表和荧光成像以互补的方式工作，可有效识别即时护理点具有高细菌负担的伤口。
