School of Biomedical Sciences, Pathology and Laboratory Science, University of Western Australia, Perth, Western Australia, Australia.
Centre for Molecular Medicine & Innovative Therapeutics, Murdoch University, Murdoch, Western Australia, Australia.
Int Wound J. 2022 Oct;19(6):1438-1448. doi: 10.1111/iwj.13737. Epub 2021 Dec 27.
Detection of bacterial burden within or near surgical wounds is critical to reducing the occurrence of surgical site infection (SSI). A distinct lack of reliable methods to identify postoperative bioburden has forced reliance on clinical signs and symptoms of infection (CSS). As a result, infection management has been reactive, rather than proactive. Fluorescence imaging of bacterial burden (FL) is positioned to potentially flip that paradigm. This post hoc analysis evaluated 58 imaged and biopsied surgical site wounds from the multi-centre fluorescence imaging assessment and guidance clinical trial. Diagnostic accuracy measures of CSS and FL were evaluated. A reader study investigated the impact of advanced image interpretation experience on imaging sensitivity. Forty-four of fifty-eight surgical site wounds (75.8%) had bacterial loads >10 CFU/g (median = 3.11 × 10 CFU/g); however, only 3 of 44 were CSS positive (sensitivity of 6.8%). FL improved sensitivity of bacterial detection by 5.7-fold compared with CSS alone (P = .0005). Sensitivity improved by 11.3-fold over CSS among clinicians highly experienced with FL interpretation (P < .0001). Surgical sites that reach the stage of referral to a wound specialist frequently harbour asymptomatic high bacterial loads that delay healing and increase infection risk. Advanced imaging of pathological bacterial burden improves surgical site monitoring and may reduce the rate of SSIs.
检测手术部位内或附近的细菌负荷对于减少手术部位感染（SSI）的发生至关重要。缺乏可靠的方法来识别术后生物负荷，这迫使我们依赖于感染的临床症状和体征（CSS）。因此，感染管理一直是被动的，而不是主动的。细菌负荷的荧光成像（FL）有可能改变这种模式。这项事后分析评估了来自多中心荧光成像评估和指导临床试验的 58 个成像和活检的手术部位伤口。评估了 CSS 和 FL 的诊断准确性措施。一项读者研究调查了先进的图像解释经验对成像灵敏度的影响。58 个手术部位伤口中的 44 个（75.8%）细菌负荷>10 CFU/g（中位数=3.11×10 CFU/g）；然而，只有 44 个中的 3 个 CSS 阳性（敏感性为 6.8%）。FL 与 CSS 相比，单独检测细菌的灵敏度提高了 5.7 倍（P =.0005）。在 FL 解释经验丰富的临床医生中，CSS 的敏感性提高了 11.3 倍（P <.0001）。经常达到转介给伤口专家阶段的手术部位常常存在无症状的高细菌负荷，这会延迟愈合并增加感染风险。病理性细菌负荷的高级成像可改善手术部位监测，并可能降低 SSI 的发生率。
