Martha R. Kelso, RN, CWHS, HBOT, is Founder and Chief Executive Officer, Wound Care Plus LLC, Blue Springs, Missouri, USA. Mark Jaros, PhD, is Senior Vice President, Summit Analytical, Denver, Colorado, USA.
Adv Skin Wound Care. 2024 Sep 1;37(9):471-479. doi: 10.1097/ASW.0000000000000177. Epub 2024 Jul 17.
High bacterial burden stalls wound healing and can quickly progress to infection and sepsis in complex, older-adult patients in long-term care (LTC) or skilled nursing facilities (SNFs).
To investigate the outcomes of point-of-care fluorescence (FL) imaging (MolecuLight i:X) of bacterial loads, which are frequently asymptomatic, to inform customized wound treatment plans for patients in LTC/SNFs.
In this retrospective pre/postinterventional cohort study, the authors compared the healing and infection-associated outcomes of 167 pressure injuries from 100 Medicare beneficiaries before and after implementation of FL imaging.
Most patient demographics and wound characteristics did not differ significantly between the standard-of-care (SOC; n = 71 wounds) and FL (n = 96 wounds) cohorts. Significantly more wounds (+71.0%) healed by 12 weeks in the FL cohort (38.5%) versus the SoC cohort (22.5%). Wounds in the FL cohort also healed 27.7% faster (-4.8 weeks), on average, and were 1.4 times more likely to heal per Kaplan-Meier survival analysis (hazard ratio = 1.40; 95% CI, 0.90-2.12). Infection-related complications decreased by 75.3% in the FL cohort, and a significant shift from largely systemic to topical antibiotic prescribing was evidenced.
Fluorescence-imaging-guided management of wounds significantly improved healing and infection outcomes in highly complex and multimorbid patients in LTC/SNFs. Proactive bacterial infection management via local treatments was enabled by earlier, objective detection. These reported outcome improvements are comparable to randomized controlled trials and cohort studies from less compromised, selectively controlled outpatient populations. Fluorescence imaging supports proactive monitoring and management of planktonic and biofilm-encased bacteria, improving patient care in a complex, real-world setting.
在长期护理（LTC）或熟练护理设施（SNF）中，高细菌负荷会阻碍伤口愈合，并迅速导致复杂的老年患者感染和脓毒症。
研究即时护理荧光（FL）成像（MolecuLight i:X）对细菌负荷的结果，这些细菌负荷通常是无症状的，以便为 LTC/SNF 中的患者制定定制的伤口治疗计划。
在这项回顾性的前后干预队列研究中，作者比较了 100 名医疗保险受益人的 167 个压力损伤在实施 FL 成像前后的愈合和感染相关结果。
在标准护理（SOC；n = 71 个伤口）和 FL（n = 96 个伤口）队列中，大多数患者人口统计学和伤口特征没有显著差异。FL 队列中（38.5%）有更多的伤口（+71.0%）在 12 周内愈合，而 SOC 队列中（22.5%）。FL 队列中的伤口平均愈合速度快 27.7%（-4.8 周），并且根据 Kaplan-Meier 生存分析，愈合的可能性高 1.4 倍（风险比 = 1.40；95%CI，0.90-2.12）。FL 队列中与感染相关的并发症减少了 75.3%，并证明了从主要全身到局部抗生素给药的显著转变。
FL 成像引导的伤口管理显著改善了 LTC/SNF 中高度复杂和多病共存患者的愈合和感染结果。通过更早、更客观的检测，实现了对细菌感染的主动管理。这些报告的结果改善与来自较不复杂、选择性控制的门诊人群的随机对照试验和队列研究相当。FL 成像支持对浮游和生物膜包裹细菌的主动监测和管理，改善了复杂真实环境中的患者护理。
