Olbrich Angelina, Motekallemi Arash, Deschka Heinz, Rotering Heinrich, Sindermann Jürgen, Wagner Nana-Maria, Welp Henryk, Dell'Aquila Angelo M
Department of Cardiac- and Thoracic Surgery, Universitätsklinikum Münster, Münster, Germany.
Department of Anesthesiology, Intensive Care and Pain Medicine, Universitätsklinikum Münster, Münster, Germany.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 29;40(4). doi: 10.1093/icvts/ivae215.
Driveline infection (DLI) is a common complication in patients with left ventricular assist devices. This complication can seriously undermine quality of life while on left ventricular assist devices. Current diagnosis of a DLI in the outpatient setting is based on clinical examination and later bacteria isolation. The Moleculight i:XTM is a handheld fluorescence imaging device capable to visualize bacterial colonization in real-time. We here evaluated the performance of the Moleculight i:XTM for diagnosis of DLIs as this device may have the potential advantage to rapidly identify infection and therefore promptly influence therapy.
A total of 107 examinations in patients with suspected DLIs were prospectively included in this study. All examinations took place in the outpatient setting. In addition to the standard treatment, Moleculight fluorescence images were captured and swabs were taken at the area of maximal luminosity. Wounds and pictures were reviewed and classified as positive or negative by a wound specialist and two heart surgeons independently from microbiological results.
The Moleculight i:XTM showed positive results (red fluorescence) in 19 cases (17.76%), whereas microbiological examination was positive for microorganisms in 74 cases (69.16%). The most common bacteria was Staphylococcus aureus. The findings resulted in a sensitivity of 13.51% and a specificity of 72.73%. The positive predictive value was 52.63% and the negative predictive value was 27.27%. Sub-analyses of different wound dressings or previous antibiotic treatment did not show any relevant difference.
The results of the Moleculight i:X show a low sensitivity and specificity when being used to detect DLIs in the outpatient setting. Clinical examination and swabs should remain the gold standard despite the delay for bacteria isolation and consequent antibiotic treatment. Sensitivity and specificity of the Moleculight i:X in open wounds after surgical revision of the driveline remain to be clarified.
driveline感染（DLI）是左心室辅助装置患者的常见并发症。这种并发症会严重影响使用左心室辅助装置期间的生活质量。目前门诊环境中DLI的诊断基于临床检查及随后的细菌分离。Moleculight i:XTM是一种手持式荧光成像设备，能够实时可视化细菌定植情况。我们在此评估了Moleculight i:XTM在诊断DLI方面的性能，因为该设备可能具有快速识别感染并因此迅速影响治疗的潜在优势。
本研究前瞻性纳入了107例疑似DLI患者的检查。所有检查均在门诊环境中进行。除标准治疗外，采集了Moleculight荧光图像，并在最大亮度区域进行拭子采样。伤口和图片由一名伤口专科医生和两名心脏外科医生独立于微生物学结果进行审查并分类为阳性或阴性。
Moleculight i:XTM在19例（17.76%）中显示阳性结果（红色荧光），而微生物学检查在74例（69.16%）中发现微生物呈阳性。最常见的细菌是金黄色葡萄球菌。结果显示敏感性为13.51%，特异性为72.73%。阳性预测值为52.63%，阴性预测值为27.27%。对不同伤口敷料或先前抗生素治疗的亚分析未显示任何相关差异。
在门诊环境中用于检测DLI时，Moleculight i:X的结果显示出较低的敏感性和特异性。尽管细菌分离及后续抗生素治疗会有延迟，但临床检查和拭子采样仍应作为金标准。Moleculight i:X在driveline手术修复后开放性伤口中的敏感性和特异性仍有待明确。
