Is Your Wound Bioburdened? Case 1

CASE

• 22-year-old male with paraplegia following a fall from a balcony presented with large presacral and buttock pressure injuries that continued to increase in size since last visit >3 months prior. Click here for photo.
• Although the ulcers were large with areas of increased depth, there were minimal clinical signs of bioburden.
• A fluorescence scan revealed red fluorescence indicative of significant bioburden that could not be removed with cleansing or debridement.
• A point-of-care fluorescence scan (MolecuLight i:X) revealed a pattern of scattered red fluorescence (white arrows) indicating elevated bacterial burden (>10⁴ CFU/g) extending beyond wound bed. Click here for photo. A week after initiating antimicrobial treatment, wound status was significantly improved.

CLINICAL DECISION

• Based on assessment and fluorescence scan information, the patient was started on an oral antibiotic for 14 days. Click here for photo.
• The wound was treated with an antimicrobial topical and foam dressing was applied along with aggressive positional offloading.
• The patient continued to be seen by home health with dressing changes every 2 to 3 days.

OUTCOME

• At a follow-up visit one week later, a significant improvement in wound granulation tissue was observed along with a decrease in wound size and drainage. Click here for photo.
• The wound remained absent of clinical signs and symptoms of infection and there was a marked reduction in red fluorescence indicative of elevated bacterial burden.
• Fluorescence scan revealed unrecognized bacterial burden denoted by red fluorescence signal (white arrows) that led to swift initiation of oral antibiotics and subsequent improvement in wound status.

Charles Andersen, MD, is the Medical Director of the Wound Care Clinic, Madigan Army Medical Center, Tacoma, WA.

This series features images of wound bioburden by MolecuLight.

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