Point-of-care testing for bacterial infection in diabetic foot ulcers: a prospective cohort study

Jonker, Leon ORCID logo ORCID: https://orcid.org/0000-0001-5867-4663 , Smith, Danielle, Mark, Emma, Schutter, Jose, Thornthwaite, Sarah and Johnston, Shona (2020) Point-of-care testing for bacterial infection in diabetic foot ulcers: a prospective cohort study. Journal of Wound Care, 29 (11). pp. 649-657.

[thumbnail of Jonker_WIDE JoWC combi manuscript dd21Jan2020.pdf]
Preview
PDF - Accepted Version
Download (411kB) | Preview
Official URL: https://doi.org/10.12968/jowc.2020.29.11.649

Abstract

Point-of-care testing for bacterial infection in diabetic foot ulcers: a prospective cohort study Leon Jonker North Cumbria Integrated Care NHS Foundation Trust, Carlisle Danielle Smith North Cumbria Integrated Care NHS Foundation Trust, Carlisle Emma Mark North Cumbria Integrated Care NHS Foundation Trust, Carlisle Jose Schutter North Cumbria Integrated Care NHS Foundation Trust, Carlisle Sarah Thornthwaite North Cumbria Integrated Care NHS Foundation Trust, Carlisle Shona Johnston North Cumbria Integrated Care NHS Foundation Trust, Carlisle Objective:

To appraise the performance of a new point-of-care wound infection detection kit in diabetic foot ulcers (DFUs), using clinician opinion as the primary comparator. The proprietary swab-based chromatic Glycologic (Glycologic Ltd., UK) detection kit used in this study is designed to detect host response to pathogenic levels of bacteria in wounds.
Method:

In high-risk podiatry clinics, patients with DFUs were recruited and infection detection kit test results compared with initial clinician opinion. Chi-squared tests, principal component analysis (PCA) and multiple regression analysis were performed to determine which variables were possibly associated with infection. The variables considered were patients' wound parameters, wider vascular comorbidity and demographics.
Results:

A total of 136 patients, providing 383 wound swabs, were included in the study. Total agreement in terms of DFU wound assessment for infection—between podiatrists' clinical opinion and Glycologic kit test result—was observed in 79% of cases (301/383). For 56 of the 349 negative infection detection kit test results (16%), podiatrists identified a ‘possible’ or ‘definite’ infection. Conversely, in 14 of the 307 cases (4.6%) where podiatrists deemed the wound ‘not infected’, the infection detection kit test showed a colour change. Regression analysis and PCA showed that clinical signs of wound infection, namely erythema, purulence and odour, were all significantly associated with both a positive clinical opinion and infection detection kit test result. However, in the case of the infection detection kit, a patient's number of lesions and vascular comorbidities were also significantly correlated with a positive test result.
Conclusion:

A host response to critical pathological levels of bioburden in a wound—as detected with the infection detection kit—may partly be determined by an individual patient's (vascular) health and therefore be person-specific. Further research is indicated to determine the relationship between an infection detection kit test result and the microbiological status of the wound.
11 02 2020 649 657 10.12968/jowc.2020.29.11.649 10.12968/jowc.2020.29.11.649 http://www.magonlinelibrary.com/doi/10.12968/jowc.2020.29.11.649 http://www.magonlinelibrary.com/doi/pdf/10.12968/jowc.2020.29.11.649 Wounds UK Grothier L 32 11 2 2015 Australas J Dermatol Halbert AR 75 33 2 1992 10.1111/j.1440-0960.1992.tb00083.x Diabet Med O'Meara S 341 23 4 2006 10.1111/j.1464-5491.2006.01830.x BMC Med Spichler A 2 13 1 2015 10.1186/s12916-014-0232-0 BMJ Open Nelson A e019437 8 1 2018 10.1136/bmjopen-2017-019437 Diabetes Care Gardner SE 2693 37 10 2014 10.2337/dc14-0051 J Trauma Levine NS 89 16 2 1976 10.1097/00005373-197602000-00002 Diabetes Care Lavery LA 1288 29 6 2006 10.2337/dc05-2425 Wound Rep Regen Boulton AJ 7 7 1 1999 10.1046/j.1524-475x.1999.00007.x Int Wound J Guest JF 43 15 1 2018 10.1111/iwj.12816 Psychometrika Horn JL. 179 30 2 1965 10.1007/BF02289447 Tabachnik BG, Fidell LS. Using multivariate statistics (6th edn). Pearson; 2013 Br J Community Nurs Cutting KF S6 9 3 2004 10.12968/bjcn.2004.9.Sup1.12495 World J Diabetes Richard JL 24 2 2 2011 10.4239/wjd.v2.i2.24 Diabetes Metab Res Rev Lipsky BA 45 32 2016 10.1002/dmrr.2699 JAMA Reddy M 605 307 6 2012 Clin Dermatol Siddiqui AR 519 28 5 2010 10.1016/j.clindermatol.2010.03.009 Adv Wound Care Tuttle MS. 1 4 1 2015 10.1089/wound.2014.0535 Med Care Sharabiani MT 1109 20 12 2012 10.1097/MLR.0b013e31825f64d0 Diabet Med Ndosi M 78 35 1 2018 10.1111/dme.13537 Ostomy Wound Manage Boykin J 20 55 9 2009 Wound Repair Regen Heinzle A 482 21 3 2013 10.1111/wrr.12040 Diabet Med Ingram JR 255 35 2 2018 10.1111/dme.13431 Wound Repair Regen Gardner SE 178 9 3 2001 10.1046/j.1524-475x.2001.00178.x

Item Type: Article
Journal / Publication Title: Journal of Wound Care
ISSN: 0969-0700
Departments: Institute of Health > Rehabilitation and Sport Science
Depositing User: Christian Stretton
Date Deposited: 17 Nov 2020 13:19
Last Modified: 13 Jan 2024 11:16
URI: https://insight.cumbria.ac.uk/id/eprint/5781

Downloads

Downloads per month over past year



Downloads each year

Edit Item