Identification of high-risk lower extremity wounds using point-of-care test for bacterial protease activity; a single-centre, single-blinded, prospective study

Jonker, Leon ORCID: https://orcid.org/0000-0001-5867-4663 , Todhunter, Jane, Mutch, Rachel, Lowes, Donna and Messenger, Grace (2024) Identification of high-risk lower extremity wounds using point-of-care test for bacterial protease activity; a single-centre, single-blinded, prospective study. International Journal of Lower Extremity Wounds . Item availability may be restricted.

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Abstract

Clinician observation is the mainstay to determine if wound infection is present, and focuses on presence of erythema, purulence, and odour. However, non-visible bacterial protease activity can delay wound healing and lead to complications. In this study, a point-of-care test to detect the presence of bacterial protease activity (BPA, tested with Woundchek Bacterial Status test) was appraised. A total of 130 patients with lower extremity wounds were recruited in vascular and podiatry clinics, and across two time-points 182 BPA tests were conducted subsequent to initial (blinded) clinician's wound appraisal. Clinical opinion (‘no infection’, ‘possible’ or ‘definite’ infection) and BPA result (negative or positive test) had a moderate Kendall's tau-c rank correlation coefficient of 0.32 ( P < 0.001). Binary logistic regression analysis and principal component analysis showed that infection determined by clinical opinion was significantly associated with abovementioned clinical signs and a positive BPA test. However, a positive BPA result was also significantly linked with wound severity, such as number of lesions, chronicity and size. Throughout a 12-week follow-up period, median ulcer size was larger for wounds positive for BPA test at baseline ( P 0.001) and week-12 ( P 0.036; both Mann-Whitney U-test) respectively. As a pilot initiative, clinical staff were allowed to act on the BPA result if they wished; in 11 out of 71 test-positive cases (15%) this happened and antimicrobial dressing was applied instead of planned standard dressing. These results show that protease-releasing bacteria may be active in ulcers that do not (yet) exhibit hallmark signs of infection, and are associated with delayed healing. Targeted point-of-care testing for bacterial protease activity may have the potential to identify and enable pro-active (antimicrobial) management of these high-risk wounds.

Item Type:	Article
Journal / Publication Title:	International Journal of Lower Extremity Wounds
Publisher:	SAGE Publications
ISSN:	1552-6941
Departments:	Institute of Health > Medical Sciences
Additional Information:	Leon Jonker, Visiting Professor, Institute of Health, University of Cumbria, UK.
Depositing User:	Anna Lupton
Date Deposited:	18 Sep 2024 09:04
Last Modified:	18 Sep 2024 09:15
URI:	https://insight.cumbria.ac.uk/id/eprint/8397