Identification of High-Risk Lower Extremity Wounds Using Point-of-Care Test for Bacterial Protease Activity; A...

Area of Science:

• Wound healing and infection management
• Microbiology and diagnostics
• Point-of-care testing

Background:

• Clinician observation is standard for wound infection diagnosis, focusing on visible signs like redness and pus.
• Undetected bacterial protease activity can impede wound healing and lead to complications.
• There is a need for objective diagnostic tools to complement clinical assessment.

Purpose of the Study:

• To evaluate a point-of-care test for detecting bacterial protease activity (BPA) in lower extremity wounds.
• To assess the correlation between BPA test results and clinical assessments of wound infection.
• To investigate the association of BPA with wound healing progression.

Main Methods:

• A prospective study involving 130 patients with lower extremity wounds in vascular and podiatry clinics.
• 182 bacterial protease activity (BPA) tests were performed, blinded to initial clinical assessment.
• Statistical analyses included Kendall's tau-c, logistic regression, principal component analysis, and Mann-Whitney U-test.

Main Results:

• A moderate correlation (Kendall's tau-c = 0.32) was found between clinical infection assessment and BPA test results.
• Positive BPA tests were significantly associated with clinical signs of infection, wound severity, chronicity, and size.
• Wounds with positive BPA tests at baseline showed larger ulcer sizes at 12 weeks.

Conclusions:

• Bacterial protease activity can be present in wounds without obvious signs of infection, contributing to delayed healing.
• Point-of-care testing for BPA offers a potential tool for early identification of high-risk wounds.
• Pro-active antimicrobial management guided by BPA testing may improve outcomes for complex wounds.