Abstract
Chronic wound treatment currently relies heavily on visual assessment by clinicians; however, the clinical signs and symptoms of infection and inflammation are unreliable in chronic wounds. The specialty of wound care has witnessed the advent of advanced interventions, such as cellular and/or tissue based products (CTP). The success of advanced therapies relies on preparing the wound bed by reducing bacterial burden and inflammation. The lack of diagnostics in chronic wound care leads to uncertainty in the adequacy of wound bed preparation. Recent research suggests that two novel point-of-care diagnostic tests can assist in the detection of chronic inflammation known as elevated neutrophil derived protease activity (EPA) and bacterial pathogenesis known as bacterial protease activity(BPA) in chronic wounds. Despite the evidence, however, clinicians report that incorporating diagnostics into every day practice is challenging and across the globe, they have requested guidance on their use. Methods and Recommendations: A panel of wound care experts, experienced with these tests, met to develop guidelines on their use in wound care practice. The consensus panel concluded that the clinician should test for BPA first. The panel maintained that the risk of invasive infection resulting from the presence of pathogenic bacteria was the greatest threat to the patient’s health. If the BPA test is negative, the panel recommended testing for EPA. In addition, it was suggested that if the wound failed to progress after the elevated BPA was treated and subsequent testing was negative for BPA, the clinician should consider testing for EPA. Conclusions: In this manuscript, the consensus panel suggests pathways for testing, treating, and retesting for EPA and BPA. The panel expects that following the algorithm has the potential to improve healing outcomes, result in more cost-effective use of advanced therapies, and improve antimicrobial stewardship by guiding antimicrobial use.
Highlights
Medicare estimates that over 8 million Americans suffer from chronic wounds at a cost ranging from 18.1 to 96.8 billion dollars [1]
The key to wound healing and the success of advanced therapies is adequate wound bed preparation consisting of debridement, proper moisture balance, reduction in bacterial burden and inflammation, offloading for diabetic and pressure ulcers, and compression for venous leg ulcers [4]
The specialty of wound care developed without the benefit of diagnostic testing for inflammation or bacterial burden [5,6,7,8]
Summary
Medicare estimates that over 8 million Americans suffer from chronic wounds at a cost ranging from 18.1 to 96.8 billion dollars [1]. The availability of point-of-care diagnostics to wound practitioners across the globe has generated questions on guidelines for their use In this manuscript a consensus panel of wound care experts addresses the most commonly asked questions: Which test should be used first (EPA or BPA), what are the best therapies for positive tests, and when is the best time to retest?. The EPA test (WoundchekTM laboratories, Gargrave, UK) provides a qualitative assessment of human inflammatory protease activity (EPA) in the wound. The BPA test (WoundchekTM laboratories, Gargrave, UK) provides a qualitative assessment of bacterial protease activity from the most common bacteria in chronic wounds (Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus faecalis). It detects elevated bacterial proteases called virulence factors that correlate with bacterial pathogenicity. FFoorraannEEPPAArerseuslut,ltt,htehpe apnaenl eslusguggegstessctslecalnesainnsginthgethweowunodunwdithwaitnhaanntiasenptitsice,pdtiecb, rdideeb-mriednetm, aenndt, parnodteparsoetmeaosdeumlaotdiounla(eti.ogn., c(eo.lgla.,gceonlldargeesnsindgress, soirnaglsd, ooxryacl ydcolixnyec,yOclRinCe/,cOolRlaCg/ecno)l.4la.3g.eQnu) estion 3: When Should I Retest?
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