Traditional and novel diagnostic techniques to assess wound infection

Abstract

In healthcare, we frequently encounter patients who suffer from one or multiple wounds that show a delayed or even failed healing process. A major complication in these patients is the development of wound infection, which delays the healing process even more. The ability to detect wound infection in an accurate and timely manner is essential to prevent further complications, such as spreading of the infection to the blood stream or the need for amputation. In addition, the ability to accurately rule out infection in wounds can prevent unnecessary use of antibiotic treatment. The aim of this Thesis was to assess traditional and novel diagnostic techniques that potentially fulfill this need for accurate and timely detection of wound infection. Traditional assessment of wound infection mainly relies on the subjective interpretation of clinical information and microbiological culture results, and therefore can vary substantially between clinical experts. This Thesis has evaluated three promising novel diagnostic techniques that potentially fulfill the need for more consistent, accurate and timely detection of wound infection; measurement of enzyme activity, wound pH and the electronic nose. Each tool requires a wound swab, which is a relatively easy, inexpensive and non-invasive method, and all techniques provide results within 20 minutes. Moreover, the novel techniques could have the ability to reduce the variability in the assessment of wound infection through traditional techniques. However, it is difficult to determine the accuracy of novel diagnostic techniques when there is no measure to establish the true infection status of the wound. Nevertheless, we tried to determine the diagnostic accuracy of each novel technique with the best reference standard available and aim to verify our results in larger studies. In the meantime, we hope our results create awareness amongst clinicians about the imperfections that exist in diagnostic techniques they currently use. Despite the uncertainty about the diagnostic accuracy of novel techniques, it might be valuable to use these techniques to support assessment of wound infection in clinical practice.