PhillipsCJ, HumphreysI, FletcherJ, : Estimating the costs associated with the management of patients with chronic wounds using linked routine data. Int Wound J13: 1193, 2016.10.1111/iwj.1244325818405)| false
PrompersL, HuijbertsM, ApelqvistJ, et al.: High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe: baseline results from the Eurodiale study. Diabetologia50: 18, 2007.
PrompersL, HuijbertsM, ApelqvistJ, : High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe: baseline results from the Eurodiale study. Diabetologia50: 18, 2007.10.1007/s00125-006-0491-117093942)| false
PichuS, PatelBM, ApparsundaramS, : Role of biomarkers in predicting diabetes complications with special reference to diabetic foot ulcers. Biomark Med11: 377, 2017.2832682510.2217/bmm-2016-0205)| false
GardnerSE, FrantzRA, DoebbelingBN: The validity of the clinical signs and symptoms used to identify localized chronic wound infection. Wound Repair Regen9: 178, 2001.1147261310.1046/j.1524-475x.2001.00178.x)| false
LevineNS, LindbergRB, MasonADJr, : The quantitative swab culture and smear: a quick, simple method for determining the number of viable aerobic bacteria on open wounds. J Trauma16: 89, 1976.10.1097/00005373-197602000-000021255833)| false
SMI. UK Standards for Microbiology Investigations: investigation of swabs from skin and superficial soft tissue infections. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/766634/B_11i6.5.pdf.)| false
LipskyBA, Aragon-SanchezJ, DiggleM, : IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev32(suppl 1): 45, 2016.2638626610.1002/dmrr.2699)| false
Umemneku ChikereCM, WilsonK, GraziadioS, et al.: Diagnostic test evaluation methodology: a systematic review of methods employed to evaluate diagnostic tests in the absence of gold standard—an update. PLoS One14: e0223832, 2019.
Umemneku ChikereCM, WilsonK, GraziadioS, : Diagnostic test evaluation methodology: a systematic review of methods employed to evaluate diagnostic tests in the absence of gold standard—an update. PLoS One14: e0223832, 2019.10.1371/journal.pone.0223832)| false
Background: Point-of-care testing for infection might help podiatric physicians optimize management of diabetic foot ulcers (DFUs). Glycologic’s proprietary GLYWD product has been developed to detect changes in a patient’s immunologic/inflammatory response related to wound infection. We evaluated how bacterial presence in DFUs relates to GLYWD test outcome.
Methods: This was a single-organization, prospective, controlled cohort study of clinical opinion versus GLYWD test result for DFU infection status and the appraisal of bacterial presence in the wounds and semiquantitative microbiology swab at weeks 0, 3, 6, 12, and 18. Spearman correlation, backward elimination linear regression, and principal components analysis were applied to determine which variables, including degree of bacterial load, are associated with a positive clinical opinion or GLYWD result for DFU infection.
Results: Forty-eight patients were enrolled, and 142 complete wound appraisals were conducted; a consensus outcome between clinical opinion and GLYWD result was achieved in most (n = 122, 86%). Clinical opinion significantly correlated with a higher bacterial load (Spearman rho = 0.38; P < .01), whereas GLYWD did not (rho = –0.010; P = .91). This observation was corroborated with logistic regression analysis, in which a previous observation of both clinical opinion and GLYWD associating with wound purulence and erythema was also confirmed.
Conclusions: Podiatric physicians are guided by hallmark signs of DFU infection, such as erythema and purulence; furthermore, we found that clinical opinion of infection correlates with increased bacterial load. GLYWD test results match clinical opinion in most cases, although the results obtained with this point-of-care method suggest that the degree of bacterial presence might not necessarily mean a higher chance of inducing an immunologic/inflammatory host response to said bacteria.
Corresponding author: Leon Jonker, PhD, Science and Innovation Manager, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, CA1 3SX, UK. (E-mail: firstname.lastname@example.org)