Identifying infection in chronic wounds in a community setting: A systematic review of diagnostic test accuracy studies

Abstract

Aim: To determine the diagnostic accuracy of different methods currently available to identify infection in chronic wounds applicable to adult patients in a community setting.

Design: Systematic review of diagnostic test accuracy studies.

Review methods: Two authors independently completed screening, data extraction and quality and bias assessments (QUADAS2). Eligible studies compared a method (index test) for detecting infection (diagnosis of interest) with microscopy and culture of either deep tissue biopsy or wound swab (reference test) in adult patients with wounds of >4 weeks duration (participants). The results were synthesized narratively.

Data sources: We systematically searched CINAHL, Embase and Medline from 2011 to April 2022.

Results: Four studies were included, all recruiting from secondary care wound clinics. Two studies assessed the diagnostic accuracy of Moleculight i:X, a bacterial fluorescence imaging device against deep tissue biopsy culture. One study assessed the diagnostic accuracy of the elevation of various enzymes detected in wound fluid against wound swab microscopy of culture. One study assessed the diagnostic accuracy of bacterial protease activity against wound swab microscopy and culture. Sensitivities of these methods ranged from 50 to 75% and specificities from 47 to 100%.

Conclusion: Only a small number of studies were included in this systematic review due to our strict inclusion criteria. We have not identified any methods for diagnosing infection in chronic wounds with either a sufficient quality of evidence to recommend their use in community settings at present. Further research is needed to develop and evaluate appropriate diagnostics for this purpose.

Impact: This study highlights the paucity of research into wound diagnostics in a community setting and should prompt further research in this area. Accurate diagnostic tests have the potential to improve community-based wound care by optimizing antibiotic use and potentially improving healing time.

Reporting method: PRISMA-DTA checklist.

Patient or public contribution: The PPI group for the NIHR Community Healthcare MIC were supportive of this topic of work.

Keywords: clinical decision-making; diagnostic tests; nursing diagnosis; primary care; systematic reviews and meta-analyses; wound care.