Use of a fluorescence imaging device to detect elevated bacterial loads, enhance antimicrobial stewardship, and increase communication across inpatient complex wound care teams.

INTRODUCTION: Wounds are increasing in number and complexity within the hospital inpatient system, and coordinated and dedicated wound care along with the use of emerging technologies can result in improved patient outcomes. OBJECTIVE: This prospective implementation study at 2 hospital inpatient sites examines the effect of bedside fluorescence imaging of wounds in the detection of elevated bacterial loads and its location in/around the wound on the inpatient wound population. MATERIALS AND METHODS: Clinical assessment and fluorescence imaging assessments were performed on 26 wounds in 21 patients. Treatment plans were recorded after the clinical assessment and again after fluorescence imaging, and any alterations made to the treatment plans after imaging were noted. RESULTS: Prior to fluorescence imaging, antimicrobial use in this patient population was common. An antimicrobial dressing, a topical antibiotic, or an oral antibiotic was prescribed in 23 wounds (88% of assessments), with antimicrobial dressings prescribed 73% of the time. Based on clinical assessment, more than half of the treated wounds were deemed negative for suspected infection. In 12 of 26 wounds, the fluorescence imaging information on bacterial presence had the potential to prompt a change in whether an antimicrobial dressing was prescribed. Five of these 12 wounds were fluorescence imaging-positive and an antimicrobial drug was not prescribed, whereas 7 of the 12 wounds were negative upon fluorescence imaging and clinical assessment but antimicrobial dressing was prescribed. Overall, fluorescence imaging detected 70% more wounds, with bacterial fluorescence indicating elevated bacterial loads, compared with clinical assessment alone, and use of imaging resulted in altered treatment plans in 35% of cases. CONCLUSIONS: Fluorescence imaging can aid in antimicrobial stewardship goals by supporting evidence-based decision-making at the point of care. In addition, use of such imaging resulted in increased communication, enhanced efficiency, and improved continuity of care between wound care providers and hospital sites.

Forest elephant crisis in the Congo Basin.

Debate over repealing the ivory trade ban dominates conferences of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). Resolving this controversy requires accurate estimates of elephant population trends and rates of illegal killing. Most African savannah elephant populations are well known; however, the status of forest elephants, perhaps a distinct species, in the vast Congo Basin is unclear. We assessed population status and incidence of poaching from line-transect and reconnaissance surveys conducted on foot in sites throughout the Congo Basin. Results indicate that the abundance and range of forest elephants are threatened from poaching that is most intense close to roads. The probability of elephant presence increased with distance to roads, whereas that of human signs declined. At all distances from roads, the probability of elephant occurrence was always higher inside, compared to outside, protected areas, whereas that of humans was always lower. Inside protected areas, forest elephant density was correlated with the size of remote forest core, but not with size of protected area. Forest elephants must be prioritised in elephant management planning at the continental scale.