APWCA Position Statement: Point-of-care bacterial autofluorescence imaging in the assessment and management of hard-to-heal wounds

Le L, Baer M, Briggs P, et al. Diagnostic accuracy of point-of-care fluorescence imaging for the detection of bacterial burden in wounds: results from the 350-patient Fluorescence Imaging Assessment and Guidance trial. Adv Wound Care (New Rochelle). 2021;10(3):123-136. https://doi.org/10.1089/wound.2020.1272

Jacob A, Jones LM, Abdo RJ, et al. Lights, fluorescence, action. Influencing wound treatment plans including debridement of bacteria and biofilms. Int Wound J. 2023;20(8):3279-3288. https://doi.org/10.1111/iwj.14208

Trafelet N, Johnson S, Schroder J, Serena TE. Audit of antimicrobial prescribing trends in 1447 outpatient wound assessments: baseline rates and impact of bacterial fluorescence imaging. Diagnostics (Basel). 2024;14(18):2034. https://doi.org/10.3390/diagnostics14182034

Price N. Routine fluorescence imaging to detect wound bacteria reduces antibiotic use and antimicrobial dressing expenditure while improving healing rates: retrospective analysis of 229 foot ulcers. Diagnostics (Basel). 2020;10(11):927. https://doi.org/10.3390/diagnostics10110927

Hsu JC, Chu YH, Wu YC, et al. Application of perioperative real-time fluorescence imaging to achieve high-quality debridement: a randomized control trial. Adv Wound Care (New Rochelle). 2026;15(10):722-734. https://doi.org/10.1177/21621918251359558

Rahma S, Woods J, Brown S, Nixon J, Russell D. The use of point-of-care bacterial autofluorescence imaging in the management of diabetic foot ulcers: a pilot randomized controlled trial. Diabetes Care. 2022;45(7):1601-1609. https://doi.org/10.2337/dc21-2218

Kelso MR, Jaros M. Improving wound healing and infection control in long-term care with bacterial fluorescence imaging. Adv Skin Wound Care. 2024;37(9):471-479. https://doi.org/10.1097/ASW.0000000000000177

Medicare Administrative Contractors. Proposed local coverage determinations: real-time fluorescence wound imaging. CGS DL40468; First Coast Service Options DL40415; Noridian DL40441; Novitas Solutions DL40413; Palmetto GBA DL40443; Wellpoint Federal (National Government Services) DL40439; WPS DL40437. Comment period ends November 14, 2026. Medicare Coverage Database. https://www.cms.gov/medicare-coverage-database (accessed 15 October 2026)

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Versey Z, da Cruz Nizer WS, Russell E, et al. Biofilm-innate immune interface: contribution to chronic wound formation. Front Immunol. 2021;12:648554. https://doi.org/10.3389/fimmu.2021.648554

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Wolcott RD, Hanson JD, Rees EJ, et al. Analysis of the chronic wound microbiota of 2,963 patients by 16S rDNA pyrosequencing. Wound Repair Regen. 2016;24(1):163-174. https://doi.org/10.1111/wrr.12370

Fazli M, Bjarnsholt T, Kirketerp-Møller K, et al. Nonrandom distribution of Pseudomonas aeruginosa and Staphylococcus aureus in chronic wounds. J Clin Microbiol. 2009;47(12):4084-4089. https://doi.org/10.1128/JCM.01395-09

Rhoads DD, Cox SB, Rees EJ, Sun Y, Wolcott RD. Clinical identification of bacteria in human chronic wound infections: culturing vs. 16S ribosomal DNA sequencing. BMC Infect Dis. 2012;12:321. https://doi.org/10.1186/1471-2334-12-321

Reddy M, Gill SS, Wu W, Kalkar SR, Rochon PA. Does this patient have an infection of a chronic wound? JAMA. 2012;307(6):605-611. https://doi.org/10.1001/jama.2012.98

Raizman R, Dunham D, Lindvere-Teene L, et al. Use of a bacterial fluorescence imaging device: wound measurement, bacterial detection and targeted debridement. J Wound Care. 2019;28(12):824-834. https://doi.org/10.12968/jowc.2019.28.12.824

Moelleken M, Jockenhöfer F, Benson S, Dissemond J. Prospective clinical study on the efficacy of bacterial removal with mechanical debridement in and around chronic leg ulcers assessed with fluorescence imaging. Int Wound J. 2020;17(4):1011-1018. https://doi.org/10.1111/iwj.13345

Serena TE, Harrell K, Serena L, Yaakov RA. Real-time bacterial fluorescence imaging accurately identifies wounds with moderate-to-heavy bacterial burden. J Wound Care. 2019;28(6):346-357. https://doi.org/10.12968/jowc.2019.28.6.346

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Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev. 2024;40(3):e3687.https://doi.org/10.1002/dmrr.3687

Armstrong DG, Edmonds ME, Serena TE. Point-of-care fluorescence imaging reveals extent of bacterial load in diabetic foot ulcers. Int Wound J. 2023;20(2):554-566. https://doi.org/10.1111/iwj.14080

Armstrong DG, Armstrong AA, Feraru LM, Deng W. Surgically rebooting the wound for a healthier operating system: why the apps will not run until you reset the wound operating system. Burns Trauma. 2026:tkag053. https://doi.org/10.1093/burnst/tkag053

Rennie MY, Dunham D, Lindvere-Teene L, Raizman R, Hill R, Linden R. Understanding real-time fluorescence signals from bacteria and wound tissues observed with the MolecuLight i:X. Diagnostics (Basel). 2019;9(1):22. https://doi.org/10.3390/diagnostics9010022

Jones LM, Dunham D, Rennie MY, et al. In vitro detection of porphyrin-producing wound bacteria with real-time fluorescence imaging. Future Microbiol. 2020;15:319-332. https://doi.org/10.2217/fmb-2019-0279

US Food and Drug Administration. De Novo classification request DEN180008 (MolecuLight i:X; product code QCR), granted July 31, 2018; and 510(k) premarket notifications under product code QJF, including K213840 indications for use, and the 510(k) summaries for K242669 (SnapshotGLO; March 26, 2025) and K251678 (Swift Ray 1; February 24, 2026). https://www.accessdata.fda.gov (accessed 15 October 2026)

DaCosta RS, Kulbatski I, Lindvere-Teene L, et al. Point-of-care autofluorescence imaging for real-time sampling and treatment guidance of bioburden in chronic wounds: first-in-human results. PLoS One. 2015;10(3):e0116623. https://doi.org/10.1371/journal.pone.0116623

Rennie MY, Lindvere-Teene L, Tapang K, Linden R. Point-of-care fluorescence imaging predicts the presence of pathogenic bacteria in wounds: a clinical study. J Wound Care. 2017;26(8):452-460. https://doi.org/10.12968/jowc.2017.26.8.452

Sandy-Hodgetts K, Andersen CA, Al-Jalodi O, Serena L, Teimouri C, Serena TE. Uncovering the high prevalence of bacterial burden in surgical site wounds with point-of-care fluorescence imaging. Int Wound J. 2022;19(6):1438-1448. https://doi.org/10.1111/iwj.13737

Johnson J, Johnson AR Jr, Andersen CA, Kelso MR, Oropallo AR, Serena TE. Skin pigmentation impacts the clinical diagnosis of wound infection: imaging of bacterial burden to overcome diagnostic limitations. J Racial Ethn Health Disparities. 2024;11(2):1045-1055. https://doi.org/10.1007/s40615-023-01584-8

Hurley CM, McClusky P, Sugrue RM, Clover JA, Kelly JE. Efficacy of a bacterial fluorescence imaging device in an outpatient wound care clinic: a pilot study. J Wound Care. 2019;28(7):438-443. https://doi.org/10.12968/jowc.2019.28.7.438

Blackshaw EL, Jeffery SLA. Efficacy of an imaging device at identifying the presence of bacteria in wounds at a plastic surgery outpatients clinic. J Wound Care. 2018;27(1):20-26. https://doi.org/10.12968/jowc.2018.27.1.20

Koo DY, Namgoong S, Han SK, et al. Diagnostic accuracy of a fluorescence imaging device in diabetic wounds: a pilot study using a tissue culture system. Wounds. 2023;35(7):E218-E223. https://doi.org/10.25270/wnds/23002

Olbrich A, Motekallemi A, Deschka H, et al. Prospective evaluation of the Moleculight i:X in the early detection of driveline infections. Interdiscip Cardiovasc Thorac Surg. 2025;40(4):ivae215. https://doi.org/10.1093/icvts/ivae215

Pijpe A, Ozdemir Y, Sinnige JC, et al. Detection of bacteria in burn wounds with a novel handheld autofluorescence wound imaging device: a pilot study. J Wound Care. 2019;28(8):548-554. https://doi.org/10.12968/jowc.2019.28.8.548

Ottolino-Perry K, Chamma E, Blackmore KM, et al. Improved detection of clinically relevant wound bacteria using autofluorescence image-guided sampling in diabetic foot ulcers. Int Wound J. 2017;14(5):833-841. https://doi.org/10.1111/iwj.12717

Serena TE, Snyder RJ, Bowler PG. Use of fluorescence imaging to optimize location of tissue sampling in hard-to-heal wounds. Front Cell Infect Microbiol. 2023;12:1070311. https://doi.org/10.3389/fcimb.2022.1070311

Mayer P, Smith AC, Hurlow J, Morrow BR, Bohn GA, Bowler PG. Assessing biofilm at the bedside: exploring reliable accessible biofilm detection methods. Diagnostics (Basel). 2024;14(19):2116. https://doi.org/10.3390/diagnostics14192116

Wu YF, Tung YC, Sheu SY, et al. Standardized quantitative imaging of extracellular polymeric substance in chronic wounds: prognostic comparison of wound blotting and bacterial fluorescence imaging. Biofilm. 2026;12:100392. https://doi.org/10.1016/j.bioflm.2026.100392

DasGupta T, Rashleigh L, Zhou K, et al. Use of a fluorescence imaging device to detect elevated bacterial loads, enhance antimicrobial stewardship, and increase communication across inpatient complex wound care teams. Wounds. 2022;34(8):201-208. https://doi.org/10.25270/wnds/21076

Serena TE, Gould L, Ousey K, Kirsner RS. Reliance on clinical signs and symptoms assessment leads to misuse of antimicrobials: post-hoc analysis of 350 chronic wounds. Adv Wound Care (New Rochelle). 2022;11(12):639-649. https://doi.org/10.1089/wound.2021.0146

Caputo WJ, Monterosa P, Beggs D. Antibiotic misuse in wound care: can bacterial localization through fluorescence imaging help? Diagnostics (Basel). 2022;12(12):3207. https://doi.org/10.3390/diagnostics12123207

Hill R, Rennie MY, Douglas J. Using bacterial fluorescence imaging and antimicrobial stewardship to guide wound management practices: a case series. Ostomy Wound Manage. 2018;64(8):18-28. https://doi.org/10.25270/owm.2018.8.1828

Cole W, Coe S. Use of a bacterial fluorescence imaging system to target wound debridement and accelerate healing: a pilot study. J Wound Care. 2020;29(Sup7):S44-S52. https://doi.org/10.12968/jowc.2020.29.Sup7.S44

Derwin R, Patton D, Strapp H, Moore Z. Integrating point-of-care bacterial fluorescence imaging-guided care with continued wound measurement for enhanced wound area reduction monitoring. Diagnostics (Basel). 2024;14(1):2. https://doi.org/10.3390/diagnostics14010002

Okeahialam NA, Thakar R, Sultan AH. The clinical progression and wound healing rate of dehisced perineal tears healing by secondary intention: a prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2022;274:191-196. https://doi.org/10.1016/j.ejogrb.2022.05.035

Oropallo A, Rao AS, Kaplan S, et al. Absence of bacterial fluorescence is associated with early response to skin substitutes in diabetic and venous ulcers: a single-blinded prospective study. Int Wound J. 2026;23(5):e70951. https://doi.org/10.1111/iwj.70951

Hanson-Viana E, Rojas-Ortiz JA, Rendón-Medina MA, Luna-Zepeda BL. Bacterial fluorescence imaging as a predictor of skin graft integration in burn wounds. Burns. 2024;50(7):1799-1811. https://doi.org/10.1016/j.burns.2024.04.003

Blumenthal E, Jeffery SLA. The use of the MolecuLight i:X in managing burns: a pilot study. J Burn Care Res. 2018;39(1):154-161. https://doi.org/10.1097/BCR.0000000000000565

Farhan N, Jeffery S. Utility of MolecuLight i:X for managing bacterial burden in pediatric burns. J Burn Care Res. 2020;41(2):328-338. https://doi.org/10.1093/jbcr/irz167

Jeffery SLA, Hanson-Viana E. A scoping review of fluorescence imaging: a promising new technology for bacterial detection in burn wounds. J Burn Care Res. 2026;47(1):315-322. https://doi.org/10.1093/jbcr/iraf173

Badrie S, Moore Z, Patton D, O’Connor T, Derwin R. The clinical utility of autofluorescence imaging for bacterial detection in wounds: a systematic review. Int Wound J. 2025;22(6):e70678. https://doi.org/10.1111/iwj.70678

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Oropallo AR, Andersen C, Abdo R, et al. Guidelines for point-of-care fluorescence imaging for detection of wound bacterial burden based on Delphi consensus. Diagnostics (Basel). 2021;11(7):1219. https://doi.org/10.3390/diagnostics11071219

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