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This post\u2010hoc multicenter clinical trial analysis of 138 diabetic foot ulcers investigates fluorescence (FL)\u2010imaging role in detecting biofilm\u2010encased and planktonic bacteria in wounds at high loads. The sensitivity and specificity of clinical assessment and FL\u2010imaging were compared across bacterial loads of concern (10<jats:sup>4<\/jats:sup>\u201310<jats:sup>9<\/jats:sup>\u2009CFU\/g). Quantitative tissue culture confirmed the total loads. Bacterial presence was confirmed in 131\/138 ulcers. Of these, 93.9% had loads &gt;10<jats:sup>4<\/jats:sup>\u2009CFU\/g. In those wounds, symptoms of infection were largely absent and did not correlate with, or increase proportionately with, bacterial loads at any threshold. FL\u2010imaging increased sensitivity for the detection of bacteria across loads 10<jats:sup>4<\/jats:sup>\u201310<jats:sup>9<\/jats:sup> (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.0001), peaking at 92.6% for &gt;10<jats:sup>8<\/jats:sup>\u2009CFU\/g. Imaging further showed that 84.2% of ulcers contained high loads in the periwound region. New terminology, chronic inhibitory bacterial load (CIBL), describes frequently asymptomatic, high bacterial loads in diabetic ulcers and periwound tissues, which require clinical intervention to prevent sequelae of infection. We anticipate this will spark a paradigm shift in assessment and management, enabling earlier intervention along the bacterial\u2010infection continuum and supporting improved wound outcomes.<\/jats:p>","DOI":"10.1111\/iwj.14080","type":"journal-article","created":{"date-parts":[[2023,1,28]],"date-time":"2023-01-28T11:59:03Z","timestamp":1674907143000},"page":"554-566","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Point\u2010of\u2010care fluorescence imaging reveals extent of bacterial load in diabetic foot ulcers"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1887-9175","authenticated-orcid":false,"given":"David G.","family":"Armstrong","sequence":"first","affiliation":[{"name":"Department of Surgery Keck School of Medicine of University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8931-0069","authenticated-orcid":false,"given":"Michael E.","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Diabetic Foot Clinic King's College Hospital Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1032-3578","authenticated-orcid":false,"given":"Thomas E.","family":"Serena","sequence":"additional","affiliation":[{"name":"SerenaGroup\u00ae Research Foundation  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3280"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis346"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0177916"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2017.0743"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.27.9.2129"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010012\u20102673\u20103"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2022.31.5.380"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.it.2019.05.001"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004770\u2010200201000\u201000007"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/labinvest.2015.160"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc06\u20101383"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2020.29.Sup7.S4"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.12.055"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2020.05.001"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12777"},{"issue":"3","key":"e_1_2_11_18_1","first-page":"S2","article-title":"Maceration and its effect on periwound margins","volume":"6","author":"Rodgers A","year":"2003","journal-title":"Diabetic Foot"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.2930020410"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/1475\u20102840\u201011\u201018"},{"key":"e_1_2_11_21_1","unstructured":"Wounds International(2022)International Consensus Update 2022 International Wound Infection Institute (IWII) Wound Infection in Clinical Practice: Principles of best practice. 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