{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:12:45Z","timestamp":1786122765303,"version":"build-2736575974"},"reference-count":29,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Woundchek Laboratories","award":["ref BIOME study"],"award-info":[{"award-number":["ref BIOME study"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    Clinician observation is the mainstay to determine if wound infection is present, and focuses on presence of erythema, purulence, and odour. However, non-visible bacterial protease activity can delay wound healing and lead to complications. In this study, a point-of-care test to detect the presence of bacterial protease activity (BPA, tested with Woundchek Bacterial Status test) was appraised. A total of 130 patients with lower extremity wounds were recruited in vascular and podiatry clinics, and across two time-points 182 BPA tests were conducted subsequent to initial (blinded) clinician's wound appraisal. Clinical opinion (\u2018no infection\u2019, \u2018possible\u2019 or \u2018definite\u2019 infection) and BPA result (negative or positive test) had a moderate Kendall's tau-c rank correlation coefficient of 0.32 (\n                    <jats:italic toggle=\"yes\">P\u2009<\/jats:italic>\n                    &lt;\u20090.001). Binary logistic regression analysis and principal component analysis showed that infection determined by clinical opinion was significantly associated with abovementioned clinical signs and a positive BPA test. However, a positive BPA result was also significantly linked with wound severity, such as number of lesions, chronicity and size. Throughout a 12-week follow-up period, median ulcer size was larger for wounds positive for BPA test at baseline (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    0.001) and week-12 (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    0.036; both Mann-Whitney U-test) respectively. As a pilot initiative, clinical staff were allowed to act on the BPA result if they wished; in 11 out of 71 test-positive cases (15%) this happened and antimicrobial dressing was applied instead of planned standard dressing. These results show that protease-releasing bacteria may be active in ulcers that do not (yet) exhibit hallmark signs of infection, and are associated with delayed healing. Targeted point-of-care testing for bacterial protease activity may have the potential to identify and enable pro-active (antimicrobial) management of these high-risk wounds.\n                  <\/jats:p>","DOI":"10.1177\/15347346241284804","type":"journal-article","created":{"date-parts":[[2024,9,14]],"date-time":"2024-09-14T02:43:27Z","timestamp":1726281807000},"page":"780-787","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Identification of High-Risk Lower Extremity Wounds Using Point-of-Care Test for Bacterial Protease Activity; A Single-Centre, Single-Blinded, Prospective Study"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5867-4663","authenticated-orcid":false,"given":"Leon","family":"Jonker","sequence":"first","affiliation":[{"name":"Science Manager, North Cumbria Integrated Care NHS FT, Carlisle, UK"},{"name":"University of Cumbria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Todhunter","sequence":"additional","affiliation":[{"name":"Specialist Vascular Nurse, North Cumbria Integrated Care NHS FT, Carlisle, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Mutch","sequence":"additional","affiliation":[{"name":"Research Nurse, North Cumbria Integrated Care NHS FT, Whitehaven, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Lowes","sequence":"additional","affiliation":[{"name":"Research Practitioner, North Cumbria Integrated Care NHS FT, Carlisle, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Messenger","sequence":"additional","affiliation":[{"name":"Lead Podiatrist, North Cumbria Integrated Care NHS FT, Carlisle, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.20692"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-045253"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10010029"},{"issue":"2","key":"e_1_3_3_5_2","first-page":"32","article-title":"An audit to determine the clinical effectiveness of a pathway for managing wound infection","volume":"11","author":"Grothier L","year":"2015","unstructured":"Grothier L, Stephenson J. An audit to determine the clinical effectiveness of a pathway for managing wound infection. Wounds UK. 2015;11(2):32-40.","journal-title":"Wounds UK"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-0960.1992.tb00083.x"},{"key":"e_1_3_3_7_2","unstructured":"NICE (National Institute for Health and Care Excellence). Clinical Guideline for venous leg ulcers. Accessed May 24 2024. https:\/\/cks.nice.org.uk\/topics\/leg-ulcer-venous\/."},{"key":"e_1_3_3_8_2","unstructured":"NICE (National Institute for Health and Care Excellence). NICE Guideline 19 Diabetic foot problems: prevention and management. Accessed May 24 2024. https:\/\/www.nice.org.uk\/guidance\/ng19."},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-0051"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2022.31.4.352"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.7547\/20-183"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12790"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2012.00763.x"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/1099800412464683"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12040"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtv.2019.12.006"},{"issue":"9","key":"e_1_3_3_17_2","article-title":"Protease activity as a prognostic factor for wound healing in venous leg ulcers","author":"Westby MJ","year":"2018","unstructured":"Westby MJ, Dumville JC, Stubbs N, et al. Protease activity as a prognostic factor for wound healing in venous leg ulcers. Cochrane Database Syst Rev. 2018;(9). https:\/\/doi.org\/10.1002\/14651858.CD012841.pub2","journal-title":"Cochrane Database Syst Rev."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.12968\/jowc.2020.29.11.649"},{"issue":"2","key":"e_1_3_3_19_2","first-page":"26","article-title":"A prospective, multicenter study to validate use of the PUSH in patients with diabetic, venous, and pressure ulcers","volume":"56","author":"Hon J","unstructured":"Hon J, Lagden K, McLaren AM, et al. A prospective, multicenter study to validate use of the PUSH in patients with diabetic, venous, and pressure ulcers. 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