TRADITIONAL AND NOVEL DIAGNOSTIC
TECHNIQUES TO ASSESS WOUND
INFECTION
Publication of this thesis was generously sponsored by Medical School Twente (Medisch Spectrum Twente) and the University of Twente (BMS-OMD). Cover design: Maarten Kleijne
Lay-out: Marieke Haalboom & Maarten Kleijne Printed by: Gildeprint
ISBN: 978-90-365-4725-3 DOI: 10.3990/1.9789036547253
© 2019 Marieke Haalboom, the Netherlands. All rights reserved. No parts of this thesis may be reproduced, stored in a retrieval system or transmitted in any form or by any means without permission of the author.
TRADITIONAL AND NOVEL DIAGNOSTIC TECHNIQUES TO
ASSESS WOUND INFECTION
PROEFSCHRIFT
ter verkrijging van
de graad van doctor aan de Universiteit Twente, op gezag van de rector magnificus,
prof. dr. T.T.M. Palstra,
volgens besluit van het College voor Promoties in het openbaar te verdedigen op vrijdag 22 maart 2019 om 12:45 uur
door
Maartje Theodora Haalboom
geboren op 25 augustus 1990PROMOTIE COMMISSIE
Voorzitter: Prof. dr. T.A.J. Toonen Universiteit Twente Promotor: Prof. dr. J. van der Palen Universiteit Twente Co-promotor: Dr. R.J. Beuk Medisch Spectrum Twente
Leden: Prof. dr. S. Siesling Universiteit Twente Prof. dr. G.C.M Kusters Universiteit Twente
Prof. dr. C.J.A.M. Zeebregts Universitair Medisch Centrum
Groningen
Prof. dr. D.T. Ubbink Academisch Medisch Centrum Amsterdam
Prof. dr. ir. G. Gübitz Universität für Bodenkultur, Wenen, Oostenrijk
CONTENTS
PART I: INTRODUCTION
CHAPTER 1: GENERAL INTRODUCTION ………... 3 CHAPTER 2: WOUND HEALING IN CHRONIC WOUNDS ……… 11 PART II: TRADITIONAL DIAGNOSTIC TECHNIQUES TO ASSESS WOUND INFECTION CHAPTER 3: WOUND SWAB AND WOUND BIOPSY YIELD SIMILAR CULTURE RESULTS ………... 35 CHAPTER 4: CULTURE RESULTS FROM WOUND BIOPSY VERSUS WOUND SWAB: DOES IT MATTER FOR THE ASSESSMENT OF WOUND INFECTION? ……….. 57 PART III: NOVEL DIAGNOSTIC TECHNIQUES TO ASSESS WOUND INFECTION CHAPTER 5: RAPID ENZYME ANALYSIS AS A DIAGNOSTIC TOOL FOR WOUND INFECTION: COMPARISON BETWEEN CLINICAL JUDGMENT, MICROBIOLOGICAL ANALYSIS AND ENZYME ANALYSIS ..………... 79 CHAPTER 6: A STUDY INTO THE DIAGNOSTIC PROPERTIES OF A NEW DEVICE FOR RAPID BEDSIDE TESTING OF INFECTION IN CHRONIC WOUNDS: THE INFACT 2 STUDY ……….… 99 CHAPTER 7: ELEVATED WOUND FLUID PH CORRELATES WITH INCREASED RISK OF WOUND INFECTION AS JUDGED BY EXPERT CLINICIANS AND MARKERS OF HOST INNATE IMMUNE RESPONSE ……….. 121 CHAPTER 8: DIFFERENTIATION BETWEEN INFECTED AND NOT INFECTED WOUNDS USING AN ELECTRONIC NOSE ………... 135 PART IV: DISCUSSION, SUMMARY AND ACKNOWLEDGMENTS
CHAPTER 9: GENERAL DISCUSSION ………....… 153 CHAPTER 10: SUMMARY – SAMENVATTING – DANKWOORD – CURRICULUM VITAE ………. 171
