Evaluation of a rapid multispectral autofluorescence device for detection and classification of bacterial infections in wounds reported to a tertiary hospital in Delhi.

BACKGROUND: Antimicrobial resistance is a growing global health challenge, amplified by the empirical use of broad-spectrum antibiotics in wound management. Conventional microbial cultures require 48-72 hours for pathogen identification, delaying targeted therapy and promoting inappropriate antibiotic use. OBJECTIVE: This study evaluated the diagnostic performance of the Illuminate® multispectral autofluorescence imaging device for rapid detection and Gram-type classification of wound infections, compared with standard culture method. METHODS: A cross-sectional study was conducted over six months at a tertiary hospital in Delhi, among 163 patients with fresh open wounds. The Illuminate® device captured autofluorescence images (365-415 nm) and provided Gram-type classification within two minutes. Parallel samples underwent Gram staining and aerobic culture according to Clinical and Laboratory Standards Institute guidelines. Diagnostic accuracy metrics were computed using STATA v17. RESULTS: The Illuminate® device demonstrated strong diagnostic performance, showing an overall accuracy of 81.6% for Gram-negative bacteria (Cohen's κ = 0.6213, p < 0.01) and 86.5% for Gram-positive bacteria (κ = 0.5916, p < 0.01). CONCLUSION: The Illuminate® device offers rapid, reagent-free bacterial classification with high specificity for both Gram types, but sensitivity for Gram-positive bacteria was only moderate; used as an adjunct to, rather than a replacement for, culture, it may support earlier antibiotic optimization and advance antimicrobial stewardship in wound care.