Bacteria-targeted fluorescence imaging of extracted osteosynthesis devices for rapid visualization of fracture-related infections

Abstract

Purpose Fracture-related infection (FRI) is a serious complication in orthopedic trauma surgery worldwide. Especially, the distinction of infection from sterile inflammation and the detection of low-grade infection are highly challenging. The objective of the present study was to obtain proof-of-principle for the use of bacteria-targeted fluorescence imaging to detect FRI on extracted osteosynthesis devices as a step-up towards real-time image-guided trauma surgery. Methods Extracted osteosynthesis devices from 13 patients, who needed revision surgery after fracture treatment, were incubated with a near-infrared fluorescent tracer composed of the antibiotic vancomycin and the fluorophore IRDye800CW (i.e., vanco-800CW). Subsequently, the devices were imaged, and vanco-800CW fluorescence signals were correlated to the results of microbiological culturing and to bacterial growth upon replica plating of the imaged devices on blood agar. Results Importantly, compared to culturing, the bacteria-targeted fluorescence imaging of extracted osteosynthesis devices with vanco-800CW allows for a prompt diagnosis of FRI, reducing the time-to-result from days to less than 30 min. Moreover, bacteria-targeted imaging can provide surgeons with real-time visual information on the presence and extent of infection. Conclusion Here, we present the first clinical application of fluorescence imaging for the detection of FRI. We conclude that imaging with vanco-800CW can provide early, accurate, and real-time visual diagnostic information on FRI in the clinical setting, even in the case of low-grade infections. Graphical abstract

Recent Development of Photoresponsive Liposomes Based on Organic Photosensitizers, Au Nanoparticles, and Azobenzene Derivatives for Nanomedicine

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Bridging the Translation of ICG-1-Maltotriose: A Multimodal Sensor for Monitoring and Detecting Bacterial Infections

“…Other groups have described vancomycin-IRDye 800CW (Vanco-800CW) for imaging of infections with Gram-positive bacteria, showing the feasibility of labeling the antibiotic vancomycin without abolishing the binding affinity to its bacterial target. , This approach has been used mostly to demonstrate surgical implant infection in preclinical studies and endocarditis models. Vanco-800CW has also been used to image cultures from the extracted osteosynthesis material to visualize fracture-related infection . Unfortunately, since vancomycin is an antibiotic, using this compound to image bacteria increases the risk for antibiotic resistance.…”

“…Vanco-800CW has also been used to image cultures from the extracted osteosynthesis material to visualize fracture-related infection. 31 Unfortunately, since vancomycin is an antibiotic, using this compound to image bacteria increases the risk for antibiotic resistance. There are also strategies to image Gram-negative bacteria, such as topical administration of the lipid A-targeting antimicrobial peptide polymyxin labeled with the fluorescent 7-nitrobenz-2-oxa-1,3-diazole (PMX-NBD) using confocal laser endomicroscopy (CLE).…”

Design of a portable fluorescence imaging platform for on-site detection target analyte by loop-medicated isothermal amplification

“…Based on the survey for available portable fluorescence detection devices on the market, there was a notable drawback: their steep cost. Traditional laboratory fluorescence detection involves the use of pulsed UV lasers and spectrometers [13], Fluorescence Probes [14], and high-grade microscopes to observe fluorescent bacteria [15]. An alternative approach involves the development of handheld devices targeting surface contamination such as tabletops, floors, and restaurant environments using fluorophores like collagen, flavins, bacterial porphyrins, and chlorophyll.…”