Is surgical debridement necessary in the diabetic foot treated with photodynamic therapy?

Tardivo, João Paulo; Serrano, Rodrigo Lorenzetti; Zimmermann, Livia M.; Matos, Leandro Luongo de; Baptista, Maurı́cio S.; Pinhal, Maria Aparecida da Silva; Atallah, Álvaro Nagib

doi:10.1080/2000625x.2017.1373552

Cited by 15 publications

(13 citation statements)

References 16 publications

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“…For proof of the principle of the applicability of the Repuls7PDI, we tested two photosensitizers and three different microbial model systems. Phenothiazinium dyes, such as MB [4], are widely used in PDT, and applications range from the treatment of diabetic leg ulcers [22], of infected burn wounds [23] and antibacterial fabrics [24], to environmental applications such as the treatment of plant pathogens [16]. Our results using red light activation prove the photoantimicrobial activity of MB against all bacteria and fungi employed in this study.…”

Section: Discussionsupporting

confidence: 59%

In the Right Light: Photodynamic Inactivation of Microorganisms Using a LED-Based Illumination Device Tailored for the Antimicrobial Application

Hasenleitner

Plaetzer

2019

Antibiotics

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Drug-resistant bacteria threaten the health of people world-wide and cause high costs to their health systems. According to Scientific American, the number of regrettable fatalities due to the bacteria that are resistant to conventional antibiotics will sum up to 300 million until 2050 if the problem is not tackled immediately. Photodynamic Inactivation (PDI) has proven effective against microorganisms irrespective of their resistance to conventional treatment, but for the translation into clinical practice, economic, homogenous and powerful light sources holding approval as medical devices are needed. In this study we present two novel light emitting diode (LED)-based lamps (Repuls7PDI-red and Repuls7PDI-blue) tailored for application in PDI and demonstrate their photodynamic efficiency upon using either methylene blue (MB), a photoactive compound widely used in PDI, or Sodium Magnesium Chlorophyllin (CHL), a water-soluble derivative of chlorophyll, which holds approval as food additive E140, against bacteria and fungi. Gram+ Staphylococcus aureus, Gram− Escherichia coli and the yeast Candida albicans serve as model systems. Repuls7PDI-red emits a wavelength of 635 nm and an intensity of 27.6 ± 2.4 mW·cm−2 at a distance of 13.5 cm between the light source and the target, while the Repuls7PDI-blue allows an exposure at 433 nm (within the range of violet light) (6.4 ± 0.5 mW·cm−2 at 13.5 cm). Methylene blue was photoactivated with the Repuls7PDI-red at 635 nm (25.6 J·cm−2) and allows for photokilling of E. coli by more than 6 log10 steps at a concentration of 10 µM MB. Using equal parameters, more than 99.99999% of S. aureus (20 µM MB) and 99.99% of C. albicans (50 µM MB) were killed. If blue light (Repuls7PDI-blue, 433 nm, 6.6 J·cm2) is used to trigger the production of reactive oxygen species (ROS), a photoinactivation of S. aureus (5 µM CHL, CFU reduction > 7 log10) and C. albicans (>7 log10) below the detection limit is achieved. PDI based on CHL (10 µM) using red light activation reduces the number of viable S. aureus by more than 6 log10. Our data prove that both LED-based light sources are applicable for Photodynamic Inactivation. Their easy-to-use concept, high light output and well-defined wavelength might facilitate the translation of PDI into clinical practice.

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Section: Discussionsupporting

confidence: 59%

In the Right Light: Photodynamic Inactivation of Microorganisms Using a LED-Based Illumination Device Tailored for the Antimicrobial Application

Hasenleitner

Plaetzer

2019

Antibiotics

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“…The use of aPDT is well documented for many diseases and conditions such as infected leg ulcers, 20 diabetic foot, 21 and chronic skin ulcers. 22 With specific regard to the oral environment, its action includes the treatment of leukoplakia, 17 lichen planus, 23 periodontal pockets, 24 peri-implantitis, 25 and oral decontamination as well.…”

Section: Discussionmentioning

confidence: 99%

The Combination of Antimicrobial Photodynamic Therapy and Photobiomodulation Therapy for the Treatment of Palatal Ulcers: A Case Report

Maya¹,

Ladeira

Maya

et al. 2020

J Lasers Med Sci

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Introduction: One of the unexpected side effects of the Haas type palatal expander is ulcers progressing to necrotic lesions in the palatal area due to poor hygiene. The use of antibiotic therapy is mandatory. However, long periods of healing/pain and the need for a systemic host response with the aid of metabolization, especially in children, are issues that should be taken into account in the management of this type of injury. Since phototherapy modalities (antimicrobial photodynamic therapy [aPDT] and photobiomodulation therapy [PBMT]) are able to enhance and accelerate the healing process and reduce the bacterial load, this case report aimed to describe the use of the above-mentioned therapies to treat palatal ulcers occurring during orthodontic expansion. Case Report: The patient, a 10-year-old boy, with a chief complaint of bleeding and continuous pain in the region of his expander was verified on a follow-up visit. After a dental examination, the expander was removed and two necrotic lesions which were in contact with the acrylic part of the tooth-tissue expander were found in the palatal region. The proposal was to use one aPDT session with methylene blue followed by 4 sessions of PBMT with a red laser diode. On the 5th day, reorganized tissue was verified, with the absence of bleeding, swelling, and pain. On the 20th day of follow-up, the area showed no signs of inflammation, healthy tissue without any pathological clinical symptoms, and complete wound healing. Conclusion: The concomitant use of PBMT and aPDT therapies may be considered feasible as an adjunct treatment to manage palatal ulcers resulting from the incorrect use of tooth-tissue types of expanders

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“…Almost all photosensitizers show photodynamic activity against gram‐positive bacteria, but activity against gram‐negative bacteria is limited to certain cationic photosensitizers. A few small published studies of low quality have reported that PDT lowered bacterial load, cured infections, and may have helped reduce lower extremity amputations . While PDT appears to be safe and well tolerated, commercial products are not yet available in most countries, and it is unclear if using PDT without systemic antibiotic therapy will be possible for most patients.…”

Section: Treatmentmentioning

confidence: 99%

“…A few small published studies of low quality have reported that PDT lowered bacterial load, cured infections, and may have helped reduce lower extremity amputations. [194][195][196][197] While PDT appears to be safe and well tolerated, commercial products are not yet available in most countries, and it is unclear if using PDT without systemic antibiotic therapy will be possible for most patients.…”

Section: Recommendation 27mentioning

confidence: 99%

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

Lipsky

Senneville

Abbas

et al. 2020

Diabetes Metabolism Res

521

729

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis and treatment of foot infection in persons with diabetes and updates the 2015 IWGDF infection guideline. On the basis of patient, intervention, comparison, outcomes (PICOs) developed by the infection committee, in conjunction with internal and external reviewers and consultants, and on systematic reviews the committee conducted on the diagnosis of infection (new) and treatment of infection (updated from 2015), we offer 27 recommendations. These cover various aspects of diagnosing soft tissue and bone infection, including the classification scheme for diagnosing infection and its severity. Of note, we have updated this scheme for the first time since we developed it 15 years ago. We also review the microbiology of diabetic foot infections, including how to collect samples and to process them to identify causative pathogens. Finally, we discuss the approach to treating diabetic foot infections, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and for bone infections, when and how to approach surgical treatment, and which adjunctive treatments we think are or are not useful for the infectious aspects of diabetic foot problems. For this version of the guideline, we also updated four tables and one figure from the 2016 guideline. We think that following the principles of diagnosing and treating diabetic foot infections outlined in this guideline can help clinicians to provide better care for these patients.

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Is surgical debridement necessary in the diabetic foot treated with photodynamic therapy?

Cited by 15 publications

References 16 publications

In the Right Light: Photodynamic Inactivation of Microorganisms Using a LED-Based Illumination Device Tailored for the Antimicrobial Application

In the Right Light: Photodynamic Inactivation of Microorganisms Using a LED-Based Illumination Device Tailored for the Antimicrobial Application

The Combination of Antimicrobial Photodynamic Therapy and Photobiomodulation Therapy for the Treatment of Palatal Ulcers: A Case Report

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

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