Postoperative Wound Infection Deep Incisional Surgical Site, Prosthesis and Implants, Prosthetic Joint Infection, Surgical Site Infection
Conditions
Brief summary
The overarching aim of this research project is to prevent orthopedic implant-associated infections. This study aims to investigate if PDT has an effect on bacterial skin colonization in order to improve skin antisepsis strategies for the prevention of surgical site infections.
Detailed description
Background: Periprosthetic joint infections are a feared complication after orthopedic surgery in particular in our increasing elderly population. These infections are usually difficult to treat, because microorganisms persist in biofilms on the orthopedic implant surface. Therefore, it would be desirable to prevent these infections. It is hypothesized that bacteria from the skin surface or dermis - such as Staphylococcus aureus, coagulase-negative staphylococci, or Cutibacterium sp. - are transmitted into the periimplant tissue during surgery. In an ongoing interdisciplinary study with the Orthopedic University Hospital Balgrist (data in preparation for publication), the investigators see that common skin antisepsis preparation is not effective to eliminate skin bacteria before surgery because they persist in sebaceous or sweat glands. Photodynamic therapy (PDT) has recently gained attention in the treatment of acne, a disease of the pilosebaceous unit, in which also Cutibacterium acnes is implicated. The PDT works here on the one hand through a long-lasting destruction of the sebaceous glands, and on the other hand due to anti-inflammatory and antimicrobial effects. In a previous pilot study, the investigators tested if skin antisepsis is improved with previous PDT with the photosensitizer-inducing prodrug 5% topical m5-aminolevulinic acid on inguinal skin in 10 participants. The induced photosensitizer was protoporphyrin IX (Pp IX, 635 nm) activated by red light. The investigators showed a complete sterilization of colonizing skin bacteria at the same day after this treatment However, orthopedic surgeons are hesitant to perform an arthroplasty surgery after such a treatment due to skin erythema for a few days. The investigators are entirely convinced about this novel prevention concept but need to identify the photosensitizer with the ideal balance of antibactericidal effect versus skin irritation. Building upon the data they gathered, they will explore PDT with the Protoporphyrin IX inducing prodrug photosensitizer MAL and the photosensitizer Methylene blue with potentially less local side-effects (skin erythema). Primary outcome: Effect of photodynamic treatment with the photosensitizers Pp IX (5-ALA) and Methylene blue in combination with surgical antisepsis on bacterial skin colonization on the day of application and on day 1, 3, and 5 after PDT. Secondary outcome: Effect of PDT on the skin microbiome using molecular techniques.
Interventions
OTHERPhotodynamic Therapy
PDT with two different photosensitizers
Sponsors
University of Zurich
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
Intervention group with PDT * Arm A will receive the photosensitizer 5-ALA * Arm B will receive Methylene blue as photosensitizer for the PDT.
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
* Healthy male and female participants ≥ 18 years who * volunteer for the pilot study in which a routine photodynamic treatment in the Department of Dermatology will be applied and effect of skin colonization will be analyzed, and * an informed consent is signed by the participant (after information about the project).
Exclusion criteria
* Pregnant and lacting women * Participants with inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc., * Participants taking antibiotics in the 14 days prior to PDT or until follow-up at 21 days * Participants who received oral retinoid therapy within the last 6 months * Participants who received anti-inflammatory agents as NSAR within the 14 days prior and after the PDT * Participants taking any photosensitizing drugs within 4 weeks prior to PDT * Participants who had a history of photosensitivity disorder * Fitzpatrick's skin phototype V-VI
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients With no Growth of Bacteria on the Skin on Day 5 Number of Patients With no Growth of Bacteria on the Skin on Day 5 | Day 5 | Quantitative evaluatuation of bacterial density and species from skin ... |
| Number of Patients With no Growth of Bacteria on the Skin | Day 0 after PDT | Quantitative evaluation of bacterial density and species from skin swabs taken before PDT, immeadiately after PDT, and after after skin antisepsis using culture technique |
| Number of Patients With no Growth of Bacteria on the Skin on After 1 Day | Day 1 after PDT | Quantitative evaluatuation of bacterial density and species from skin swabs taken 1 day after PDT before and after skin antisepsis |
| Number of Patients With no Growth of Bacteria on the Skin After 3 Days | Day 3 after PDT | Quantitative evaluatuation of bacterial density and species from skin swabs taken 3 days after PDT before and after skin antisepsis |
Countries
Switzerland
Participant flow
Recruitment details
Each study participant was a control participant as well (procedure on the contralateral leg without intervention)
Participants by arm
| Arm | Count |
|---|---|
| Arm A (MAL Group) 1. Skin swab for culture in the groin for baseline
2. PDT with 5% topical methyl aminolevulinate (MAL) as the prodrug for the photosensitizer Pp IX
3. Skin swab for culture
4. Skin antisepsis
5. Skin swab for culture
Photodynamic Therapy: PDT with two different photosensitizers | 10 |
| Arm B (Methylene Blue Group) 1. Skin swab for culture in the groin for baseline
2. PDT with 0.01% methylene blue based photosensitizer (NF-031)
3. Skin swab for culture
4. Skin antisepsis
5. Skin swab for culture
Photodynamic Therapy: PDT with two different photosensitizers | 10 |
| Total | 20 |
Baseline characteristics
| Characteristic | Arm A (MAL Group) | Arm B (Methylene Blue Group) | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 10 Participants | 10 Participants | 20 Participants |
| Age, Continuous | 27.5 years | 32 years | 30 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 10 Participants | 10 Participants | 20 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment Switzerland | 10 participants | 10 participants | 40 participants |
| Sex: Female, Male Female | 6 Participants | 7 Participants | 13 Participants |
| Sex: Female, Male Male | 4 Participants | 3 Participants | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 10 | 0 / 10 | 0 / 20 |
| other Total, other adverse events | 0 / 10 | 0 / 10 | 0 / 20 |
| serious Total, serious adverse events | 0 / 10 | 0 / 10 | 0 / 20 |
Outcome results
Primary
Number of Patients With no Growth of Bacteria on the Skin
Quantitative evaluation of bacterial density and species from skin swabs taken before PDT, immeadiately after PDT, and after after skin antisepsis using culture technique
Time frame: Day 0 after PDT
Population: Number of patients with no growth of bacteria on the skin
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Arm A (MAL Group) | Number of Patients With no Growth of Bacteria on the Skin | PDT group right side | 3 Participants |
| Arm A (MAL Group) | Number of Patients With no Growth of Bacteria on the Skin | Control side without PDT | 6 Participants |
| Arm B (Methylene Blue Group) | Number of Patients With no Growth of Bacteria on the Skin | PDT group right side | 7 Participants |
| Arm B (Methylene Blue Group) | Number of Patients With no Growth of Bacteria on the Skin | Control side without PDT | 7 Participants |
Primary
Number of Patients With no Growth of Bacteria on the Skin After 3 Days
Quantitative evaluatuation of bacterial density and species from skin swabs taken 3 days after PDT before and after skin antisepsis
Time frame: Day 3 after PDT
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Arm A (MAL Group) | Number of Patients With no Growth of Bacteria on the Skin After 3 Days | 3 Participants |
| Arm B (Methylene Blue Group) | Number of Patients With no Growth of Bacteria on the Skin After 3 Days | 6 Participants |
Primary
Number of Patients With no Growth of Bacteria on the Skin on After 1 Day
Quantitative evaluatuation of bacterial density and species from skin swabs taken 1 day after PDT before and after skin antisepsis
Time frame: Day 1 after PDT
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Arm A (MAL Group) | Number of Patients With no Growth of Bacteria on the Skin on After 1 Day | 2 Participants |
| Arm B (Methylene Blue Group) | Number of Patients With no Growth of Bacteria on the Skin on After 1 Day | 7 Participants |
Primary
Number of Patients With no Growth of Bacteria on the Skin on Day 5 Number of Patients With no Growth of Bacteria on the Skin on Day 5
Quantitative evaluatuation of bacterial density and species from skin ...
Time frame: Day 5
Population: Day 5 was for most of the patients on the weekend which was not feasible to take swabs. Therefore we skipped day 5