Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial.
Am J Kidney Dis
; 81(5): 528-536.e1, 2023 05.
Article
em En
| MEDLINE
| ID: mdl-36396084
ABSTRACT
RATIONALE & OBJECTIVE:
Infections are an important cause of mortality among patients receiving maintenance hemodialysis. Staphylococcus aureus is a frequent etiological agent, and previous nasal colonization is a risk factor for infection. Repeated antimicrobial decolonization reduces infection in this population but can induce antibiotic resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of S aureus. STUDYDESIGN:
Randomized controlled pilot study. SETTING &PARTICIPANTS:
34 patients receiving maintenance hemodialysis who had nasal carriage of S aureus.INTERVENTIONS:
Patients were randomly assigned to decolonization with a single application of photodynamic therapy (wavelength of 660nm, 400mW/cm2, 300 seconds, methylene blue 0.01%) or with a topical mupirocin regimen (twice a day for 5 days).OUTCOME:
Nasal swabs were collected at time 0 (when the carrier state was identified), directly after treatment completion, 1 month after treatment, and 3 months after treatment. Bacterial isolates were subjected to proteomic analysis to identify the species present, and antimicrobial susceptibility was characterized.RESULTS:
All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Directly after treatment was completed, 12 participants receiving photodynamic therapy (71%) and 13 participants treated with mupirocin (77%) had cultures that were negative for S aureus (risk ratio, 0.92 [95% CI, 0.61-1.38]; P=0.9). Of the patients who had negative cultures directly after completion of photodynamic therapy, 67% were recolonized within 3 months. There were no adverse events in the photodynamic therapy group.LIMITATIONS:
Testing was restricted to assessing nasal colonization; infectious complications were not assessed.CONCLUSIONS:
Photodynamic therapy is a feasible approach to treating nasal carriage of S aureus. Future larger studies should be conducted to determine whether photodynamic therapy is equivalent to the standard of care with mupirocin.FUNDING:
Government grant (National Council for Scientific and Technological Development process 3146682020-9). TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT04047914.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Fotoquimioterapia
/
Infecções Estafilocócicas
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Am J Kidney Dis
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Brasil