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American Journal of Kidney Diseases

Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial

Published:November 14, 2022DOI:https://doi.org/10.1053/j.ajkd.2022.09.013

      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 resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of Staphylococcus aureus.

      Study Design

      A randomized, controlled follow-up pilot study.

      Setting & Participants

      34 patients receiving maintenance hemodialysis with nasal Staphylococcus aureus.

      Intervention(s)

      Decolonization with photodynamic therapy (λ= 660 nm, 400 mW/cm2, 300 seconds, methylene blue 0.01%, single application) or with topical mupirocin (twice a day for 5 days).

      Outcomes

      Nasal swabs were collected at T0 (when carrier state was identified), T1 (immediately after intervention), T2 (1 month after treatment), and T3 (3 months after treatment). Bacterial isolates were subjected to proteomic analysis to identify the species present and were characterized using an antibiogram.

      Results

      All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Among these participants, 12 (71%) had negative T1 cultures compared with 13 (77%) of the 17 participants treated with mupirocin (P=1.000; RR 0.92, CI 0.61 to 1.38). Moreover, 67% of patients who had negative cultures at T1 were recolonized within 3 months. There were no adverse events in the photodynamic therapy group.

      Limitations

      Restricted to nasal colonization and infectious complications were not assessed.

      Conclusions

      Photodynamic therapy is a feasible approach to treating nasal carriage of Staphylococcus aureus. Future larger studies should be conducted to determine if photodynamic therapy is equivalent to the standard of care with mupirocin.

      Graphical abstract

      KEYWORDS

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