Abstract
PurposeFracture-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.MethodsExtracted 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.ResultsImportantly, 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.ConclusionHere, 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
Highlights
Fracture-related infection (FRI) is a devastating complication after bone fracture treatment, resulting in severe patient morbidity and loss of quality of life
The investigated patient cohort consisted of 13 patients who underwent revision surgery in the University Medical Center Groningen (UMCG) between January 2018 and February 2020 to extract osteosynthesis devices after a bone fracture treatment
One-half of the plate was used for fluorescence imaging with vanco-800CW, whereas the other half was used for regular diagnostic microbiological culturing (Table S1)
Summary
FRI is a devastating complication after bone fracture treatment, resulting in severe patient morbidity and loss of quality of life. FRIs can be differentiated into (1) acute infections. A major challenge is a distinction between noninfected and infected areas and devices during surgery, especially in the case of low-grade infections. Surgeons rely on tactile and visual information to establish whether and to what extent wound areas are affected by the suspected infection. A definitive preoperative diagnosis of FRI is often not possible in the case of low-grade infections due to the absence of unambiguous clinical symptoms of infection. The results from diagnostic modalities, such as white blood cell scintigraphy, fluorodeoxyglucose positron emission tomography (FDG-PET), or magnetic resonance imaging (MRI), are often inconclusive [3, 5, 6]. A diagnostic imaging tool enabling early, accurate, and realtime visualization of the infecting bacteria themselves, rather than inflammatory responses elicited by the infection, would provide a solution to this clinical problem
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