Bacteria-targeted fluorescence imaging of extracted osteosynthesis devices for rapid visualization of
Marina López-Álvarez1, Marjolein Heuker1, Klaas A Sjollema2
1Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30001, 9700 RB, Groningen, The Netherlands.
Purpose:
Fracture-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.
Methods:
Extracted 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.
Results:
Importantly, 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.
Conclusion:
Here, 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.
Insights
Bacteria-targeted fluorescence imaging offers a rapid and accurate method for detecting fracture-related infections (FRI) on removed orthopedic devices. This technique provides real-time visual diagnostic information, significantly reducing diagnosis time compared to traditional methods.
Area of Science:
- Orthopedic Surgery
- Medical Imaging
- Infectious Diseases
Background:
- Fracture-related infection (FRI) is a significant challenge in orthopedic trauma surgery.
- Distinguishing FRI from sterile inflammation and detecting low-grade infections are difficult.
- Current diagnostic methods for FRI can be time-consuming.
Purpose of the Study:
- To demonstrate the feasibility of bacteria-targeted fluorescence imaging for detecting FRI.
- To evaluate this imaging technique on extracted osteosynthesis devices.
- To advance towards real-time image-guided orthopedic trauma surgery.
Main Methods:
- Extracted osteosynthesis devices from 13 patients undergoing revision surgery were used.
- Devices were incubated with a near-infrared fluorescent tracer (vancomycin-IRDye800CW, vanco-800CW).
- Fluorescence signals were correlated with microbiological culturing and replica plating results.
Main Results:
- Bacteria-targeted fluorescence imaging with vanco-800CW enabled prompt FRI diagnosis in under 30 minutes.
- This is a significant reduction from the days required for traditional culturing.
- The imaging provided real-time visual data on infection presence and extent.
Conclusions:
- This study presents the first clinical application of fluorescence imaging for FRI detection.
- Vanco-800CW imaging provides early, accurate, and real-time diagnostic information for FRI.
- The technique is effective even for diagnosing low-grade infections in a clinical setting.
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