目的:慢性伤口昂贵且难以治疗,在某些情况下,由于耐甲氧西林金黄色葡萄球菌(MRSA)负担较高,导致发病率甚至死亡率。我们旨在观察新型光敏剂生泰补芬(STBF)介导的抗菌光动力疗法(PDT)对MRSA感染的慢性腿部溃疡的抗菌活性和促进愈合的作用。
方法:这是一个回顾性研究,比较,单中心临床研究。通过检索华东医院皮肤科的电子病历,最终将2022年1月至2023年12月的32例感染MRSA的慢性下肢伤口患者纳入本研究,包括一组红光联合碘伏(对照+碘伏,n=16,每周一次接受红光,持续8周,每天一次使用碘伏常规换药)和一组STBF介导的PDT(STBF-PDT)联合碘伏(STBF-PDT+碘伏,n=16,接受STBF-PDT和每日一次碘伏常规换药)。STBF-PDT每周进行一次(1mg/mlSTBF,孵育1小时,630nm红光,80J/cm2)持续8周。主要终点包括伤口临床体征,伤口大小,伤口相关疼痛,再上皮化评分,MRSA负荷和伤口相关生活质量(伤口-QoL)。还记录任何不良事件。
结果:我们发现STBF-PDT+碘伏能有效缓解临床感染症状,加速伤口闭合,与对照组+碘伏组相比,降低平均生物负荷并改善伤口生活质量,无严重不良事件。STBF-PDT+碘伏组伤口大小平均减少65.22%(从18.96±11.18cm2降至6.59±7.94cm2),再上皮化评分优异,与对照组碘伏组相比,下降了30.17%(从19.23±9.80cm2降至13.43±9.32cm2)。在第6周(p=0.028*)和第8周(p=0.002**)观察到伤口面积的显著差异。STBF-PDT碘伏组的细菌载量降低了99.86%(从6.45×107±2.69×107降至8.94×104±1.92×105CFU/cm2,p<0.0001),而1.82%(从6.61×107±2.13×107降至6.49×107±2.01×107CFU/cm2,p=0.029)。与接受红灯和常规伤口护理的患者相比,STBF-PDT碘伏组的伤口QoL总体评分降低了51.62%(从最初的29.65±9.33降至第8周的14.34±5.17,p<0.0001)(从第8周的30.73±17.16降至29.32±15.89,p=0.003)。此外,接受STBF-PDT+碘伏治疗的患者在伤口QoL的所有领域都表现出巨大的改善(物理,心理和日常生活),而对照组+碘伏组仅在一个领域(日常生活)得到改善。
结论:我们的数据证实了一种新型光敏剂,STBF介导的PDT,当与碘伏联合使用时,作为MRSA感染的潜在方式和其他耐药微生物的可能疗法,并作为慢性皮肤传染病的有希望的替代品。
OBJECTIVE: Chronic wounds are costly and difficult to treat, resulting in morbidity and even mortality in some cases due to a high methicillin-resistant Staphylococcus aureus (MRSA) burden contributing to chronicity. We aimed to observe the antimicrobial activity and healing-promoting effect of a novel photosensitizer Shengtaibufen (STBF)-mediated antibacterial photodynamic therapy (PDT) on MRSA-infected chronic leg ulcers.
METHODS: This was a retrospective, comparative, single-center clinical study. A total of 32 patients with chronic lower limb wounds infected with MRSA from January 2022 to December 2023 were finally included in this study by searching the electronic medical records of the dermatology department of Huadong Hospital, including a group of red light combined with iodophor (control+iodophor, n=16, receiving red light once a week for 8 weeks and routine dressing change with iodophor once a day) and a group of STBF-mediated PDT (STBF-PDT) combined with iodophor (STBF-PDT+iodophor, n=16, receiving STBF-PDT and routine dressing change with iodophor once a day). STBF-PDT was performed once a week (1 mg/ml STBF, 1 h incubation, 630 nm red light, 80 J/cm2) for 8 weeks. The primary endpoints included wound clinical signs, wound size, wound-related pain, re-epithelialization score, MRSA load and wound-related quality of life (wound-QoL). Any adverse events were also recorded.
RESULTS: We found that STBF-PDT+iodophor could effectively alleviate clinical infection symptoms, accelerate wound closure, reduce average biological burden and improve wound-QoL without severe adverse events in comparison to the control+iodophor group. The STBF-PDT+iodophor group obtained a mean percentage reduction of 65.22% in wound size (from 18.96±11.18 cm2 to 6.59±7.94 cm2) and excellent re-epithelialization scores, as compared with a decrease of 30.17% (from 19.23±9.80 cm2 to 13.43±9.32 cm2) for the control+iodophor group. Significant differences in wound area were observed at week 6 (p=0.028*) and week 8 (p=0.002**). The bacterial load decreased by 99.86% (from 6.45 × 107±2.69 × 107 to 8.94 × 104±1.92 × 105 CFU/cm2, p<0.0001) in the STBF-PDT+iodophor group and 1.82% (from 6.61 × 107±2.13 × 107 to 6.49 × 107±2.01 × 107 CFU/cm2, p=0.029) in the control+iodophor group. The wound-QoL in STBF-PDT+iodophor group had a 51.62% decrease in overall score (from 29.65±9.33 at the initial to 14.34±5.17 at week 8, p<0.0001) compared to those receiving red light and routine wound care (from 30.73±17.16 to 29.32±15.89 at week 8, p=0.003). Moreover, patients undergoing STBF-PDT+iodophor exhibited great improvements in all domains of wound-QoL (physical, psychological and everyday-life), whereas the control+iodophor group ameliorated in only one field (everyday-life).
CONCLUSIONS: Our data confirmed that a novel photosensitizer, STBF-mediated PDT, when combined with iodophor, served as a potential modality for MRSA infection and a possible therapy for other drug-resistant microorganisms, and as a promising alternative for chronic cutaneous infectious diseases.