Antimicrobial photodynamic therapy may treat nasal carriage of S. aureus
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Antimicrobial photodynamic therapy may be an effective alternative to mupirocin in treating nasal carriage of Staphylococcus aureus in patients on maintenance hemodialysis, according to data in the American Journal of Kidney Diseases.
“Mupirocin is the gold-standard topical treatment for nasal decolonization, but there are reports of increasing bacterial resistance, especially after prolonged and repeated use, thereby limiting its use in the dialysis population,” Daniella T. Bezerra, from the postgraduate program in biophotonics applied to health sciences at the University Nove de Julho in São Paulo, Brazil, and colleagues wrote in the study. “Therefore, we need new effective therapeutic approaches for nasal decolonization which do not induce bacterial resistance and thus can be used regularly to decolonize patients on hemodialysis.”
In a randomized, controlled follow-up pilot study, researchers studied 34 patients receiving maintenance hemodialysis who had nasal S. aureus. Patients were randomized into a control group (n=17), that received mupirocin 2% ointment twice a day for 5 days, or an experimental group (n=17), that received a single application of antimicrobial photodynamic therapy. The primary study outcome was efficacy of decolonization, and the secondary outcomes were adverse events, adherence to treatments and recolonization.
Researchers found that the primary and secondary outcomes did not significantly differ between the control and experimental groups. Efficacy was achieved in 13 of 17 patients in the control and in 12 of 17 patients in the experimental group. However, researchers noted a wide confidence interval for the efficacy outcome (95%, CI: 0.61 to 1.38). Regarding recolonization, this was found in seven of 13 patients in the control group and in eight of 12 patients in the experimental group.
In the control group, four patients reported nasal itching and two patients reported sneezing. However, there were no adverse effects observed in the experimental group.
"This pilot study suggests that [antimicrobial photodynamic therapy] aPDT is a safe treatment, well-tolerated and effective in the decolonization of nasal carriers of S. aureus on hemodialysis. A similar decolonization effectiveness pattern between aPDT treatment and conventional antibiotic treatment with mupirocin should be tested in a larger non-inferiority trial to prove this effect, since aPDT has the advantage of not inducing bacterial resistance and can therefore be used repeatedly and reduce risks for patients,” Bezerra and colleagues wrote. They added, “Future larger studies should be conducted to determine if photodynamic therapy is equivalent to the standard of care with mupirocin.”
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