Photodynamic inactivation of multi‐resistant bacteria (PIB) – a new approach to treat superficial infections in the 21st century

The increasing resistance of bacteria against antibiotics is one of the most important clinical challenges of the 21st century. Within the gram‐positive bacteria the methicillin‐resistant Staphylococcus aureus and Enterococcus faecium represent the major obstacle to successful therapy. Apart from the development of new antibiotics it requires additional differently constituted approaches, like photodynamic inactivation in order to have further effective treatment options against bacteria available. Certain dyes, termed photosensitizers, are able to store the absorbed energy in long‐lived electronic states upon light activation with appropriate wavelengths and thus make these states available for chemical activation of the immediate surroundings. The interaction with molecular oxygen, which leads to different, very reactive and thus cytotoxic oxygen species, is highlighted. In this review the application of the photodynamic inactivation of bacteria will be discussed regarding the possible indications in dermatology, like localized skin and wound infections or the reduction of nosocomial colonization with multi‐resistant bacteria on the skin. The crucial advantage of the local application of photosensitizers followed by irradiation of the area of interest is the fact that independent of the resistance pattern of a bacterium a direct inactivation takes place similarly as with an antiseptic. In this review the physical‐chemical and biological basics of photo‐dynamic inactivation of bacteria (PIB) will be discussed as well as the possible dermatological indications.

[1]  Johnson Lin,et al.  Antimicrobial susceptibility patterns and characterization of clinical isolates of Staphylococcus aureus in KwaZulu-Natal province, South Africa , 2006, BMC infectious diseases.

[2]  T. Dougherty.  Photodynamic therapy. , 1993, Photochemistry and photobiology.

[3]  R. Szeimies,et al.  Antibakterielle photodynamische Therapie , 2005, Der Hautarzt.

[4]  B. Kim,et al.  Pilot study on photodynamic therapy for acne using indocyanine green and diode laser , 2009, The Journal of dermatology.

[5]  B. Murray,et al.  Antibiotic-resistant bugs in the 21st century--a clinical super-challenge. , 2009, The New England journal of medicine.

[6]  Tayyaba Hasan,et al.  Rapid Control of Wound Infections by Targeted Photodynamic Therapy Monitored by In Vivo Bioluminescence Imaging ¶ , 2002, Photochemistry and photobiology.

[7]  Keane Ct,et al.  Strain Variation in the MRSA Population Over a 10-Year Period in One Dublin Hospital , 2002 .

[8]  C. Rovaldi,et al.  P-113d, an Antimicrobial Peptide Active againstPseudomonas aeruginosa, Retains Activity in the Presence of Sputum from Cystic Fibrosis Patients , 2001, Antimicrobial Agents and Chemotherapy.

[9]  M. Vaara,et al.  Characterization of the lipopolysaccharide from the polymyxin‐resistant pmrA mutants of Salmonella typhimurium , 1981, FEBS letters.

[10]  E. J. Young,et al.  The Current Spectrum of Staphylococcus aureus Infection in a Tertiary Care Hospital , 1994, Medicine.

[11]  Benjamin Ehrenberg,et al.  Porphyrin depth in lipid bilayers as determined by iodide and parallax fluorescence quenching methods and its effect on photosensitizing efficiency. , 2004, Biophysical journal.

[12]  J. Jekler.  Phototherapy of atopic dermatitis with ultraviolet radiation. , 1992, Acta dermato-venereologica. Supplementum.

[13]  R. Tompkins,et al.  Antibody-targeted Photolysis of Bacteria In Vivo , 1994, Bio/Technology.

[14]  A. Rossney,et al.  Strain Variation in the MRSA Population Over a 10-Year Period in One Dublin Hospital , 2001, European Journal of Clinical Microbiology and Infectious Diseases.

[15]  Cale Street,et al.  In vivo killing of Staphylococcus aureus using a light-activated antimicrobial agent , 2009, BMC Microbiology.

[16]  P. Stewart,et al.  Lethal and mutational effects of solar and UV radiation on Staphylococcus aureus , 1992, Archives of Microbiology.

[17]  J. Powers,et al.  Trends in antimicrobial drug development: implications for the future. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  P. Appelbaum.  MRSA--the tip of the iceberg. , 2006, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[19]  Michael Kemp,et al.  Excretion of ciprofloxacin in sweat and multiresistant Staphylococcus epidermidis , 1997, The Lancet.

[20]  Joanna Bryant,et al.  Efficacy of a New Cream Formulation of Mupirocin: Comparison with Oral and Topical Agents in Experimental Skin Infections , 2000, Antimicrobial Agents and Chemotherapy.

[21]  Angelo DePaola,et al.  Phage Therapy of Local and Systemic Disease Caused by Vibrio vulnificus in Iron-Dextran-Treated Mice , 2002, Infection and Immunity.

[22]  G. Fabbrocini,et al.  The Effect of Aminolevulinic Acid Photodynamic Therapy on Microcomedones and Macrocomedones , 2009, Dermatology.

[23]  C. Rovaldi,et al.  P-113 D , an Antimicrobial Peptide Active against Pseudomonas aeruginosa , Retains Activity in the Presence of Sputum from Cystic Fibrosis Patients , 2001 .

[24]  S. Boyle-Vavra,et al.  A Spectrum of Changes Occurs in Peptidoglycan Composition of Glycopeptide-Intermediate Clinical Staphylococcus aureus Isolates , 2001, Antimicrobial Agents and Chemotherapy.

[25]  M. Vaara,et al.  Polycations as outer membrane-disorganizing agents , 1983, Antimicrobial Agents and Chemotherapy.

[26]  H. Nikaido,et al.  Mutants of Escherichia coli That Are Resistant to Certain Beta-Lactam Compounds Lack the ompF Porin , 1981, Antimicrobial Agents and Chemotherapy.

[27]  L. Rice.  Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. , 2008, The Journal of infectious diseases.

[28]  A. Kedzierska,et al.  Susceptibility testing and resistance phenotype detection in Staphylococcus aureus strains isolated from patients with atopic dermatitis, with apparent and recurrent skin colonization , 2008, The British journal of dermatology.

[29]  R. Rietschel.  Dermatologic manifestations of antimicrobial adverse reactions with special emphasis on topical exposure. , 1994, Infectious disease clinics of North America.

[30]  S. Mclinn.  A bacteriologically controlled, randomized study comparing the efficacy of 2% mupirocin ointment (Bactroban) with oral erythromycin in the treatment of patients with impetigo. , 1990, Journal of the American Academy of Dermatology.

[31]  R. Weinstein,et al.  Vancomycin-intermediate and -resistant Staphylococcus aureus: what the infectious disease specialist needs to know. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[32]  H. Nikaido,et al.  Molecular basis of bacterial outer membrane permeability. , 1985, Microbiological reviews.

[33]  K. Berg,et al.  THE PHOTODEGRADATION OF PORPHYRINS IN CELLS CAN BE USED TO ESTIMATE THE LIFETIME OF SINGLET OXYGEN , 1991, Photochemistry and photobiology.

[34]  M. Wainwright,et al.  A study of photobactericidal activity in the phenothiazinium series. , 1997, FEMS immunology and medical microbiology.

[35]  W. Cunliffe,et al.  Topical aminolaevulinic acid‐photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action , 2004, The British journal of dermatology.

[36]  J. Jernigan,et al.  Mupirocin resistance. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[37]  R. Anderson,et al.  Topical ALA-photodynamic therapy for the treatment of acne vulgaris. , 2000, The Journal of investigative dermatology.

[38]  G. Horneck,et al.  High sensitivity of Deinococcus radiodurans to photodynamically-produced singlet oxygen. , 1998, International journal of radiation biology.

[39]  K. Bielawski,et al.  Bactericidal effect of photodynamic inactivation against methicillin-resistant and methicillin-susceptible Staphylococcus aureus is strain-dependent. , 2008, Journal of photochemistry and photobiology. B, Biology.

[40]  J. Leyden,et al.  Antibiotic resistance patterns in coagulase‐negative staphylococci after treatment with topical erythromycin, benzoyl peroxide, and combination therapy , 1992, The British journal of dermatology.

[41]  J. Krutmann,et al.  Charakterisierung von Non-Respondern bei der hochdosierten UVA1-Therapie der akut exazerbierten Atopischen Dermatitis , 1997, Der Hautarzt.

[42]  K. Hiller,et al.  Combination of 10% EDTA, Photosan, and a blue light hand‐held photopolymerizer to inactivate leading oral bacteria in dentistry in vitro , 2009, Journal of applied microbiology.

[43]  B. Spellberg.  Antibiotic resistance and antibiotic development. , 2008, The Lancet. Infectious diseases.

[44]  T. Maisch,et al.  Photodynamic Effects of Novel XF Porphyrin Derivatives on Prokaryotic and Eukaryotic Cells , 2005, Antimicrobial Agents and Chemotherapy.

[45]  Michael R Hamblin,et al.  Effect of Cell-Photosensitizer Binding and Cell Density on Microbial Photoinactivation , 2005, Antimicrobial Agents and Chemotherapy.

[46]  M. Landthaler,et al.  A HCl/alcohol formulation increased 5‐aminolevulinic acid skin distribution using an ex vivo full thickness porcine skin model , 2008, Experimental dermatology.

[47]  R. Gaynes,et al.  Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[48]  S. Tajima,et al.  Photodynamic therapy of acne vulgaris with topical δ‐aminolaevulinic acid and incoherent light in Japanese patients , 2001, The British journal of dermatology.

[49]  J. H. Parish,et al.  Photoinactivation of bacteria. Use of a cationic water-soluble zinc phthalocyanine to photoinactivate both gram-negative and gram-positive bacteria. , 1996, Journal of photochemistry and photobiology. B, Biology.