J Bone Jt Infect 2020; 5(4):187-197. doi:10.7150/jbji.46199

Research Paper

Effect of Blue Light and Photosensitizers on Cutibacterium acnes on Shoulder Periprosthetic Joint Infection Isolates

Swati Bhargava1, Thomas Listopadzki2, Sara Diletti2, John K. Crane1✉, Thomas R. Duquin3, K. Keely Boyle3✉

1. Department Medicine, Division of Infectious Disease, University at Buffalo, Buffalo, NY.
2. Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.
3. Department of Orthopaedics, State University of New York at Buffalo, Buffalo, NY.

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Citation:
Bhargava S, Listopadzki T, Diletti S, Crane JK, Duquin TR, Boyle KK. Effect of Blue Light and Photosensitizers on Cutibacterium acnes on Shoulder Periprosthetic Joint Infection Isolates. J Bone Jt Infect 2020; 5(4):187-197. doi:10.7150/jbji.46199. Available from http://www.jbji.net/v05p0187.htm

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Abstract

Introduction: Cutibacterium acnes is gaining recognition as a leading pathogen after orthopaedic shoulder procedures. Photodynamic therapy, a combination of light and a photosensitizer, has demonstrated antimicrobial activity against C. acnes in the treatment of acne vulgaris. We sought to evaluate the effect of photodynamic therapy using blue light and photosensitizers on C. acnes isolates from shoulder prosthetic joint infections.

Methods: C. acnes strains isolated from 19 patients with shoulder PJI were exposed to blue light alone (415 nm) or in combination with photosensitizers (fluorescein, riboflavin and demeclocycline). C. acnes strains were divided into 4 categories: Highly Sensitive (HS), Sensitive (S), Weakly Sensitive (WS), Resistant to blue light.

Results: 13 of 19 C. acnes strains (68%) were S or HS to blue light alone. Of these 19 strains tested, 11 were tested with blue light and fluorescein or blue light plus riboflavin. Fluorescein (1 µg/mL) enhanced the effect of blue light in 6 of 11 strains (55%). Blue light plus riboflavin (10 µg/mL) resulted enhanced killing in 3 of 11 strains (27%), but produced a paradoxical photoprotective effect in 4 of 11 strains (36%), resulting in a net decrease compared to blue light alone. Demeclocycline, however, enhanced the effect of blue light in 16 of 17 strains (94 %).

Conclusions: Blue light with the addition of photosensitizers killed C. acnes from periprosthetic shoulder infections in vitro, with demeclocycline having the most pronounced effect.

Keywords: Propionibacterium acnes, shoulder infection, demeclocycline, anaerobic pathogens, fluorescein, riboflavin