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Antimicrobial Photodynamic Therapy in Infected Diabetic Foot Ulcers: A Multicenter Preliminary Experience

Matteo Monami Diabetology, Careggi Hospital and University of Florence, Florence, Italy.

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Alessia Scatena Diabetology Unit, San Donato Hospital, Arezzo, Italy.

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Michael Schlecht Clinic for Endocrinology, Diabetology and Geriatric Medicine, Klinikum Stuttgart-Krankenhaus Bad Cannstatt, Stuttgart, Germany.

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Ralf Lobmann Clinic for Endocrinology, Diabetology and Geriatric Medicine, Klinikum Stuttgart-Krankenhaus Bad Cannstatt, Stuttgart, Germany.

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Letizia Landi Diabetology, Careggi Hospital and University of Florence, Florence, Italy.

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Lucia Ricci Diabetology Unit, San Donato Hospital, Arezzo, Italy.

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Edoardo Mannucci Diabetology, Careggi Hospital and University of Florence, Florence, Italy.

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Background:

The increasing resistance of bacteria to antibiotics and the frequency of comorbid conditions of patients make the treatment of diabetic foot infections problematic. In this context, photodynamic therapy could be a useful tool to treat infected wounds. The aim of this study was to evaluate the effect of repeated applications of a phthalocyanine derivative (RLP068) on the bacterial load and on the healing process.

Methods:

The present analysis was performed on patients with clinically infected ulcers who had been treated with RLP068. A sample for microbiological culture was collected at the first visit before and immediately after the application of RLP068 on the ulcer surface, and the area was illuminated for 8 minutes with a red light. The whole procedure was repeated three times per week at two centers (Florence and Arezzo, Italy) (sample A), and two times per week at the third center (Stuttgart, Germany) (sample B) for 2 weeks.

Results:

Sample A and sample B were composed of 55 and nine patients, respectively. In sample A, bacterial load decreased significantly after a single treatment, and the benefit persisted for 2 weeks. Similar effects of the first treatment were observed in sample B. In both samples, the ulcer area showed a significant reduction during follow-up, even in patients with ulcers infected with gram-negative germs or with exposed bone.

Conclusions:

RLP068 seems to be a promising topical wound management procedure for the treatment of infected diabetic foot ulcers.

Corresponding author: Matteo Monami, MD, Diabetology, Careggi Hospital and University of Florence, Via delle Oblate, n. 4 , 50141 Florence, Italy. (E-mail: matteo.monami@unifi.it)