Purpose: Bacterial infections associated with musculoskeletal injuries are challenging to detect and distinguish from sterile inflammation. Here we present the combined first-time application of a bacteria-targeted positron emission tomography (PET) tracer and a near-infrared fluorescent tracer to detect infected osteosynthesis implants and guide surgical treatment.
Methods: To this end, osteosynthesis plates covered with bacterial biofilm and pre-incubated with [18F]PQ-VE1-vancomycin for PET imaging and/or vancomycin-IRDye800CW for optical imaging were fixed to post-mortem human tibiae and femora. PET/CT and fluorescence imaging were used to quantify the bacterial load before and after surgical debridement.
Results: Pre-debridement, PET imaging showed a significant 2.2-fold higher tracer uptake on biofilm-covered plates compared to plates without biofilm (p < 0.001). Post-debridement, the PET signal was marginal, demonstrating effective biofilm removal. Fluorescence-guided surgery enabled real-time visualization and removal of bacterial biofilms.
Conclusion: Combined preoperative PET and intraoperative fluorescence imaging with vancomycin-based tracers allows noninvasive detection and real-time infection management, as demonstrated by these preliminary findings.
Keywords: Bacterial biofilm; Bacterial imaging agents; Debridement; Fluorescence guided surgery; Fracture-related infections; Human post-mortem; Near infrared fluorescence; Positron emission tomography; Vancomycin.
© 2025. The Author(s).