Quebec-based hospitals pilot nasal photodisinfection to reduce antibiotic resistance

Quebec-based hospitals pilot nasal photodisinfection to reduce antibiotic resistance

• The world-renowned Montreal Heart Institute and Hôpital Fleurimont, University of Sherbrooke (CHUS) in Sherbrooke, Quebec are piloting nasal photodisinfection to prevent post-operative infections in an era of rising antibiotic resistance.
• 2022 SHEA guidelines elevated nasal decolonization to an essential practice for orthopedic and cardiothoracic surgical procedures.
• The topical antibiotic commonly used for nasal decolonization has bacterial resistance rates reported as high as 81%.

Two of Quebec’s leading hospitals, Montreal Heart Institute (MHI), Canada’s largest cardiology research centre, and the Hôpital Fleurimont, affiliated with the Centre de Recherche (CHUS), University of Sherbrooke, are piloting Ondine’s proprietary Steriwave® nasal photodisinfection in an effort to stay ahead of increasing antibiotic resistance. MHI is evaluating patient outcomes in elective cardiac surgical procedures and Hôpital Fleurimont is evaluating outcomes in elective spine surgeries.

The Steriwave nasal photodisinfection treatment, developed by Canadian life sciences company Ondine Biomedical Inc. (LON: OBI), uniquely kills all types of pathogens – viruses, bacteria, and fungi – in minutes without causing resistance. Pre-surgical use of Steriwave in hospital settings has resulted in significant improvement in post-surgical outcomes including lower rates of surgical site infections (SSIs), reduced patient length of stay, fewer readmissions, and lower rates of antibiotic prescribing.[1]^,[2],[3]

Surgical site infections (SSIs) are serious complications that can occur following surgery and made worse by the growing resistance to antibiotics. Certain types of infection, such as deep sternal infections, can be a serious threat,  increasing a patient’s mortality risk by 40% as surgeons have to reopen the sternum to prevent the infection from spreading to internal organs.[4] Cardiac SSIs are strongly associated with poorer prognosis, longer hospitalization, higher medical costs, and high mortality.[5] Post-surgical infections are also a greater risk for spinal surgeries, affecting up to 17% of patients and treatment can be particularly challenging. [6]^,[7]

Universal pre-operative nasal decolonization has been found to significantly decrease SSIs caused by the infection-causing pathogen S. aureus.[8] The Society for Healthcare Epidemiology of America (SHEA) updated guidelines elevate nasal decolonization from a recommended practice to essential for orthopedic (including spine) and cardiothoracic surgical procedures.[9]

Rising rates of antimicrobial resistance are also a serious concern for both cardiac and spine surgery patients. The reported resistance rates for the antibiotic commonly used for nasal decolonization, mupirocin, are as high as 81%.[10] SSIs involving resistant pathogens are associated with significant increases in the length of hospitalization and costs.[11] Unlike currently used topical antibiotics, Steriwave can eradicate pathogens including extensively drug-resistant (XDR) bacteria, viruses (including coronaviruses), and fungi such as Candida auris.[12]

Ondine Biomedical’s CEO Carolyn Cross said: “We are very pleased to be working with the Montreal Heart Institute, an innovation leader in cardiac research and care. Steriwave offers a powerful alternative to traditional antibiotic-based nasal decolonization, which is undermined by a narrow range of efficacy, antibiotic resistance, and patient compliance issues. For patients, preventing a post-surgical infection can be the difference between life and death. With its immediate, broad-spectrum efficacy—including against extensively drug-resistant (XDR) bacteria, the novel coronavirus, and the emerging fungal threat, Candida auris—without generating resistance, we believe that pre-surgical use of Steriwave can become the new standard of care for improved protection against serious post-surgical multi-drug resistant infections.”

Ondine’s nasal photodisinfection is already in use in or under evaluation at other major hospitals across Canada, including Vancouver General Hospital, The Ottawa Hospital, and the Mazankowski Alberta Heart Institute.

[1] Banaszek D, Inglis T, Tamir Ailon T, Charest-Morin R, Dea N, Fisher C, Kwon B, Paquette S, Street J. The efficacy and cost-effectiveness of photodynamic therapy in prevention of surgical site infection. The Spine Journal, Volume 19, Issue 9, Supplement, 2019, Page S138.

[2] https://www.londonstockexchange.com/news-article/OBI/ottawa-hospital-presents-steriwave-study- results/15860312

[3] Bryce E, Wong T, Forrester L, et al. Nasal photodisinfection and chlorhexidine wipes decrease surgical site infections: a historical control study and propensity analysis [published correction appears in J Hosp Infect. 2015 Sep;91(1):93]. J Hosp Infect. 2014;88(2):89-95. doi:10.1016/j.jhin.2014.06.017

[4] https://www.dicardiology.com/article/rethinking-heart-surgery-surgical-site-infection-prevention

[5] Zukowska A, Zukowski M. Surgical Site Infection in Cardiac Surgery. J Clin Med. 2022 Nov 26;11(23):6991. doi: 10.3390/jcm11236991. PMID: 36498567; PMCID: PMC9738257.

[6] Merkow RP, Ju MH, Chung JW, Hall BL, Cohen ME, Williams MV, Tsai TC, Ko CY, Bilimoria KY. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA. 2015 Feb 3;313(5):483-95. doi: 10.1001/jama.2014.18614.

[7] Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KM, Dellinger EP, Ko CY, Duane TM. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017 Jan;224(1):59-74.

[8] Lemaignen A, Armand-Lefevre L, Birgand G, et al. Thirteen-year experience with universal Staphylococcus aureus nasal decolonization prior to cardiac surgery: a quasi-experimental study. J Hosp Infect. 2018;100(3):322-328. doi:10.1016/j.jhin.2018.04.023.

[9] Calderwood MS, Anderson DJ, Bratzler DW, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2023;44(5):695-720. doi:10.1017/ice.2023.67

[10] Poovelikunnel T, Gethin G, Humphreys H. Mupirocin resistance: clinical implications and potential alternatives for the eradication of MRSA. J Antimicrob Chemother. 2015;70(10):2681-2692. doi:10.1093/jac/dkv169

[11] Weigelt JA, Lipsky BA, Tabak YP, Derby KG, Kim M, Gupta V (2010) Surgical site infections: causative pathogens and associated outcomes. Am J Infect Control 38:112–120. https://doi.org/10.1016/j.ajic.2009.06.010

[12] Ondine Biomedical Inc. (2023, September 14). Steriwave proven highly effective against XDR bacteria [Press release]. https://www.londonstockexchange.com/news-article/OBI/steriwave-proven-effective-against-xdr-bacteria/16124940

[13] Poovelikunnel T, Gethin G, Humphreys H. Mupirocin resistance: clinical implications and potential alternatives for the eradication of MRSA. J Antimicrob Chemother. 2015;70(10):2681-2692. doi:10.1093/jac/dkv169