A Wearable Extracorporeal Device for Imaging-Guided Therapy of Sepsis Through Rapid Removal of Bacteria.

Sepsis is a severe infectious disease triggered by pathogenic bacteria invading the bloodstream, with mortality risk increasing by 7%-9% for each hour of delayed treatment. Real-time pathogen monitoring and rapid intervention are crucial for the timely and effective management of sepsis. Here, we show that a wearable extracorporeal blood purification device, filled with bioorthogonal polydimethylsiloxane (PDMS) microspheres, can effectively remove bacteria while allowing for visual monitoring of bacteria clearance. The PDMS microspheres exhibit excellent stability in the bloodstream and enable efficient bacterial removal by coupling with metabolic engineering. Moreover, the extracorporeal device serves as a visual window, enabling real-time monitoring of the removal process via NIR II fluorescence imaging of captured bacteria with Ag2Se quantum dot-based nanoprobes. In both rabbit and porcine sepsis models, over 99.5% of bacteria are removed from the bloodstream within 3.5 h, while in situ quantification of removal efficacy is achieved simultaneously, promoting immune homeostasis restoration and rapid resolution of sepsis. The device offers a promising theranostic platform for real-time management of sepsis.