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Real\u2010time 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\u2010time monitoring of the removal process via NIR II fluorescence imaging of captured bacteria with Ag\n                    <jats:sub>2<\/jats:sub>\n                    Se quantum dot\u2010based nanoprobes. In both rabbit and porcine sepsis models, over 99.5% of bacteria are removed from the bloodstream within 3.5\u00a0h, 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\u2010time management of sepsis.\n                  <\/jats:p>","DOI":"10.1002\/smll.74879","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T07:30:31Z","timestamp":1785137431000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Wearable Extracorporeal Device for Imaging\u2010Guided Therapy of Sepsis Through Rapid Removal of Bacteria"],"prefix":"10.1002","volume":"22","author":[{"given":"Yingping","family":"Li","sequence":"first","affiliation":[{"name":"Key Laboratory of Advanced Technologies of Materials, Ministry of Education, Institute of Biomedical Engineering, College of Medicine Southwest Jiaotong University  Chengdu China"},{"name":"School of Materials Science and Engineering Southwest Jiaotong University  Chengdu 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