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Brandly JE, Levine DG, Stefanovski D, Aitken MR. In vitro evaluation of the effect of tris-EDTA and 0.0005% chlorhexidine solution on the strength of two absorbable sutures. Vet Surg 2024; 53:701-709. [PMID: 37743444 DOI: 10.1111/vsu.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 08/13/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To determine the effect of 0.0005% chlorhexidine and tris-EDTA solution on the strength of three commonly used suture types for closure of equine ventral midline celiotomy. STUDY DESIGN Controlled laboratory study. SAMPLE POPULATION Knotted loops (n = 10/group, 150 knot constructs total). METHODS Strands of 2 polyglactin 910, 3 polyglactin 910, and 2 polydioxanone were tied to form knotted loops. All knotted loops were mounted on a tabletop force measurement machine system and loaded at 100 mm/min until the breaking force (N) was determined. The breaking force (N) of knotted loops using dry suture was recorded at study start, then of knotted loops soaked in either 0.0005% chlorhexidine and tris-EDTA for 20 min followed by incubation in equine serum (treatment) or serum alone (control) for 14 and 21 days. Analysis of variance (ANOVA) compared the breaking force between the treatment and control groups at each time point. RESULTS There was no significant difference in the breaking force of 2 USP polyglactin 910 (p = .35, confidence interval [CI] = -0.21-0.59), 3 USP polyglactin 910 (p = .61, CI = -0.41-0.24), or 2 USP polydioxanone (p = .76, CI = -0.63-0.46) soaked in 0.0005% chlorhexidine and tris-EDTA solution followed by equine serum when compared to each respective suture soaked in equine serum only. CONCLUSION/CLINICAL SIGNIFICANCE Since 0.0005% chlorhexidine and tris-EDTA solution did not exhibit a significant effect on the breaking force of the absorbable sutures studied, the solution may be used for incisional lavage in the clinical setting.
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Affiliation(s)
- Jerrianne E Brandly
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - David G Levine
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Maia R Aitken
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
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Zebley JA, Klein A, Wanersdorfer K, Quintana MT, Sarani B, Estroff JM, Kartiko S. 0.05% Chlorhexidine Gluconate Irrigation in Trauma/Emergency General Surgical Laparotomy Wounds Closure: A Pilot Study. J Surg Res 2024; 293:427-432. [PMID: 37812876 DOI: 10.1016/j.jss.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Patients who undergo exploratory laparotomy (EL) in an emergent setting are at higher risk for surgical site infections (SSIs) compared to the elective setting. Packaged Food and Drug Administration-approved 0.05% chlorhexidine gluconate (CHG) irrigation solution reduces SSI rates in nonemergency settings. We hypothesize that the use of 0.05% CHG irrigation solution prior to closure of emergent EL incisions will be associated with lower rates of superficial SSI and allows for increased rates of primary skin closure. METHODS A retrospective observational study of all emergent EL whose subcutaneous tissue were irrigated with 0.05% CHG solution to achieve primary wound closure from March 2021 to June 2022 were performed. Patients with active soft-tissue infection of the abdominal wall were excluded. Our primary outcome is rate of primary skin closure following laparotomy. Descriptive statistics, including t-test and chi-square test, were used to compare groups as appropriate. A P value <0.05 was statistically significant. RESULTS Sixty-six patients with a median age of 51 y (18-92 y) underwent emergent EL. Primary wound closure is achieved in 98.5% of patients (65/66). Bedside removal of some staples and conversion to wet-to-dry packing changes was required in 27.3% of patients (18/66). We found that most of these were due to fat necrosis. We report no cases of fascial dehiscence. CONCLUSIONS In patients undergoing EL, intraoperative irrigation of the subcutaneous tissue with 0.05% CHG solution is a viable option for primary skin closure. Further studies are needed to prospectively evaluate our findings.
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Affiliation(s)
- James A Zebley
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Andrea Klein
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Karen Wanersdorfer
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Megan T Quintana
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Babak Sarani
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Jordan M Estroff
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia
| | - Susan Kartiko
- Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
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Diaz JC, Braunstein ED, Cañas F, Duque M, Marín JE, Aristizabal J, Niño CD, Bastidas O, Hoyos C, Steiger NA, Matos CD, Sauer WH, Romero JE. Chlorhexidine gluconate pocket lavage to prevent cardiac implantable electronic device infection in high-risk procedures. Heart Rhythm 2023; 20:1674-1681. [PMID: 37598986 DOI: 10.1016/j.hrthm.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Infection is the most dreaded complication of cardiac implantable electronic devices (CIEDs), particularly in patients undergoing high-risk procedures (eg, generator change, device upgrade, lead/pocket revision). OBJECTIVE The purpose of this study was to describe the impact of chlorhexidine gluconate (CHG) pocket lavage in high-risk procedures. METHODS Patients from a prospective multicenter registry undergoing high-risk procedures were included. CHG lavage was performed by irrigating the generator pocket with 20 cc of 2% CHG without alcohol followed by and normal saline (NS) irrigation. Only NS irrigation was performed in the comparison group. The primary efficacy outcome was CIED-related infection at 12 months. The primary safety outcome was any CHG-associated adverse event. The secondary outcome was CIED infection during long-term follow-up. Propensity score matching (PSM) analysis was performed for the primary efficacy outcome. RESULTS A total of 1504 patients were included. At 12-month follow-up, the primary efficacy outcome occurred in 4 of 904 CHG (0.4%) and 14 of 600 NS (2.3%) subjects (log-rank P = .005). On multivariate analysis, the use of CHG irrigation was associated with a lower risk of infection at 1-year follow-up (Cox proportional hazard ratio [HR] 0.138; 95% confidence interval [CI] 0.04-0.45; P = .001). This effect persisted during long-term follow-up. PSM demonstrated a significant reduction in CIED-related infection for the CHG group (0.2% vs 2.5%; Cox proportional HR 0.08; 95% CI 0.01-0.59; P = .014). No adverse events were associated with the use of CHG. CONCLUSION CHG lavage during high-risk procedures was associated with a reduction in CIED-related infections without any adverse events reported. The benefits of CHG lavage were observed even during long-term follow up and in PSM analysis.
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Affiliation(s)
- Juan Carlos Diaz
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia.
| | - Eric D Braunstein
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California
| | - Felipe Cañas
- Universidad CES School of Medicine, Medellin, Colombia
| | - Mauricio Duque
- Cardiac Electrophysiology Service, Hospital San Vicente Fundación, Rionegro, Colombia
| | - Jorge Eduardo Marín
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Julian Aristizabal
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Department of Medicine, Clinica Las Americas, Medellin, Colombia
| | - Cesar Daniel Niño
- Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobon, Medellin, Colombia
| | - Oriana Bastidas
- Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nathaniel A Steiger
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Griggs R, Karpman E, Jones L, Twomey C, Henry G. Effect of 0.05% chlorhexidine gluconate in water on the hydrophilic inflatable penile prosthesis: biocompatibility, adherence, and dip time. J Sex Med 2023; 20:113-117. [PMID: 36897235 DOI: 10.1093/jsxmed/qdac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/26/2022] [Accepted: 09/18/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Rates of infection after inflatable penile prosthesis range from 1% to 3%; however, a new surgical irrigation solution is Food and Drug Administration cleared as antimicrobial wound lavage and appears to be safe for patients and noncaustic during hydrophilic inflatable penile prosthesis (hIPP) dipping and irrigation. AIM To evaluate if 0.05% chlorhexidine (CHG) lavage is caustic to the hIPP coating and if dip adherence is dependent on time. METHODS Preconnected hIPP devices were tested at a Coloplast research and development laboratory. The devices were soaked in the 0.05% CHG lavage solution or normal saline for 1, 15, 30, and 60 minutes. Subsequently, all parts were dried for 15 minutes in a 35 °C oven. A Congo red dye test was performed following a Coloplast-validated and Food and Drug Administration-cleared test method to ensure product reliability. Implants were then visually inspected for deleterious effects as well as dip coverage. In addition, we evaluated 0.05% CHG lavage solution vs previously published hIPP dipping solutions. OUTCOMES 0.05% CHG lavage does not appear to damage the hIPP coating, and adherence of this solution is not dependent on dip time. RESULTS All components of the preconnected hydrophilic IPPs were tested for coating adherence and defects. All tested IPPs achieved a "satisfactory" coating, meaning a uniform coat without flaking or clumping. Furthermore, there were no noticeable caustic effects or differences in coating adherence between the normal saline-soaked control and 0.05% CHG-coated arms with increasing dip time. A review of the literature for 0.05% CHG lavage solutions vs previously published hIPP dipping solutions revealed that it may have some advantages over previously reported antibiotic solutions. CLINICAL IMPLICATIONS This study serves as a foundation to introduce 0.05% CHG lavage to the urologic literature as a potentially new "magic bullet" irrigation. STRENGTHS AND LIMITATIONS Major strengths of the study are that it is the first study of its kind to address the question of what dip duration should be used and whether it is scientifically reproducible. A limitation is the in vitro model, thus needing validation in a clinical setting. CONCLUSION 0.05% CHG does not appear to negatively affect the hIPP coating or differ in adherence with increasing dip time; however, long-term device performance has not been verified.
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Affiliation(s)
- Ryan Griggs
- Willis Knighton Advanced Urology, Bossier City, LA 71111, United States
| | - Edward Karpman
- El Camino Health Urology, Mountain View, CA 94040, United States
| | - LeRoy Jones
- Urology San Antonio, San Antonio, TX 78229, United States
| | - Carolyn Twomey
- Department of Medical Affairs and Research, Irrimax Corporation, Lawrenceville, GA 30043, United States
| | - Gerard Henry
- Willis Knighton Advanced Urology, Bossier City, LA 71111, United States
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Wang J, Lv W, Xu S, Yang C, Du B, Zhong Y, Shi F, Shan A. Intraoperative incision irrigation with high-volume saline reduces surgical site infection for abdominal infections. Front Surg 2022; 9:927896. [PMID: 35903254 PMCID: PMC9314743 DOI: 10.3389/fsurg.2022.927896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeSurgical site infection (SSI) remains one of the most common postoperative complications for patients with abdominal infections. This study aimed at investigating the effectiveness of high-volume normal saline (NS) irrigation in preventing postoperative SSI for patients with abdominal infections.MethodsIn this retrospective before-after clinical study, patients who underwent emergency laparotomy due to abdominal infections between Jan 2015 and Dec 2021 were included consecutively. A cohort of 207 patients with NS irrigation was compared to historical controls. A propensity score matching (PSM) with a 1:1 ratio was performed to reduce potential bias. The primary outcome was the 30-day SSI rate.ResultsIrrigation (n = 207) and control (n = 207) matched patients were statistically identical on baseline characteristics, perioperative, and intraoperative parameters. Irrigation patients had lower overall SSI rates (10.6% vs. 26.1%, p < 0.001), mainly due to reduction in superficial (4.3% vs. 17.9%) and deep (1.4% vs. 3.9%) SSIs, rather than space/organ SSIs (4.8% vs. 4.3%). Irrigation patients also had lower rates of incision seroma (4.8% vs. 11.6%, p = 0.012), shorter duration of antibiotics use (5.2 ± 1.7 d vs. 7.2 ± 2.0 d, p < 0.001), and unplanned readmission (1.0% vs. 8.7%, p < 0.001). Length of hospital stay showed a declining trend with irrigation intervention, while no significant difference was observed. Moreoever, logistic regression revealed that NS irrigationwas an independent protector against SSI (OR 0.309; 95% CI, 0.207–0.462; p < 0.001).ConclusionIntraoperative incision irrigation with high-volume NS is associated with a lower rate of SSI for patients with abdominal infections.
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Affiliation(s)
| | | | | | | | - Bo Du
- Correspondence: Aijun Shan Fei Shi Yuanbo Zhong Bo Du
| | - Yuanbo Zhong
- Correspondence: Aijun Shan Fei Shi Yuanbo Zhong Bo Du
| | - Fei Shi
- Correspondence: Aijun Shan Fei Shi Yuanbo Zhong Bo Du
| | - Aijun Shan
- Correspondence: Aijun Shan Fei Shi Yuanbo Zhong Bo Du
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6
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Zenga J, Atkinson S, Yen T, Massey B, Stadler M, Bruening J, Peppard W, Reuben M, Hayward M, Mesich B, Buchan B, Ledeboer N, Sanchez JL, Fraser R, Lin CW, Holtz ML, Awan M, Wong SJ, Puram SV, Salzman N. A phase 2 trial of a topical antiseptic bundle in head and neck cancer surgery: Effects on surgical site infection and the oral microbiome. EBioMedicine 2022; 81:104099. [PMID: 35671624 PMCID: PMC9168040 DOI: 10.1016/j.ebiom.2022.104099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/27/2022] Open
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Papadakis M. Wound irrigation for preventing surgical site infections. World J Methodol 2021; 11:222-227. [PMID: 34322371 PMCID: PMC8299912 DOI: 10.5662/wjm.v11.i4.222] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/06/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
Wound irrigation (i.e. washing out a wound before wound closure) aims to reduce the microbial burden by removing tissue debris, metabolic waste, and tissue exudate from the surgical field before site closure. Although it is a popular procedure in every day surgical practice, the lack of procedure standardization, leads to studies with high heterogeneity and often controversial results. Thus, there are studies that advocate its use, while others discourage its implementation in clinical practice to reduce the risk of surgical site infection. The present article reviews the current literature on wound irrigation for preventing surgical site infections. Several irrigants are presented. Chlorexidine is generally considered to be less effective than povidone-iodine, while antibiotics are not that common nowadays, as they require prolonged exposure with the target to act. Hydrogen peroxide has several potential complications, which eliminate its use. Any differences in the incidence of surgical site infections between different irrigants, especially between antibacterial and non-bacterial ones, should be viewed sceptically. More randomized controlled studies are needed to provide better quality of evidence regarding the irrigants' effectiveness and safety.
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Affiliation(s)
- Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 42283, Germany
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8
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Andrade EG, Guerra JJ, Punch L. A Multi-Modal Approach to Closing Exploratory Laparotomies Including High-Risk Wounds. Cureus 2020; 12:e9087. [PMID: 32789037 PMCID: PMC7417030 DOI: 10.7759/cureus.9087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Laparotomy incisions with contamination have a high incidence of surgical site infection (SSI). One strategy to reduce SSI has been to allow these wounds to heal by secondary intention; however, this results in an ongoing need for wound care after discharge. Methods A prospectively maintained Acute and Critical Care Surgery database was queried for patients who underwent exploratory laparotomy during 2008-2018. Patients were stratified into two groups: 2008-2015 (no protocol [NP]) and 2016-2018 (closure protocol [CP]). CP patients were operated on by a single surgeon utilizing a multi-modal high-risk incisional closure protocol, which included dilute chlorhexidine lavage, closed suction drains for incisions deeper than 3 centimeters, and incisional negative-pressure wound therapy (iNPWT). The CDC (Centers for Disease Control and Prevention) guidelines were used to determine wound classification and SSI based on chart review. Groups were compared using univariate and multivariate analysis. Results A total of 139 patients met the study criteria. The overall SSI rate, including superficial and deep space infections, was no different in NP versus CP (21.6 vs. 24.1%; p=0.74). The rate of superficial SSI was similar between NP and CP (11.8 vs. 8.4%; p=0.53). Rates of wound closure at discharge were higher in the CP group than the NP group across wound classes, with the greatest difference among dirty wounds (50.0% NP vs. 94.9% CP; p<0.01). CP significantly increased the likelihood of wound closure (OR=179.2; p<0.001) even after controlling for body mass index, wound classification, ASA (American Society of Anesthesiologists) status, and initially open abdomen. Conclusions By addressing both tissue factors and bacterial burden through the use of a multi-modal high-risk incisional closure protocol involving iNPWT, all wounds can be considered for closure without increasing the risk of SSI.
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Affiliation(s)
| | | | - Laurie Punch
- Surgery, Barnes-Jewish Hospital, Washington University, St. Louis, USA
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Manka MG, Yang D, Andrews J, Chalmers B, Hebert K, Köhler TS, Trost L. Intraoperative Use of Betadine Irrigation is Associated With a 9-Fold Increased Likelihood of Penile Prosthesis Infection: Results From a Retrospective Case-Control Study. Sex Med 2020; 8:422-427. [PMID: 32601002 PMCID: PMC7471124 DOI: 10.1016/j.esxm.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Infection remains a persistent complication of penile prosthesis (PP) surgery. Despite popularity of Mulcahy’s PP washout protocol, Betadine has known tissue toxicity. Aim We evaluated PP infection rate based on the type of intraoperative irrigation used, ½ strength Betadine vs vancomycin/gentamicin. Methods We reviewed a prospective database of men undergoing primary, revision, and salvage PPs. No other changes to operative or perioperative techniques occurred after the change in irrigation solution. Univariate and logistic regression analyses were used to evaluate differences in infection rate with use of Betadine vs vancomycin/gentamicin irrigation. Potential confounders were reviewed. Main Outcome Measure The primary outcome was rate of PP infection before and after change of intraoperative irrigation. Results From 2014 to 2018, 217 patients underwent PP placement at our institution by a single surgeon; of whom, 21 (9.7%) experienced an infection (primary = 10 [7.1%], revision = 11 [17.19%], salvage = 0 [0%]). Overall, 152 (70%) received irrigation with Betadine and 65 (30%) with Vancomycin/Gentamicin. Univariate analysis demonstrated significantly increased infection rates with Betadine irrigation (odds ratio [OR]: 4.64, P = .006) and with revision surgery (OR: 2.68, P = .02). Significance of increased infection rate with Betadine was maintained (OR: 9.3; P = .025) after controlling for age, body mass index, Charlson comorbidity index, smoking, diabetes, primary vs revision/salvage, prior penile surgery, use of ectopic reservoir, and adjunctive glanulopexy. Conclusions Changing from intraoperative Betadine to vancomycin/gentamicin solution dramatically reduced infection rates among men undergoing PP placement in both primary and revision cases. We hypothesize that differences in infection rate may relate to the relative toxicity or non-sterile nature of Betadine. Manka MG, Yang D, Andrews J, et al. Intraoperative Use of Betadine Irrigation is Associated With a 9-Fold Increased Likelihood of Penile Prosthesis Infection: Results From a Retrospective Case-Control Study. Sex Med 2020;8:422–427.
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Affiliation(s)
- Madeleine G Manka
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - David Yang
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Jack Andrews
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Brian Chalmers
- Department of Orthopedics, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Kevin Hebert
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
| | - Tobias S Köhler
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA.
| | - Landon Trost
- Department of Urology, Mayo Clinic and Mayo Medical School, Rochester, MN, USA
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Pan S, Rodriguez D, Thirumavalavan N, Gross MS, Eid JF, Mulcahy J, Munarriz R. The Use of Antiseptic Solutions in the Prevention and Management of Penile Prosthesis Infections: A Review of the Cytotoxic and Microbiological Effects of Common Irrigation Solutions. J Sex Med 2020; 16:781-790. [PMID: 31146926 DOI: 10.1016/j.jsxm.2019.03.271] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Mulcahy salvage fundamentally altered the management of penile prosthesis infections (PPI). Central to this procedure is a sequence of antiseptic irrigations that aims to remove and eradicate pathogenic microflora from the infected field, thus preparing for immediate reimplantation. The antiseptic solutions and their respective concentrations, however, have never been evaluated for efficacy. AIM This review critically examines 3 commonly used antiseptic irrigation solutions (povidone-iodine [PVI], hydrogen peroxide [H2O2], and chlorhexidine gluconate [CHG]) in terms of their antimicrobial activity, cytotoxicity, and clinical use. METHODS A PubMed literature review was performed on articles published between 2003 and 2018. Both preclinical as well as clinical studies from various surgical disciplines were included in this review. MAIN OUTCOME MEASURE The original salvage protocol selected for irrigation solutions at concentrations that are likely detrimental to native tissue. RESULTS All 3 agents demonstrate in vitro cytotoxic effects at subclinical concentrations, but H2O2 is associated with the most significant deleterious properties. It does not seem to broaden antimicrobial coverage beyond what is covered by PVI. Dilute PVI (0.35-3.5% with exposure time of at least 3 minutes) possesses the most robust clinical evidence as an intraoperative adjunct, reducing the incidence of postoperative infectious complications. chlorhexidine gluconate is a promising new agent but lacks clinical data. CLINICAL IMPLICATION Improvements in the salvage protocol are warranted based on current evidence. Careful selection of lavage solution and usage of the lowest necessary concentration will help achieve desired antimicrobial activity while avoiding native tissue cytotoxicity. Strength and limitation: The study is limited by its retrospective nature, and the heterogeneity of literature reviewed precluded a formal meta-analysis. Furthermore, future studies will need to address the roles of normal saline and antibiotic irrigations as intraoperative adjuncts for infection prevention. CONCLUSION Diluted PVI (0.35-3.5% for 3 minutes) may be beneficial in the prevention of PPI. Evidence supports its use both in the setting of primary implantation as well as salvage of infected hardware. An improved, evidence-based protocol may increase positive outcomes of urologic prosthetic surgery. Pan S, Rodriguez D, Thirumavalavan N, et al. The Use of Antiseptic Solutions in the Prevention and Management of Penile Prosthesis Infections: A Review of the Cytotoxic and Microbiological Effects of Common Irrigation Solutions. J Sex Med 2019;16:781-790.
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Affiliation(s)
- Shu Pan
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
| | - Dayron Rodriguez
- Department of Urology, Boston University School of Medicine, Boston, MA, USA
| | | | - Martin S Gross
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - J Francois Eid
- Lenox Hill Hospital Northwell Health System, New York, NY, USA
| | - John Mulcahy
- Department of Urology, University of Alabama Madison, Madison, AL, USA
| | - Ricardo Munarriz
- Department of Urology, Boston University School of Medicine, Boston, MA, USA.
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11
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Arslan NC, Degirmenci AK, Ozdenkaya Y, Terzi C. Wound Irrigation with Chlorhexidine Gluconate Reduces Surgical Site Infection in Pilonidal Disease: Single-Blind Prospective Study. Surg Infect (Larchmt) 2019; 21:143-149. [PMID: 31460835 DOI: 10.1089/sur.2019.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: The aim of this study was to determine whether incision irrigation with chlorhexidine gluconate (CHG) reduces surgical site infections (SSIs) in pilonidal disease surgery. Methods: Between 2013 and 2018, patients who underwent wide excision with primary closure for pilonidal disease were enrolled in this prospective observational multi-institutional cohort. The incision was irrigated with either saline or 0.05% CHG before skin closure. The infection risk of each patient was determined by the National Nosocomial Infection Surveillance System. Post-operative site care and follow-up were carried out according to the U.S. Centers for Disease Control and Prevention guideline by two surgeons blinded to the irrigation solution used. Surgical site infection rates in the saline and 0.05% CHG groups were compared. The secondary outcomes were seroma formation, incision dehiscence, and time to healing. Results: There were 129 patients in the control group and 138 patients in the CHG group. The mean age was 25.1 ± 5.4, and 225 patients (84.3%) were male. Surgical site infection was seen in 35 patients (13.1%): 26 (20.2%) in the control group and 9 (6.5%) in the CHG group (p = 0.001). There were no differences in seroma formation (n = 12; 9.3% in the control vs n = 12; 8.7% in the CHG group; p = 0.515) or incision dehiscence (n = 9; 7% in the control vs n = 9; 6.5% in the CHG group; p = 0.537). The primary healing rate was higher in the CHG group (n = 130; 94.2%) than in the control group (n = 104; 80.6%). Time to healing was 20.5 ± 7.8 days in the control group and 16 ± 4.3 days in the CHG group (p < 0.001). Conclusion: Intra-operative incision irrigation with CHG decreased the SSI rate and time to healing in pilonidal disease surgery. Further randomized trials should focus on specific irrigation methods and procedures to build a consensus on the effect of incision irrigation on SSIs.
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Affiliation(s)
| | | | - Yasar Ozdenkaya
- Department of General Surgery, Medipol University, Istanbul, Turkey
| | - Cem Terzi
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
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