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Leskur D, Bročić I, Mićanović M, Lozić M, Rušić D, Perišin AŠ, Maleš I, Modun D, Bukić J. Introducing the model of repeated exposure of skin to antiseptics: Randomised pilot trial. Contact Dermatitis 2024; 90:585-593. [PMID: 38417425 DOI: 10.1111/cod.14532] [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: 09/25/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Intensified hand hygiene measures were recommended for preventing the spread of SARS-CoV-2. However, these measures can lead to skin damage and the development of hand eczema, particularly among health professionals. OBJECTIVES This pilot study aimed to evaluate the effects of repeated antiseptic use on healthy skin under controlled conditions and to assess the emollient use. METHODS Twelve healthy volunteers (nine females, age = 22.3 ± 2.8 years (mean ± SD), Fitzpatrick phototypes II and III) with no skin diseases were recruited. Antiseptic was applied daily for 3 weeks on the volar sides of forearms. Emollient cream was also applied daily. Skin assessments were performed using non-invasive methods (transepidermal water loss-TEWL, skin hydration, erythema and melanin content). RESULTS Prolonged antiseptic use increased TEWL, decreased hydration and elevated erythema and melanin levels. Emollient cream significantly reduced TEWL and improved hydration on antiseptic-treated sites, and also enhanced hydration on intact skin. CONCLUSIONS Prolonged use of antiseptics can have adverse effects on the skin, including barrier disruption and inflammation. Emollient showed promise in improving skin hydration and reducing the damage caused by antiseptics. Further research with a larger sample is needed to confirm these findings and assess emollient efficacy during frequent antiseptic use.
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Affiliation(s)
- Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Ivana Bročić
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Mislav Mićanović
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Mirela Lozić
- Department of Medical Chemistry and Biochemistry, University of Split School of Medicine, Split, Croatia
| | - Doris Rušić
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Ana Šešelja Perišin
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Ivanka Maleš
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Josipa Bukić
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
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Nye AK, Thieman Mankin KM. Small animal patient preoperative preparation: a review of common antiseptics, comparison studies, and resistance. Front Vet Sci 2024; 11:1374826. [PMID: 38605919 PMCID: PMC11007076 DOI: 10.3389/fvets.2024.1374826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
This review aims to describe commonly used antiseptics in veterinary medicine including their mechanism of action, spectrum of activity, potential adverse effects, and application techniques. Additionally, it provides a review of the veterinary literature comparing antiseptics, a discussion of effectiveness and efficacy studies, and the potential for increased resistance to biocides and antimicrobials. This review concludes that appropriate selection and use is necessary to prevent the occurrence of surgical site infections, adverse effects, and potential for increasing resistance to antimicrobials. Continued research is needed to fill gaps in the current knowledge such as optimal preparation procedures for various surgical sites, standardization of efficacy and effectiveness testing, and the clinical impact of decreased susceptibility to chlorhexidine and other antiseptics.
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Affiliation(s)
| | - Kelley M. Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
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Masferrer E, Riera-Rodríguez L, Farré-Alins V, Vilà de Muga S, Arroyo-Muñoz FJ, González-Caro MD. Randomized controlled trial on healthy volunteers of pharmacokinetic and antimicrobial activity of a novel hydrogel-containing chlorhexidine dressing to prevent catheter-related bloodstream infection. Front Med (Lausanne) 2024; 10:1335364. [PMID: 38259833 PMCID: PMC10800819 DOI: 10.3389/fmed.2023.1335364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Catheter-related blood stream infection (CRBSI) is one of the most relevant complications associated to the use of intravascular catheters. In this context, chlorhexidine gluconate (CHG) releasing dressings have been developed to reduce the catheter colonization rate and the risk of infection. The aim of this study is to analyze the release rate of CHG and the antimicrobial activity of a novel CHG-releasing dressing, Oper film® protect CHG, and to compare these parameters to those of the dressing Tegaderm™ CHG in healthy volunteers. Methods The study was performed in a cohort of 25 healthy volunteers. Two commercially available chlorhexidine-containing dressings were evaluated and compared in this study, Oper film® protect CHG and Tegaderm™ CHG. The release of CHG and the antimicrobial capacity was determined for one week. Results HPLC analysis revealed that both dressings have an equivalent CHG release to the skin 2 days (Oper film® protect CHG, 321 μg/cm2; Tegaderm™ CHG, 279 μg/cm2) and 7 days (Oper film® protect CHG, 456 μg/cm2; Tegaderm™ CHG, 381 μg/cm2) after the placement of the products in the non-disinfected back of the subjects. On the other hand, Oper film® protect CHG and Tegaderm™ CHG similarly reduced colony forming units (CFU) in cultures obtained from the skin under the CHG-containing hydrogel compared to control cultures at both 2 days (control, 3.34 log10 cfu/cm2; Oper film® protect CHG, 0.64 log10 cfu/cm2; Tegaderm™ CHG, 0.7 log10 cfu/cm2) and 7 days (control, 3.95 log10 cfu/cm2; Oper film® protect CHG, 0.11 log10 cfu/cm2; Tegaderm™ CHG, 1 log10 cfu/cm2). Discussion Data confirm that the recent commercially available dressing Oper film® protect CHG maintains the release of CHG and the antimicrobial activity during at least 7 days, and possesses equivalent drug release and antimicrobial action to Tegaderm™ CHG.
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Affiliation(s)
- Emili Masferrer
- Department of Dermatology, Hospital Universitari Mútua Terrassa, Terrassa, Spain
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Warshaw EM, Han J, Kullberg SA, DeKoven JG, Adler BL, Silverberg JI, Houle MC, Pratt MD, Belsito DV, Yu J, Botto NC, Reeder MJ, Taylor JS, Atwater AR, Dunnick CA, DeLeo VA, Mowad CM. Patch Testing to Chlorhexidine Digluconate, 1% Aqueous: North American Contact Dermatitis Group Experience, 2015-2020. Dermatitis 2023; 34:501-508. [PMID: 37279017 DOI: 10.1089/derm.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background: Chlorhexidine is an antiseptic that may cause allergic contact dermatitis. Objectives: To describe the epidemiology of chlorhexidine allergy and characterize positive patch test reactions. Methods: This retrospective study analyzed patients patch tested to chlorhexidine digluconate 1% aqueous by the North American Contact Dermatitis Group, 2015-2020. Results: Of 14,731 patients tested to chlorhexidine digluconate, 107 (0.7%) had an allergic reaction; of these, 56 (52.3%) reactions were currently clinically relevant. Most (59%) reactions were mild (+), followed by strong (++, 18.7%) and very strong (+++, 6.5%). Common primary dermatitis anatomic sites in chlorhexidine-positive patients were hands (26.4%), face (24.5%), and scattered/generalized distribution (17.9%). Compared with negative patients, chlorhexidine-positive patients were significantly more likely to have dermatitis involving the trunk (11.3% vs 5.1%; P = 0.0036). The most commonly identified source category was skin/health care products (n = 41, 38.3%). Only 11 (10.3%) chlorhexidine reactions were occupationally related; of these, 81.8% were in health care workers. Conclusions: Chlorhexidine digluconate allergy is uncommon, but often clinically relevant. Involvement of the hands, face, and scattered generalized patterns was frequent. Occupationally related reactions were found predominantly in health care workers.
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Affiliation(s)
- Erin M Warshaw
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joohee Han
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
| | - Sara A Kullberg
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina C Botto
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Chris M Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
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Immediate Hypersensitivity to Chlorhexidine: Experience from an Allergy Center in China. Anesthesiology 2023; 138:364-371. [PMID: 36630143 DOI: 10.1097/aln.0000000000004495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Chlorhexidine generally has a good safety profile. However, allergic reactions are reported with increasing frequency. In China, it is rarely reported, and its characteristics are unknown. The purpose of this study was to summarize the experience of a Chinese allergy center with chlorhexidine allergy. METHODS The authors retrospectively reviewed all patients who underwent chlorhexidine allergy testing in the Allergy Center of West China Hospital, Sichuan University (Chengdu, China), in the period February 2018 to May 2022 (n = 43 patients) and included the patients diagnosed with chlorhexidine allergy for analysis. RESULTS Ten patients who were diagnosed by skin prick and serum-specific immunoglobulin E tests were included. They experienced a total of 30 allergic reactions to chlorhexidine (mean ± SD, 3.0 ± 1.3). Five patients experienced six allergic reactions (6 of 30, 20%) during general or local anesthesia, and they may have been exposed to chlorhexidine via different routes. Only one allergic reaction (1 of 30, 3%) was recorded with exposure via a mouthwash. The other 23 allergic reactions (23 of 30, 77%) were caused via a skin disinfectant; the route of exposure was IV cannulation in 22 allergic reactions (22 of 23, 96%) and broken skin in one allergic reaction (1 of 23, 4%). The symptoms included a quick onset and great severity. Two patients (2 of 10, 20%) had been accidentally re-exposed to chlorhexidine after diagnosis. CONCLUSIONS This study conducted in China showed that the majority of reactions to chlorhexidine were attributed to skin disinfectants, and IV cannulation was the most common exposure route; in general, however, chlorhexidine allergy was easily overlooked. The potential allergenicity of chlorhexidine used for skin preparation before IV cannulation or should be considered in patients who develop allergic reactions perioperatively. EDITOR’S PERSPECTIVE
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AlSheddi M, Rahman I, Mohammed A, Algazlan A, Alwably A, Hebbal M, Omar M. Nigella sativa oil as a treatment for gingivitis: A randomized active–control trial. ASIAN PAC J TROP MED 2023. [DOI: 10.4103/1995-7645.372290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Griffith A, Mateen A, Markowitz K, Singer SR, Cugini C, Shimizu E, Wiedman GR, Kumar V. Alternative Antibiotics in Dentistry: Antimicrobial Peptides. Pharmaceutics 2022; 14:1679. [PMID: 36015305 PMCID: PMC9412702 DOI: 10.3390/pharmaceutics14081679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 01/12/2023] Open
Abstract
The rise of antibiotic resistant bacteria due to overuse and misuse of antibiotics in medicine and dentistry is a growing concern. New approaches are needed to combat antibiotic resistant (AR) bacterial infections. There are a number of methods available and in development to address AR infections. Dentists conventionally use chemicals such as chlorohexidine and calcium hydroxide to kill oral bacteria, with many groups recently developing more biocompatible antimicrobial peptides (AMPs) for use in the oral cavity. AMPs are promising candidates in the treatment of (oral) infections. Also known as host defense peptides, AMPs have been isolated from animals across all kingdoms of life and play an integral role in the innate immunity of both prokaryotic and eukaryotic organisms by responding to pathogens. Despite progress over the last four decades, there are only a few AMPs approved for clinical use. This review summarizes an Introduction to Oral Microbiome and Oral Infections, Traditional Antibiotics and Alternatives & Antimicrobial Peptides. There is a focus on cationic AMP characteristics and mechanisms of actions, and an overview of animal-derived natural and synthetic AMPs, as well as observed microbial resistance.
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Affiliation(s)
- Alexandra Griffith
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA
| | - Akilah Mateen
- Department of Chemistry and Biochemistry, Seton Hall University, South Orange, NJ 07079, USA
| | - Kenneth Markowitz
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ 07103, USA
| | - Steven R. Singer
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ 07103, USA
| | - Carla Cugini
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ 07103, USA
| | - Emi Shimizu
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ 07103, USA
- Department of Endodontics, Rutgers School of Dental Medicine, Newark, NJ 07103, USA
| | - Gregory R. Wiedman
- Department of Chemistry and Biochemistry, Seton Hall University, South Orange, NJ 07079, USA
| | - Vivek Kumar
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA
- Department of Endodontics, Rutgers School of Dental Medicine, Newark, NJ 07103, USA
- Department of Biology, New Jersey Institute of Technology, Newark, NJ 07102, USA
- Department of Chemical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA
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Collins AP, Simpson J, Richey B, Zaruta D, Levin S, Lewellyn B, Service BC. Efficacy of antimicrobial washes before shoulder surgery against Cutibacterium: a systematic review and meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:315-322. [PMID: 37588870 PMCID: PMC10426554 DOI: 10.1016/j.xrrt.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Cutibacterium acnes is a commensal intradermal microorganism that is commonly isolated at revision shoulder arthroplasty. Standard practice chlorhexidine gluconate (CHG) skin preparation agents have limited effectiveness at eradicating C. acnes in the dermis. Benzoyl peroxide (BPO) has demonstrated effectiveness against C. acnes. This meta-analysis compares the efficacy of at-home shoulder decolonization before surgery using CHG vs. BPO to reduce shoulder C. acnes burden. Methods This was a Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review. PubMed and MEDLINE databases were searched for studies evaluating the effects of CHG and BPO in reducing C. acnes at the shoulder. Trial results were extracted and pooled using a random effects model, separating data from randomized controlled trials (RCTs) and non-RCTs. Methodologic quality of studies was assessed using the Cochrane Risk of Bias Assessment Tools. Results Ten studies (589 patients) were included. RCTs showed that both BPO and CHG led to significant reductions in culture positivity compared with negative controls (risk ratio [RR] with 95% confidence interval [CI] = 0.20 [0.13, 0.30], P < .0001 and 0.46 [0.37, 0.57], P < .0001, respectively). Non-RCT data demonstrated similar results comparing BPO and CHG to the control (RR with 95% CI = 0.34 [0.21, 0.57], P < .0001 and 0.31 [0.20, 0.49], P < .0001, respectively). Comparing BPO and CHG, RCT data showed a significant reduction in culture positivity with BPO (RR with 95% CI = 0.46 [0.27, 0.77], P < .009). Of RCTs, 5 were low and one was of moderate risk of bias. Of non-RCTs, 3 had low risk of bias, whereas one had moderate risk of bias. Conclusion This review demonstrated that preoperative CHG and BPO can reduce C. acnes at the shoulder. However, BPO exhibits greater efficacy than CHG, potentially because of the compound's ability to penetrate the dermis. BPO is a simple and economical agent that may reduce joint exposure to C. acnes in shoulder surgery.
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Affiliation(s)
| | - Jeffrey Simpson
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | - Bradley Richey
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | - Douglas Zaruta
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | - Samantha Levin
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | - Brett Lewellyn
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
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Inhibition of the Human Hsc70 System by Small Ligands as a Potential Anticancer Approach. Cancers (Basel) 2021; 13:cancers13122936. [PMID: 34208232 PMCID: PMC8230956 DOI: 10.3390/cancers13122936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary High levels of Heat shock proteins (Hsps) in specific cancers are usually linked to a poor prognosis, tumor progression, invasiveness, and resistance to treatment. Chaperone inhibition could therefore be toxic for cancer cells due to their high dependence on chaperone activity to survive. This study shows the potential to repurpose the small chemical compound pinaverium bromide, currently used to treat functional gastrointestinal disorders, as a possible antitumor drug since it displays a marked toxicity against two melanoma cell lines without affecting the viability of fibroblast and primary melanocytes. This compound interacts with structural regions shared by representatives of the Hsp70 and Hsp110 families, inhibiting the substrate remodeling ability of the Hsp70 system in vitro and in a cellular context. Abstract Heat shock protein (Hsp) synthesis is upregulated in a wide range of cancers to provide the appropriate environment for tumor progression. The Hsp110 and Hsp70 families have been associated to cancer cell survival and resistance to chemotherapy. In this study, we explore the strategy of drug repurposing to find new Hsp70 and Hsp110 inhibitors that display toxicity against melanoma cancer cells. We found that the hits discovered using Apg2, a human representative of the Hsp110 family, as the initial target bind also to structural regions present in members of the Hsp70 family, and therefore inhibit the remodeling activity of the Hsp70 system. One of these compounds, the spasmolytic agent pinaverium bromide used for functional gastrointestinal disorders, inhibits the intracellular chaperone activity of the Hsp70 system and elicits its cytotoxic activity specifically in two melanoma cell lines by activating apoptosis. Docking and molecular dynamics simulations indicate that this compound interacts with regions located in the nucleotide-binding domain and the linker of the chaperones, modulating their ATPase activity. Thus, repurposing of pinaverium bromide for cancer treatment appears as a promising novel therapeutic approach.
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Calado R, Calvão da Silva J, Gomes T, Gonçalo M. Is there a place for chlorhexidine in the European baseline series? Contact Dermatitis 2021; 85:372-373. [PMID: 33843062 DOI: 10.1111/cod.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rebeca Calado
- Dermatology Department, University Hospital, Coimbra, Portugal
| | | | - Tiago Gomes
- Dermatology Department, University Hospital, Coimbra, Portugal.,Dermatology Department, Leiria Hospital, Leiria, Portugal
| | - Margarida Gonçalo
- Dermatology Department, University Hospital, Coimbra, Portugal.,Dermatology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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González-Serrano J, López-Pintor RM, Cecilia-Murga R, Torres J, Hernández G, López-Quiles J. Application of propolis extract, nanovitamin C and nanovitamin E to prevent alveolar osteitis after impacted lower third molar surgery. A randomized, double-blind, split-mouth, pilot study. Med Oral Patol Oral Cir Bucal 2021; 26:e118-e125. [PMID: 33609021 PMCID: PMC7980291 DOI: 10.4317/medoral.23915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 01/27/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Propolis has anti-inflammatory, analgesic and healing properties. The purpose of this study was to determine whether a gel containing 2% of propolis extract, 0.2% of ascorbic acid and 0.2% of tocopherol acetate is effective in preventing surgical complications related to impacted lower third molar extractions. MATERIAL AND METHODS A randomized, double-blind, split-mouth study was performed. Fifteen patients were recruited who needed bilateral impacted lower third molar extractions with a similar surgical difficulty. A test or placebo gel was administered randomly inside post-extraction sockets. Each patient was instructed to apply the gel 3 times/day in the surgical wound for a week. After a month, the contralateral third molar was extracted, and the opposite gel applied. The following parameters were diagnosed/evaluated and then recorded: alveolar osteitis following Blum's criteria, swelling and trismus at day one, two, three and seven post-intervention, wound healing at day 7 post-intervention, and postoperative pain using a visual analog scale, as well as, the number of analgesic pill intake. RESULTS A total of twenty-six surgical procedures were performed in 13 patients (mean age 20.67±2 years). Alveolar osteitis was reported in 3 patients from the placebo group (23.1%) and none in the test group (0%) (p=0.25). No statistically significant differences were reported in swelling, trismus, wound healing or analgesic pill consumption between two groups. But statistically lower postoperative pain during the 7 days after surgical extractions was found according to visual analog scale in test group compared to the placebo group (p=0.007). No side effects were reported. CONCLUSIONS The application of this gel may be effective in preventing alveolitis and thus reducing postoperative pain after impacted third molar extractions. More randomized clinical trials with larger sample are needed to confirm these results.
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Affiliation(s)
- J González-Serrano
- Departamento de Especialidades Clínicas Odontológicas Facultad de Odontología. Universidad Complutense de Madrid Plaza Ramón y Cajal s/n, 28040, Madrid, Spain
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A Rare Complication of Chlorhexidine: Buccal Mucosal Burn. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ram PK, Begum F, Crabtree-Ide C, Uddin MR, Weaver AM, Dostogir Harun MG, Allen JV, Kumar S, Nasreen S, Luby SP, El Arifeen S. Waterless Hand Cleansing with Chlorhexidine during the Neonatal Period by Mothers and Other Household Members: Findings from a Randomized Controlled Trial. Am J Trop Med Hyg 2020; 103:2116-2126. [PMID: 32959761 DOI: 10.4269/ajtmh.19-0773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Observational data suggest maternal handwashing with soap prevents neonatal mortality. We tested the impact of a chlorhexidine-based waterless hand cleansing promotion on the behavior of mothers and other household members. In rural Bangladesh in 2014, we randomized consenting pregnant women to chlorhexidine provision and hand cleansing promotion or standard practices. We compared hand cleansing with chlorhexidine or handwashing with soap before baby care, among mothers and household members in the two groups, and measured chlorhexidine use in the intervention arm. Chlorhexidine was observed in the baby's sleep space in 97% of 130 intervention homes, versus soap in 59% of 128 control homes. Hand cleansing before baby care was observed 5.6 times more frequently among mothers in the intervention arm than in the controls (95% CI = 4.0-7.7). Hand cleansing was significantly more frequently observed in the intervention arm among women other than the mother (RR = 10.9) and girls (RR = 37.0). Men and boys in the intervention arm cleansed hands before 29% and 44% of baby care events, respectively, compared with 0% in the control arm. The median number of grams consumed during the neonatal period was 176 (IQR = 95-305 g), about 7.8 g/day (IQR = 4.2-13.8 g). Promotion of waterless chlorhexidine increased hand cleansing behavior among mothers and other household members. Discrepancy between observed use and measured chlorhexidine consumption suggested courtesy bias in structured observations. A waterless hand cleanser may represent one component of the multimodal strategies to prevent neonatal infections in low-resource settings.
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Affiliation(s)
- Pavani K Ram
- State University of New York at Buffalo, Buffalo, New York
| | | | | | | | - Anne M Weaver
- State University of New York at Buffalo, Buffalo, New York
| | | | | | | | | | - Stephen P Luby
- Stanford University, Palo Alto, California.,icddr,b, Dhaka, Bangladesh
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Salazar-Vargas K, Padilla-Orozco M, Garza-González E, Camacho-Ortiz A. Chlorhexidine impregnated surgical scrubs and whole-body wash for reducing colonization of health care personnel. Am J Infect Control 2020; 48:1216-1219. [PMID: 32057510 DOI: 10.1016/j.ajic.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The use of chlorhexidine as a strategy to reduce nosocomial infections in patients has been proven useful. Bacterial contamination of health care worker's uniforms during routine patient care has been demonstrated to have potential for horizontal transmission of pathogens. METHODS We performed a prospective, open comparative trial. We included nurses who were in direct patient care and evaluated clothing microbial growth during 3 interventions: (1) participants were given a sterile surgical scrub (SSS) to put on the beginning of the shift, (2) they were instructed to take a chlorhexidine bath (CHG-B) before putting on the SSS, and (3) participants were given a chlorhexidine impregnated SSS (CI-SSS). Cultures were obtained from 3 areas (chest pocket, chest, and abdominal) at hour 0, 6, and 12 hours after the start of the shift. RESULTS A total of 306 cultures processed with 17 bacterial groups. The uniform area with the highest number of CFU was the abdomen (818 CFU), followed by the thorax (654 CFU). Over 50% of the bacterial load occurred at 12 hours (1,092 CFU at 12 hours, 766 CFU at 6 hours, and 184 CFU at 0 hour). There was a significant reduction in CFU when SSS was compared to CHG-B (CFU mean = 12.5 [0-118] vs CFU mean = 3.5 [0-22], P = .003); and SSS versus CI-SSS (CFU mean = 12.5 [0-118] vs CFU mean = 3 [0-39], P = .007). No severe adverse events were reported. CONCLUSIONS Bacterial load in uniforms decreased when chlorhexidine was used (bathing of personnel or impregnation) when compared to the use of a sterile uniform.
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Affiliation(s)
- Karina Salazar-Vargas
- Department of Internal Medicine, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Magaly Padilla-Orozco
- Department of Hospital Epidemiology and Infectious Disease Service, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Elvira Garza-González
- Gastroenterology service, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Adrián Camacho-Ortiz
- Department of Hospital Epidemiology and Infectious Disease Service, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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Chlorhexidine Hypersensitivity: A Case Report of Delayed Reactions Associated with Epidermal Preparations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2945. [PMID: 32983757 PMCID: PMC7489580 DOI: 10.1097/gox.0000000000002945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
Chlorhexidine is a topical antiseptic that is generally well tolerated in patients, making it a common preparatory substance in various surgical settings. Sparse case reports have identified immediate hypersensitivity reactions after exposure to this substance, especially in patients with a history of atopy. The purpose of this case report is to describe 3 unique presentations of delayed hypersensitivity to epidermal chlorhexidine preparation. Patients undergoing breast surgery by a single surgeon between December 2018 and January 2019 were retrospectively reviewed for incidence of dermatologic complications. Medical and surgical history of patients as well as dermatologic hypersensitivity course were collected. Three patients presented with a delayed hypersensitivity to the epidermal chlorhexidine surgical preparation, ChloraPrep. Each patient developed an erythematous, pruritic maculopapular rash in the distribution of the chlorhexidine application. This occurred beyond the immediate postoperative period—ranging from postoperative days 5 to 35. Initial treatment included the use of 1% hydrocortisone along with a systemic antihistamine. If there was no improvement in symptoms after 3 days, we transitioned patients to 0.5% triamcinolone ointment. If there was no improvement after 5 days on triamcinolone, the patient was reexamined and systemic steroids were prescribed. In each of our cases, all skin changes had resolved within 7–10 days of initial symptoms. Our findings highlight a series of delayed adverse reactions to epidermal chlorhexidine occurring beyond the intraoperative and immediate postoperative period. This case report serves to recognize a unique presentation pattern to ensure that all patients are accurately diagnosed and promptly treated via a systematic treatment algorithm.
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Abstract
BACKGROUND Both surgical personnel and patients undergoing procedures are exposed regularly to different antiseptic chemicals in various forms. Little is known about the ingredients in these antiseptics and the risk these products may provoke allergic contact dermatitis. OBJECTIVE The aim of the study was to identify and characterize common allergens in surgical scrubs and patient surgical cleansers that health care workers and surgical patients may encounter in the perioperative period. METHODS DailyMed website was searched using numerous terms for surgical disinfectants. Products used for health care worker handwashing/scrubbing or patient surgical cleansing/disinfecting were included. Each product's ingredients were recorded; those found on the 2017 American Contact Dermatitis Society (ACDS) Core Allergen Series were noted from each product. CONCLUSIONS A total of 1940 products were identified, of which 267 were included in the analysis. A total of 66.3% contained iodine, 25.8% contained chlorhexidine digluconate, and 2.6% contained chloroxylenol. Within the group analyzed, 1586 ingredients were identified. Of these, 241 were ACDS Core Series allergens. Most products contained a single ACDS allergen. There were significant differences in allergens based on product type and active ingredient, with iodine-containing products having the fewest number of allergens. The most common ACDS allergens found were cocamide diethanolamide (22.5%), fragrance (21.7%), lanolin (19.5%), propylene glycol (6.7%), alkyl glucosides (6.0%), and sorbic acid derivatives (5.6%).
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Affiliation(s)
- Jamie P Schlarbaum
- From the Park Nicollet Contact Dermatitis Clinic
- University of Minnesota Medical School
| | - Sara A Hylwa
- From the Park Nicollet Contact Dermatitis Clinic
- Department of Dermatology, University of Minnesota, Minneapolis
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20
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High Potential of Bacterial Adhesion on Block Bone Graft Materials. MATERIALS 2020; 13:ma13092102. [PMID: 32370084 PMCID: PMC7254222 DOI: 10.3390/ma13092102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022]
Abstract
Bone graft infections represent a challenge in daily clinics, resulting in increased patient discomfort and graft removal. The aim of this study was to investigate the initial adhesion of five representative pathogens on three different block bone graft materials (xenogeneic, alloplastic and allogeneic) and to assess if chlorhexidine (CHX) can effectively control the initial bacterial adhesion. Three different block bone grafting materials (Tutobone®, Endobon® and human spongiosa) were incubated with Escherichia coli, Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis and Pseudomonas aeruginosa in the presence or absence of 0.2% CHX solution. Bacterial adhesion was assessed by the direct counting of the colony-forming units (CFUs) and visualized by scanning electron microscopy (SEM). Overall, the selected bacterial species adhered successfully to all tested bone replacement scaffolds, which showed similar bacterial counts. The lg CFU values ranged from 5.29 ± 0.14 to 5.48 ± 0.72 for E. coli, from 4.37 ± 0.62 to 5.02 ± 0.48 for S. aureus, from 4.92 ± 0.34 to 4.95 ± 0.21 for S. mutans, from 4.97 ± 0.40 to 5.22 ± 0.13 for E. faecalis and from 4.23 ± 0.54 to 4.58 ± 0.26 for P. aeruginosa. CHX did not interfere with initial microbial adhesion, and yet it killed all adhered bacterial cells. Thus, CHX can be used to prevent subsequent biofilm infections.
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Rastogi S, Glaser L, Friedman J, Carter IV, Milad MP. Tolerance of Chlorhexidine Gluconate Vaginal Cleansing Solution: A Randomized Controlled Trial. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Supriya Rastogi
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Laura Glaser
- Department of Obstetrics and Gynecology, Northwestern Prentice Women's Hospital, Chicago, IL
| | - Jaclyn Friedman
- Department of Obstetrics and Gynecology, Northwestern Prentice Women's Hospital, Chicago, IL
| | - Isabelle V. Carter
- Department of Obstetrics and Gynecology, Northwestern Prentice Women's Hospital, Chicago, IL
| | - Magdy P. Milad
- Department of Obstetrics and Gynecology, Northwestern Prentice Women's Hospital, Chicago, IL
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Dantas EMGL, Lima SMF, Cantuária APC, Amorim IA, Almeida JA, Cunha TF, Franco OL, Rezende TMB. Synergistic activity of chlorhexidine and synoeca-MP peptide against Pseudomonas aeruginosa. J Cell Physiol 2019; 234:16068-16079. [PMID: 30740688 DOI: 10.1002/jcp.28265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 01/24/2023]
Abstract
This study aims to evaluate the in vitro antimicrobial and immunomodulatory activities and cytotoxicity of chlorhexidine (CHX) and synoeca-MP peptide alone or in combination against Pseudomonas aeruginosa. The antimicrobial property was evaluated by the determination of minimal inhibitory concentration, minimum bactericidal concentration, and planktonic bacteria and biofilm inhibition. Immunomodulatory activity was determined by enzyme-linked immunosorbent assay and nitric oxide production by the Griess reaction method. According to the results, synoeca-MP combined with CHX demonstrated antimicrobial effectiveness compared with its isolated use, in addition to immunomodulatory activity (upregulating MPC-1 and tumor necrosis factor-α and downregulating nitric oxide and interleukin-10). In this context, it is expected that the substances, together, could be capable of controlling bacterial infection and dissemination, besides potentiating macrophages' immune response against the studied microorganism. Moreover, reducing the CHX concentration by the addition of synoeca-MP peptide may, in a beneficial way, minimize the undesirable effects of both, CHX and synoeca-MP in a clinical setting.
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Affiliation(s)
- Elaine M G L Dantas
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Federal District, Brazil.,Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
| | - Stella M F Lima
- Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
| | - Ana Paula C Cantuária
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Federal District, Brazil
| | - Ingrid A Amorim
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
| | - Jeeser A Almeida
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Tássio F Cunha
- Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil
| | - Octávio L Franco
- Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil.,Programa de Doutorado da Rede Centro-Oeste, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, Federal District, Brazil.,S-Inova Biotech, Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Mato Grosso do Sul, Brazil
| | - Taia M B Rezende
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Federal District, Brazil.,Curso de Odontologia, Escola de Saúde, Universidade Católica de Brasília, Campus 1, Brasília, Federal District, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Programa de Pós-Graduação em Ciências Genômicas e Biotecnologia, Escola de Saúde, Universidade Católica de Brasília, Campus Avançado Asa Norte, Brasília, Federal District, Brazil
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Opstrup MS, Jemec GBE, Garvey LH. Chlorhexidine Allergy: On the Rise and Often Overlooked. Curr Allergy Asthma Rep 2019; 19:23. [PMID: 30874959 DOI: 10.1007/s11882-019-0858-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW In recent years, the risk of allergy to chlorhexidine is increasingly recognised. In this review, we discuss why the allergy is so easily overlooked and point out several preventative initiatives that can minimise the risk of both chlorhexidine sensitisation and allergy development and accidental re-exposure in patients with chlorhexidine allergy. Testing for chlorhexidine allergy is also discussed. RECENT FINDINGS Numerous reports have been published from many different specialties. Symptoms range from mild skin symptoms to life-threatening anaphylaxis. Testing for chlorhexidine allergy is based on skin testing and in vitro testing. Recently, it was found that both skin prick testing and specific IgE have high sensitivities and specificities. This review gives an overview of chlorhexidine allergy with a special focus on preventative initiatives and testing.
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Affiliation(s)
- Morten Schjørring Opstrup
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark. .,Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900, Hellerup, Denmark.
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Heise Garvey
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900, Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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26
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Aerts O, Goossens A. Preservatives. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_85-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Allergic Contact Dermatitis Due to Chlorhexidine in 2 Pediatric Patient. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Córdoba S, Sanz-Sánchez T, Mohedano-Vicente E, Borbujo J. Dermatitis alérgica de contacto a clorhexidina en dos pacientes pediátricos. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:76-77. [DOI: 10.1016/j.ad.2017.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/11/2017] [Accepted: 10/14/2017] [Indexed: 11/17/2022] Open
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Lasa EM, González C, García-Lirio E, Martínez S, Arroabarren E, Gamboa PM. Anaphylaxis caused by immediate hypersensitivity to topical chlorhexidine in children. Ann Allergy Asthma Immunol 2017; 118:118-119. [PMID: 28007083 DOI: 10.1016/j.anai.2016.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 09/28/2016] [Accepted: 10/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Eva María Lasa
- Servicio de Alergología, Hospital Universitario Donostia, San Sebastián, España.
| | - Carlos González
- Servicio de Alergología, Hospital Universitario de Basurto, Bilbao, España
| | | | - Sara Martínez
- Servicio de Alergología, Hospital Universitario Donostia, San Sebastián, España
| | - Esozia Arroabarren
- Servicio de Alergología, Complejo Hospitalario de Navarra, Pamplona, España
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Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clin Microbiol Rev 2017; 30:827-860. [PMID: 28592405 DOI: 10.1128/cmr.00112-16] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.
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31
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Cho H, Lynham AJ, Hsu E. Postoperative interventions to reduce inflammatory complications after third molar surgery: review of the current evidence. Aust Dent J 2017; 62:412-419. [DOI: 10.1111/adj.12526] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 12/26/2022]
Affiliation(s)
- H Cho
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - AJ Lynham
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - E Hsu
- Maxillofacial Unit; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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32
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Cook KA, Kelso JM. Surgery-Related Contact Dermatitis: A Review of Potential Irritants and Allergens. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1234-1240. [PMID: 28396114 DOI: 10.1016/j.jaip.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/06/2017] [Accepted: 03/01/2017] [Indexed: 11/29/2022]
Abstract
Surgical procedures utilize an increasing number of medical products including antiseptics, anesthetics, gloves, suture materials, tissue adhesives, topical antibiotics, and bandages. Many of these products have irritant potential. Allergic contact dermatitis has also been reported. This review covers preoperative, operative, and postoperative exposures that may result in contact dermatitis. Testing with standard patch panels such as T.R.U.E. Test and the North American Contact Dermatitis Group 65 allergen series does not evaluate for all relevant contactants. A thorough understanding of potential exposures is vital to effectively evaluate a patient with surgery-related contact dermatitis. A systematic approach is needed to ensure that standard patch panels and supplementary patches adequately address each encountered contactant.
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Affiliation(s)
- Kevin A Cook
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
| | - John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
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Kampf G, Kramer A, Suchomel M. Lack of sustained efficacy for alcohol-based surgical hand rubs containing ‘residual active ingredients’ according to EN 12791. J Hosp Infect 2017; 95:163-168. [DOI: 10.1016/j.jhin.2016.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
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Chlorhexidine-related refractory anaphylactic shock: a case successfully resuscitated with extracorporeal membrane oxygenation. J Clin Anesth 2016; 34:654-7. [DOI: 10.1016/j.jclinane.2016.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 06/25/2016] [Accepted: 07/05/2016] [Indexed: 11/22/2022]
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35
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Merani R, McPherson ZE, Luckie AP, Gilhotra JS, Runciman J, Durkin S, Muecke J, Donaldson M, Aralar A, Rao A, Davies PE. Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature. Ophthalmology 2016; 123:2588-2594. [PMID: 27720552 DOI: 10.1016/j.ophtha.2016.08.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety. DESIGN Multicenter retrospective case series. PARTICIPANTS All patients receiving intravitreal injections from 7 retinal specialists. METHODS An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine. MAIN OUTCOME MEASURES Incidence of endophthalmitis after intravitreal injections. RESULTS A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used. CONCLUSIONS Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients.
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Affiliation(s)
- Rohan Merani
- Save Sight Institute, University of Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, NSW, Australia; Concord Repatriation General Hospital, Concord NSW, Australia; Retina Associates, Chatswood, NSW, Australia
| | | | | | - Jagjit S Gilhotra
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia; Adelaide Eye and Retina Centre, Adelaide, SA, Australia
| | - Jim Runciman
- Adelaide Eye and Retina Centre, Adelaide, SA, Australia
| | - Shane Durkin
- Adelaide Eye and Retina Centre, Adelaide, SA, Australia
| | - James Muecke
- Adelaide Eye and Retina Centre, Adelaide, SA, Australia
| | | | | | - Anupam Rao
- Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - Peter E Davies
- The University of Newcastle, Newcastle, NSW, Australia; Newcastle Eye Hospital, Newcastle, NSW, Australia.
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Verhulst L, Goossens A. Cosmetic components causing contact urticaria: a review and update. Contact Dermatitis 2016; 75:333-344. [DOI: 10.1111/cod.12679] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/24/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Lien Verhulst
- Department of Dermatology; University Hospitals KU Leuven; Leuven 3000 Belgium
| | - An Goossens
- Department of Dermatology; University Hospitals KU Leuven; Leuven 3000 Belgium
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37
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Opstrup MS, Johansen JD, Zachariae C, Garvey LH. Contact allergy to chlorhexidine in a tertiary dermatology clinic in Denmark. Contact Dermatitis 2015; 74:29-36. [DOI: 10.1111/cod.12487] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/11/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Morten S. Opstrup
- Department of Dermato-Allergology; National Allergy Research Centre and Allergy Clinic, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Jeanne D. Johansen
- Department of Dermato-Allergology; National Allergy Research Centre and Allergy Clinic, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Claus Zachariae
- Department of Dermato-Allergology; National Allergy Research Centre and Allergy Clinic, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Lene H. Garvey
- Department of Dermato-Allergology; National Allergy Research Centre and Allergy Clinic, Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
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Moka E, Argyra E, Siafaka I, Vadalouca A. Chlorhexidine: Hypersensitivity and anaphylactic reactions in the perioperative setting. J Anaesthesiol Clin Pharmacol 2015; 31:145-8. [PMID: 25948890 PMCID: PMC4411823 DOI: 10.4103/0970-9185.155138] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Eleni Moka
- Department of Anaesthesiology, Creta Interclinic Hospital, Heraklion-Crete, Greece
| | - Eriphili Argyra
- A' Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Ioanna Siafaka
- A' Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Athens, Greece
| | - Athina Vadalouca
- A' Anaesthesiology Clinic, Pain Relief and Palliative Care Unit, Aretaieion University Hospital, University of Athens, Athens, Greece
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Inoue Y, Hagi A, Nii T, Tsubotani Y, Nakata H, Iwata K. Novel antiseptic compound OPB-2045G shows potent bactericidal activity against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus both in vitro and in vivo: a pilot study in animals. J Med Microbiol 2014; 64:32-36. [PMID: 25351713 DOI: 10.1099/jmm.0.080861-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
There is a need for new compounds to effectively treat methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). The novel monobiguanide compound 1-(3,4-dichlorobenzyl)-5-octylbiguanide gluconate (OPB-2045G) has potential bactericidal activity. We sought to elucidate the potency of OPB-2045G bactericidal activity against MRSA and VRE compared to those of chlorhexidine digluconate (CHG) and povidone iodine (PVP-I). In vitro bactericidal activity was analysed using minimum bactericidal concentration (MBC) as the index. The in vivo bactericidal efficacy of OPB-2045G was examined by determining MRSA and VRE contamination of the normal dorsal skin of mice following removal of hair. After a 3 min treatment period, the MBC of OPB-2045G was lower than that of CHG and PVP-I against standard strains and clinical isolates. Additionally, in our in vivo mouse model, the in vivo bactericidal activity of 1.5 % OPB-2045G (a clinically relevant dose) was higher than that of 0.5 % CHG and equivalent to that of 10 % PVP-I against MRSA. Similarly, the in vivo bactericidal activity of OPB-2045G was higher than that of 0.5 % CHG and 10 % PVP-I against VRE. OPB-2045G showed more potent bactericidal activity against MRSA and VRE both in vitro and in vivo compared to CHG and PVP-I, indicating that OPB-2045G may provide better protection against health care-associated infections caused by these pathogens.
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Affiliation(s)
- Yasuhide Inoue
- Naruto Research Institute, Research and Development Centre, Otsuka Pharmaceutical Factory Inc., Tokushima, Japan
| | - Akifumi Hagi
- Naruto Research Institute, Research and Development Centre, Otsuka Pharmaceutical Factory Inc., Tokushima, Japan
| | - Takuya Nii
- Naruto Research Institute, Research and Development Centre, Otsuka Pharmaceutical Factory Inc., Tokushima, Japan
| | - Yoshie Tsubotani
- Naruto Research Institute, Research and Development Centre, Otsuka Pharmaceutical Factory Inc., Tokushima, Japan
| | - Hikaru Nakata
- Naruto Research Institute, Research and Development Centre, Otsuka Pharmaceutical Factory Inc., Tokushima, Japan
| | - Koushi Iwata
- Naruto Research Institute, Research and Development Centre, Otsuka Pharmaceutical Factory Inc., Tokushima, Japan
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Opstrup MS, Johansen JD, Bossi R, Lundov MD, Garvey LH. Chlorhexidine in cosmetic products - a market survey. Contact Dermatitis 2014; 72:55-8. [PMID: 25209186 DOI: 10.1111/cod.12298] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/21/2014] [Accepted: 08/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chlorhexidine may cause type I and type IV allergy. Some chlorhexidine-allergic individuals have been exposed in the healthcare setting as patients or healthcare workers, but for others the source of sensitization is unknown. Chlorhexidine may be used as a preservative or an antimicrobial agent in cosmetic products at a concentration up to 0.3%, as set by the European Cosmetics Directive (now Regulations). OBJECTIVES To identify cosmetic product types containing chlorhexidine, and to measure the concentration of chlorhexidine in selected products. METHODS Between February 2013 and April 2013, we checked for chlorhexidine in cosmetic products in 14 supermarkets, one hairdressing salon and one beauty and retail store in Copenhagen, Denmark by reading the ingredient labels. The chlorhexidine concentration was measured in 10 selected products by high-performance liquid chromatography (HPLC) with an ultraviolet (UV) detector. RESULTS Chlorhexidine was found in 80 of 2251 checked products (3.6%) in the following categories: hair products (57/760), creams (9/324), face washes (4/24), wet wipes (4/63), skin tonics (3/22), make-up removers (2/25), and mouth washes (1/17). Chlorhexidine concentrations were 0.01-0.15%. CONCLUSIONS We found chlorhexidine in various cosmetic product types, predominantly aimed at females, and in hair products. The measured chlorhexidine concentrations were all within the permitted limit. The relevance for allergic sensitization should be further explored.
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Affiliation(s)
- Morten S Opstrup
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Ledreborg Allé 40, 1, DK-2820 Gentofte, Denmark; Department of Dermato-Allergology, Allergy Clinic, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, DK-2900 Hellerup, Denmark
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Georges H, Alfandari S, Gois J, Thellier D, Leroy O. Doit-on utiliser la décontamination cutanée par la chlorhexidine en réanimation ? MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0853-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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