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Takeda M, Morita Y, Akai T, Murakami T, Booka E, Matsumoto T, Katahashi K, Takaoka M, Kikuchi H, Hiramatsu Y, Inuzuka K, Kurachi K, Takeuchi H. Effects of povidone-iodine wound irrigation on surgical site infection in gastroenterological surgery: A randomized controlled trial. Surgery 2024; 176:371-378. [PMID: 38825398 DOI: 10.1016/j.surg.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The irrigation efficacy of a povidone-iodine solution to prevent surgical site infection is still controversial. We assessed the irrigation effect with a povidone-iodine solution on the incidence of surgical site infection after gastroenterological surgery. METHODS This study is a single-center, prospective, randomized, blinded-end point superiority trial for surgical wound irrigation. Patients undergoing gastroenterological surgery were randomly assigned in a 1:1 replacement ratio using computer-generated randomization. Patients were grouped according to their surgical wound treatment into the control group using the normal sterile saline and the povidone-iodine group using 10% povidone-iodine solution after the NS solution. The main finding was 30-day surgical site infections assessed in the full analysis set. RESULTS From November 2020 to December 2022, 697 of 894 patients were eligible for the study, among which 347 were in the povidone-iodine group and 350 in the control group. Thirty-day surgical site infections occurred in 100 (14%) patients-54 (16%) in the povidone-iodine group and 46 (13%) in the control group (odds ratio, 1.229; 95% CI, 0.800-1.889; P = .406). Superficial incisional surgical site infections occurred in 30 (9%) and 15 (4%) patients, respectively (odds ratio, 2.154; 95% CI, 1.134-4.090; P = .026). Only 3 patients (1%) in the control group developed adverse skin reactions. CONCLUSION This study examined the irrigation efficacy of povidone-iodine for surgical site infection prevention compared to control in gastroenterological surgery. Povidone-iodine wound irrigation has shown no additional beneficial effect on the occurrence of surgical site infections.
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Affiliation(s)
- Makoto Takeda
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiya Akai
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Murakami
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Matsumoto
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuto Katahashi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masayo Takaoka
- Data Ops Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunori Inuzuka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kiyotaka Kurachi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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Portais A, Gallouche M, Pavese P, Caspar Y, Bosson JL, Astagneau P, Pailhé R, Tonetti J, Duval BR, Landelle C. Staphylococcus aureus screening and preoperative decolonisation with Mupirocin and Chlorhexidine to reduce the risk of surgical site infections in orthopaedic surgery: a pre-post study. Antimicrob Resist Infect Control 2024; 13:75. [PMID: 38992708 PMCID: PMC11238515 DOI: 10.1186/s13756-024-01432-2] [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: 03/13/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Nasal carriage of Staphylococcus aureus is a risk factor for surgical site infections (SSI) in orthopaedic surgery. The efficacy of decolonisation for S. aureus on reducing the risk of SSI is uncertain in this speciality. The objective was to evaluate the impact of a nasal screening strategy of S. aureus and targeted decolonisation on the risk of S. aureus SSI. METHODS A retrospective pre-post and here-elsewhere study was conducted between January 2014 and June 2020 in 2 adult orthopaedic surgical sites (North and South) of a French university hospital. Decolonisation with Mupirocin and Chlorhexidine was conducted in S. aureus carriers starting February 2017 in the South site (intervention group). Scheduled surgical procedures for hip, knee arthroplasties, and osteosyntheses were included and monitored for one year. The rates of S. aureus SSI in the intervention group were compared to a historical control group (South site) and a North control group. The risk factors for S. aureus SSI were analysed by logistic regression. RESULTS A total of 5,348 surgical procedures was included, 100 SSI of which 30 monomicrobial S. aureus SSI were identified. The preoperative screening result was available for 60% (1,382/2,305) of the intervention group patients. Among these screenings, 25.3% (349/1,382) were positive for S. aureus and the efficacy of the decolonisation was 91.6% (98/107). The rate of S. aureus SSI in the intervention group (0.3%, 7/2,305) was not significantly different from the historical control group (0.5%, 9/1926) but differed significantly from the North control group (1.3%, 14/1,117). After adjustment, the risk factors of S. aureus SSI occurrence were the body mass index (ORaper unit, 1.05; 95%CI, 1.0-1.1), the Charlson comorbidity index (ORaper point, 1.34; 95%CI, 1.0-1.8) and operative time (ORaper minute, 1.01; 95%CI, 1.00-1.02). Having benefited from S. aureus screening/decolonisation was a protective factor (ORa, 0.24; 95%CI, 0.08-0.73). CONCLUSIONS Despite the low number of SSI, nasal screening and targeted decolonisation of S. aureus were associated with a reduction in S. aureus SSI.
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Affiliation(s)
- Antoine Portais
- Infectious and Tropical Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Meghann Gallouche
- Hospital Hygiene Unit, Grenoble Alpes University Hospital, Grenoble, France.
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France.
| | - Patricia Pavese
- Infectious and Tropical Diseases Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Yvan Caspar
- Bacteriology Laboratory, Grenoble Alpes University Hospital, Grenoble, France
- Univ. Grenoble Alpes, CEA, CNRS, IBS, Grenoble, France
| | - Jean-Luc Bosson
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
- Public Health Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Pascal Astagneau
- Centre for the prevention of healthcare associated infections (CPIAS), Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, INSERM, Paris, France
| | - Regis Pailhé
- Orthopaedic Surgery Unit, Clinique Aguiléra, Ramsay Santé, Biarritz, France
| | - Jérôme Tonetti
- Department of Orthopaedic Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Brice Rubens Duval
- Department of Osteoarthritis and Sport Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Landelle
- Hospital Hygiene Unit, Grenoble Alpes University Hospital, Grenoble, France
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
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Inglis SS, Kanwar A, Bonilla HG, Singh S, Pearson JY, Abbas M, Folkens LA, Ou NN, Spencer PJ, Villavicencio MA, Clavell AL, Frantz RP, Rosenbaum AN, Behfar A. Reduction in Balloon Pump Size Reduces Axillary Intraaortic Balloon Pump Failure Risk. ASAIO J 2024:00002480-990000000-00521. [PMID: 38976860 DOI: 10.1097/mat.0000000000002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Axillary artery intra-aortic balloon pump (axIABP) placement has been implemented as a bridging solution before heart transplantation. This study evaluates complications associated with axIABP support and describes an approach to minimize adverse events. We previously described a percutaneous approach for axIABP placement. However, patients receiving axIABP between September 1, 2017, and September 26, 2019 (n = 32) demonstrated a high rate of balloon pump malfunction (8/32; 25%) and other complications (totaling 15/32; 47%). Sixty-four patients were sequentially treated under a revised protocol. Compared to the initial cohort, no significant differences in demographics were noted. A significant reduction in rate of balloon malfunction (8/32, 25% vs. 1/64, 2%; p < 0.001) and total complications (15/32, 47% vs. 10/64, 16%; p = 0.0025) during the period of support were noted after intervention. Subsequent analysis of total complications per device size (40 vs. ≤ 34 ml balloon) revealed significantly reduced complications in patients with smaller devices (40% vs. 13%, respectively; p = 0.0022). This study provides guidelines to limit complications in patients supported with axIABP, facilitating a protracted period of bridging support.
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Affiliation(s)
- Sara S Inglis
- From the Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ardaas Kanwar
- From the Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, Minnesota
| | | | - Swaiman Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mohsin Abbas
- From the Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, Minnesota
| | - Lori A Folkens
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Narith N Ou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Department of Pharmacy Operations, Rochester, Minnesota
| | - Philip J Spencer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Alfredo L Clavell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Robert P Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Saidel-Odes L, Yosipovich R, Benkovich V, Friesem T, Nativ R, Sagi O, Shimoni O, Borer A. Getting the drop on Staphylococcus aureus: Semiquantitative Staphylococcus aureus nasal colony reduction in orthopedic surgery reduces surgical site infection. Am J Infect Control 2024; 52:785-789. [PMID: 38551523 DOI: 10.1016/j.ajic.2024.02.014] [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: 11/22/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Surgical site infection (SSI) is a frequent health care-associated infection. We aimed to reduce SSI risk after joint arthroplasty and spine surgery by reducing Staphylococcus aureus colonization burden with presurgery intranasal povidone-iodine (PVP-I) application in conjunction with skin antisepsis ("the intervention"). METHODS Retrospective case-control study; postintervention cohort versus a historical cohort. Adults who underwent joint arthroplasty or spine surgery during February 2018 through October 2021 ("post-intervention cohort") included. In the analysis cases any patient who underwent surgery and developed SSI within 90 days postsurgery, controls had no SSI. Postintervention cohort data were compared with a similar retrospective 2016 to 2017 patient cohort that did not use intranasal PVP-I. RESULTS The postintervention cohort comprised 688 consecutive patients aged 65y/o, 48.8% male, 28 cases, and 660 controls. Relatively more cases than controls had diabetes mellitus (P = .019). There was a 39.6% eradication rate of S aureus nasal colonization post intranasal PVP-I (P < .0001). SSI rate was higher in patients positive versus those negative for S aureus on a 24-hour postsurgery nasal culture (P < .0001). The deep SSI rate per 100 operations postintervention versus the historical cohort decreased for all surgical procedures. CONCLUSIONS Semiquantitative S aureus nasal colony reduction using intranasal PVP-I is effective for decreasing SSI rate in joint arthroplasty and spine surgery. In patients with presurgery S aureus nasal colonization additional intranasal PVP-I postsurgery application should be considered.
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Affiliation(s)
- Lisa Saidel-Odes
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Rivka Yosipovich
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Vadim Benkovich
- Orthopedic Surgery Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tai Friesem
- Orthopedic Surgery Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ronit Nativ
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Orli Sagi
- Clinical Microbiology Laboratory, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orly Shimoni
- Hospital Pharmacy, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Abraham Borer
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Alsaeedi EE, Rose P, Welham SJM. Salivary iodide status as a measure of whole body iodine homoeostasis? Br J Nutr 2024; 131:1740-1753. [PMID: 38287697 PMCID: PMC11063662 DOI: 10.1017/s000711452400031x] [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: 10/20/2023] [Revised: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 01/31/2024]
Abstract
Iodine is a trace element required to produce the thyroid hormones, which are critical for development, growth and metabolism. To ensure appropriate population iodine nutrition, convenient and accurate methods of monitoring are necessary. Current methods for determining iodine status either involve a significant participant burden or are subject to considerable intra-individual variation. The continuous secretion of iodide in saliva potentially permits its use as a convenient, non-invasive assessment of status in populations. To assess its likely effectiveness, we reviewed studies analysing the association between salivary iodide concentration (SIC) and dietary iodine intake, urinary iodide concentration (UIC) and/or 24-h urinary iodide excretion (UIE). Eight studies conducted in different countries met the inclusion criteria, including data for 921 subjects: 702 healthy participants and 219 with health conditions. SIC correlated positively with UIC and/or UIE in four studies, with the strength of relationship ranging from r = 0·19 to r = 0·90 depending on sampling protocol, age, and if salivary values were corrected for protein concentration. Additionally, SIC positively correlated with dietary intake, being strongest when saliva was collected after dinner. SIC varied with external factors, including thyroid function, use of some medications, smoking and overall health status. Evidence provided here supports the use of SIC as a viable, low-burden method for determining iodine status in populations. However, small sample sizes and high variability indicates the need for more extensive analyses across age groups, ethnicities, disease states and dietary groups to clarify the relative accuracy and reliability in each case and standardise procedure.
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Affiliation(s)
- Eatedal Eenizan Alsaeedi
- University of Nottingham, School of Biosciences, Division of Food, Nutrition & Dietetics, Loughborough, LeicestershireLE12 5RD, UK
- University of Hafr Al Batin, College of Applied Medical Sciences, Division of Clinical Nutrition, Hafr Al Batin, Saudi Arabia
| | - Peter Rose
- University of Nottingham, School of Biosciences, Division of Food, Nutrition & Dietetics, Loughborough, LeicestershireLE12 5RD, UK
| | - Simon J. M. Welham
- University of Nottingham, School of Biosciences, Division of Food, Nutrition & Dietetics, Loughborough, LeicestershireLE12 5RD, UK
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Chrysostomou D, Pokorná A, Cremers N, Peters L. Medical-Grade Honey Is a Versatile Wound Care Product for the Elderly. JAR LIFE 2024; 13:51-59. [PMID: 38774269 PMCID: PMC11106090 DOI: 10.14283/jarlife.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/08/2024] [Indexed: 05/24/2024]
Abstract
Introduction Ageing of the global population has led to an increase in the demand for the treatment of wounds, especially considering the challenges of managing wounds in the elderly. Therefore, more effective treatment strategies need to be explored. In this article, we aimed to compare medical-grade honey (MGH) products with other wound care products and to provide guidelines on using MGH in wounds commonly found in the elderly. Methods Based on literature research and expert opinion, an overview of commonly used wound care products and their wound healing characteristics is provided. In addition, literature-based classification of wounds in the elderly and the recommendations for treatments are provided. Results Frequently used wound care products include povidone-iodine, enzymatic products, absorbing dressings, larvae, silver dressings, and MGH dressings. Supported by systematic reviews and meta-analyses, MGH dressings were identified as the most potent and all-round wound care product compared to the others. Next, we provided basic guidelines for managing the most common wounds in the elderly, both acute and chronic, and specified how and which MGH products can be used in these wounds. Conclusion MGH is a widely applicable, safe, easy-to-use, and cost-effective product to manage wounds in the elderly. In case of doubt, refer to a trained wound care specialist who can support the treatment of difficult-to-heal wounds.
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Affiliation(s)
- D. Chrysostomou
- Wound Clinic Health@45, Linksfield Road 45, Dowerglen, Johannesburg 1612, South Africa
- Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - A. Pokorná
- Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- College of Polytechnics Jihlava, Jihlava, Czech Republic
| | - N.A.J. Cremers
- Triticum Exploitatie BV, Sleperweg 44, 6222NK Maastricht, The Netherlands
- Department of Gynecology and Obstetrics, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - L.J.F. Peters
- Triticum Exploitatie BV, Sleperweg 44, 6222NK Maastricht, The Netherlands
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Nahra R, Darvish S, Gandhi S, Gould S, Floyd D, Devine K, Fraimow H, Dibato JE, Rachoin JS. Impact of Povidone Application to Nares in Addition to Chlorhexidine Bath in Critically Ill Patients on Nosocomial Bacteremia and Central Line Blood Stream Infection. J Clin Med 2024; 13:2647. [PMID: 38731176 PMCID: PMC11084507 DOI: 10.3390/jcm13092647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial (MRSA) bacteremia in critically ill patients. A quality improvement study was completed with pre and post-design. The study period was from January 2018 until February 2020 and February 2021 and June 2021. The control period (from January 2018 to May 2019) consisted of CHG bathing alone, and in the intervention period, we added 10% PI to the nares of critically ill patients. Our primary outcome is rates of nosocomial MRSA bacteremia, and our secondary outcome is central line associated blood stream infection (CLABSI) and potential cost savings. There were no significant differences in rates of MRSA bacteremia in critically ill patients. Nosocomial MRSA bacteremia was significantly lower during the intervention period on medical/surgical areas (MSA). CLABSIs were significantly lower during the intervention period in critically ill patients. There were no Staphylococcus aureus CLABSIs in critical care area (CCA)during the intervention period. The intervention showed potential significant cost savings. The application of 10% povidone iodine twice a day in addition to CHG bathing resulted in a significant decrease in CLABSIs in critically ill patients and a reduction in nosocomial MRSA in the non-intervention areas. Further trials are needed to tease out individual patients who will benefit from the intervention.
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Affiliation(s)
- Raquel Nahra
- Division of Infectious Diseases, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA;
- Division of Critical Care Medicine, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
- Department of Infection Prevention, Cooper University Healthcare, Camden, NJ 08103, USA;
| | - Shahrzad Darvish
- Department of Infection Prevention, Cooper University Healthcare, Camden, NJ 08103, USA;
| | - Snehal Gandhi
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
- Division of Hospital Medicine, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA
| | | | - Diane Floyd
- Department of Nursing, Cooper University Healthcare, Camden, NJ 08103, USA
| | - Kathy Devine
- Department of Nursing, Cooper University Healthcare, Camden, NJ 08103, USA
| | - Henry Fraimow
- Division of Infectious Diseases, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA;
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
| | - John E. Dibato
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
- Cooper University Healthcare, Camden, NJ 08103, USA
| | - Jean-Sebastien Rachoin
- Division of Critical Care Medicine, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA; (S.G.)
- Division of Hospital Medicine, Department of Medicine, Cooper University Healthcare, Camden, NJ 08103, USA
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Caetano JVB, Valera FCP, Anselmo-Lima WT, Tamashiro E. Non-antibiotic antimicrobial agents for chronic rhinosinusitis: a narrative review. Braz J Otorhinolaryngol 2024; 90:101436. [PMID: 38696892 PMCID: PMC11078632 DOI: 10.1016/j.bjorl.2024.101436] [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: 01/17/2024] [Revised: 03/13/2024] [Accepted: 03/30/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE This narrative review explores alternative non-antibiotic antimicrobial agents for CRS management in adults. METHODS Alternative antimicrobial agents using EPOS 2020 guidelines as reference were selected, and articles dated from 2003 to 2022 in English, Portuguese, or Spanish using PubMed and EMBASE databases. The parameters analyzed included study design, evidence level, population characteristics, CRS characteristics, interventions, outcomes, sample size, randomization, blinding, and side effects. Reviews, unrelated contexts,in vitro experiments, and duplicates were excluded. RESULTS 148 articles were screened; 19 articles were selected for analysis. Randomized controlled trials and cohort studies assessing non-antibiotic antimicrobial treatments for CRS were included. Xylitol demonstrated effectiveness in reducing CRS symptoms, particularly SNOT-22 scores, surpassing saline irrigation benefits. Manuka honey showed potential microbiological benefits in recalcitrant CRS, but symptomatic and endoscopic improvements remained inconclusive. Baby shampoo irrigation improved nasal mucociliary clearance and postoperative outcomes. Colloidal silver nasal irrigation showed limited efficacy in reducing CRS symptoms or endoscopic scores. Povidone-Iodine (PI) nasal irrigation yielded mixed results, with varying effects on culture negativity and SNOT-20 scores. Bacteriophage treatment exhibited promise in decreasing specific bacterial strains and cytokine levels. CONCLUSION Non-antibiotic antimicrobial therapies, including xylitol, manuka honey, baby shampoo, colloidal silver, PI, bacteriophages, lactoferrin, and carrageenan offer potential alternatives for CRS in adult patients. Xylitol, baby shampoo, and PI presented benefits in improving symptoms and nasal endoscopic scores, however, the number of studies is limited for conclusive recommendations and safety assessments. CRS management should adopt a comprehensive approach, particularly for non-infectious or immune-related cases, moving beyond antibiotics. Antibiotics should be reserved for confirmed bacterial infections. Overall, this review shows the importance of exploring non-antibiotic therapies to enhance the management of CRS.
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Affiliation(s)
- Joao Vitor Bizinoto Caetano
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Fabiana Cardoso Pereira Valera
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Wilma T Anselmo-Lima
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
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Crisafi C, Grant MC, Rea A, Morton-Bailey V, Gregory AJ, Arora RC, Chatterjee S, Lother SA, Cangut B, Engelman DT. Enhanced Recovery After Surgery Cardiac Society turnkey order set for surgical-site infection prevention: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00281-2. [PMID: 38574802 DOI: 10.1016/j.jtcvs.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES Surgical-site infections (SSIs) after cardiac surgery increase morbidity and mortality, consume health care resources, impair recovery, and diminish patients' quality of life. Numerous guidelines and expert consensus documents have been published to address the prevention and management of SSIs. Our objective is to integrate these documents into an order set that will facilitate the adoption and implementation of evidence-based best practices for preventing and managing SSIs after cardiac surgery. METHODS Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set for SSI reduction. Orders derived from consistent class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the turnkey order set in bold type. Selected orders that were inconsistent class I or IIA, class IIB or otherwise supported by published evidence, were also included in italicized type. RESULTS Preventative care begins with the preoperative identification of both modifiable and nonmodifiable SSI risks by health care providers. Assessment tools can be used to assist in identifying patients at a high risk of SSI. Preoperative recommendations include screening for and treating Staphylococcus aureus nasal carriage. Intraoperatively, tailored prophylactic intravenous antibiotics and maintaining blood glucose levels below 180 mg/dL are essential elements. Postoperative care includes maintaining normothermia, glucose control and patient engagement. CONCLUSIONS Despite the well-documented advantages of a multidisciplinary care pathway for SSI in cardiac surgery, there are inconsistencies in its adoption and implementation. This article provides an order set that incorporates recommendations from existing guidelines to prevent SSI in the cardiac surgical population.
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Affiliation(s)
- Cheryl Crisafi
- Heart & Vascular Program Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Md
| | - Amanda Rea
- Division of Cardiac Surgery, University of Maryland St Joseph Medical Center, Towson, Md
| | | | - Alexander J Gregory
- Department of Anesthesiology, Cumming School of Medicine & Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rakesh C Arora
- Division of Cardiac Surgery, Department of Surgery, Harrington Heart and Vascular, Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | | | - Sylvain A Lother
- Sections of Infectious Diseases and Critical Care Rady Faculty of Health Sciences, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Busra Cangut
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel T Engelman
- Heart & Vascular Program Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass
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Hasegawa H, Kiyofuji S, Umekawa M, Shinya Y, Okamoto K, Shono N, Kondo K, Shin M, Saito N. Profiles of central nervous system surgical site infections in endoscopic transnasal surgery exposing the intradural space. J Hosp Infect 2024; 146:166-173. [PMID: 37516279 DOI: 10.1016/j.jhin.2023.06.033] [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: 04/30/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Despite its efficacy and minimal invasiveness, the clean-contaminated nature of endoscopic transnasal surgery (ETS) may be susceptible to central nervous system surgical site infections (CNS-SSIs), especially when involving intradural exposure. However, the profiles of ETS-associated CNS-SSIs are not fully elucidated. METHODS The institutional ETS cases performed between May 2017 and March 2023 were retrospectively analysed. The incidences of CNS-SSIs were calculated, and their risk factors examined. RESULTS The incidence of CNS-SSIs was 2.3% (7/305) in the entire cohort and 5.0% (7/140) in ETSs with intradural exposure. All the CNS-SSIs were meningitis and developed following ETS with intradural exposure. The incidences were 0%, 5.6% and 5.8% in ETSs with Esposito grade 1, 2 and 3 intraoperative cerebrospinal fluid leakage, respectively. Among the pre- and intra-operative factors, body mass index (unit odds ratio (OR), 0.62; 95% confidence interval (CI), 0.44-0.89; P<0.01), serum albumin (unit OR, 0.03; 95% CI, 0.0007-0.92; P=0.02), and American Society of Anesthesiologists physical status score (unit OR, 20.7; 95% CI, 1.65-259; P<0.01) were significantly associated with CNS-SSIs. Moreover, postoperative cerebrospinal fluid leakage was also significantly associated with CNS-SSIs (OR, 18.4; 95% CI, 3.55-95.0; P<0.01). CONCLUSIONS The incidence of ETS-associated CNS-SSIs is acceptably low. Intradural exposure was a prerequisite for CNS-SSIs. Malnutrition and poor comorbidity status should be recognized as important risks for CNS-SSIs in ETS.
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Affiliation(s)
- H Hasegawa
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan.
| | - S Kiyofuji
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - M Umekawa
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Y Shinya
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - K Okamoto
- Department of Infectious Diseases, University of Tokyo, Tokyo, Japan
| | - N Shono
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - K Kondo
- Department of Otorhinolaryngology, University of Tokyo, Tokyo, Japan
| | - M Shin
- Department of Neurosurgery, Teikyo University, Tokyo, Japan
| | - N Saito
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
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Friedland PL, Tucker S. Phase II Trial of the Impact 0.5% Povidone-Iodine Nasal Spray (Nasodine®) on Shedding of SARS-CoV-2. Laryngoscope 2024. [PMID: 38554057 DOI: 10.1002/lary.31430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVE A Phase II trial was conducted to determine if nasal disinfection with a commercial Good Manufacturing Practice-manufactured 0.5% povidone-iodine nasal spray (Nasodine®) may be a useful adjunct in the management of COVID-19 by reducing viral shedding and prevention of transmission of SARS-CoV-2. The aim was to confirm the results from a human single-dose pilot study by assessing repeated and frequent doses on nasal shedding of SARS-CoV-2 from adult subjects with confirmed COVID-19. METHODS A multicenter, randomized, double-blinded, placebo-controlled Phase II clinical trial involving adults with early COVID-19 symptoms. Baseline nasal swabs were collected to quantify pretreatment SARS-CoV-2 nasal viral load, followed by Nasodine treatment eight times daily over 3 calendar days. Daily nasal swabs were collected post-dose to assess the impact of treatment on nasal viral load, measured by log10 TCID50 in quantitative culture. RESULTS Nasodine subjects exhibited significantly improved reduction in viral load (log10 TCID50) on Days 2-4 compared to placebo recipients (p = 0.028), rate of nasal clearance of viable virus (p = 0.032), and complete (100%) nasal and throat clearance of the virus by Day 5. No difference was seen in antigen shedding as measured by time transition from Rapid Antigen Test (RAT) positivity to RAT negativity. CONCLUSION A total of 20 doses of Nasodine® nasal spray administered over 2.5 days significantly reduced the titers of viable SARS-CoV-2 virus in the nasal passages of COVID-19 subjects. This is the first study demonstrating the efficacy of a tolerable intranasal formulation of povidone-iodine on viral shedding in COVID-19 subjects. Nasal disinfection may diminish viral transmission to others. LEVEL OF EVIDENCE Level 2 Laryngoscope, 2024.
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Affiliation(s)
- Peter L Friedland
- Faculty of Medical and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Department Otorhinolaryngology Head Neck Skull Base Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Firebrick Pharma Limited, Melbourne, Victoria, Australia
| | - Simon Tucker
- Firebrick Pharma Limited, Melbourne, Victoria, Australia
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Bourget-Murray J, Tubin N, Bureau A, Morris J, Ann Azad M, Abdelbary H, Grammatopoulos G, Garceau S. Lower Rates of Reoperation Following Partial or Complete Revision Arthroplasty Compared to Debridement, Antibiotics, and Implant Retention for Early Postoperative and Acute Hematogenous Periprosthetic Hip Infection. J Arthroplasty 2024:S0883-5403(24)00270-5. [PMID: 38531489 DOI: 10.1016/j.arth.2024.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND This study aimed to: 1) compare treatment outcomes between debridement, antibiotics, and implant retention (DAIR) and partial or complete revision arthroplasty (RA) for early postoperative and acute hematogenous total hip arthroplasty periprosthetic joint infection (PJI) and 2) identify factors associated with treatment outcome. METHODS The study consisted of a retrospective cohort of patients who underwent surgery for PJI between 2004 and 2021. There were 76 patients (74.5%) who underwent DAIR and 26 patients (25.5%) who underwent RA. Treatment success was defined as treatment eradication at a minimum of a 2-year follow up. Bivariate regression analysis was used to assess the effect of different factors on treatment outcomes. Kaplan-Meier survivorship was performed to compare survivorship between cohorts. RESULTS At a mean follow-up of 8.2 years (range, 2.2 to 16.4), significantly more DAIR failed treatment (DAIR, 50 [65.8%]; 10 [38.5%]; P = .015). The 8-year Kaplan-Meier survivorship was 35.1% [95% confidence interval (CI), 24.3 to 45.9] for patients treated with DAIR and 61.5% [95% CI, 42.9 to 80.1] for those treated with RA (log rank = 0.039). Bivariate regression analysis showed performing a RA was associated with a higher likelihood of treatment success (odds ratio 4.499, 95% CI 1.600 to 12.647, P = .004), whereas a higher body mass index was associated with treatment failure (odds ratio 0.934, 95% CI 0.878 to 0.994, P = .032). CONCLUSIONS To reduce the rate of recalcitrant infection following early postoperative or acute hematogenous total hip arthroplasty PJI, RA may be of benefit over DAIR. This is especially relevant in the early postoperative period, when components can be readily exchanged.
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Affiliation(s)
- Jonathan Bourget-Murray
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas Tubin
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Antoine Bureau
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jared Morris
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Marisa Ann Azad
- Hôtel-Dieu de Lévis, Université Laval, Quebec City, Quebec, Canada
| | - Hesham Abdelbary
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Garceau
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Spaide RF. METHOD OF POVIDONE-IODINE APPLICATION AND ENDOPHTHALMITIS RISK. Retin Cases Brief Rep 2024; 18:141-144. [PMID: 36730810 DOI: 10.1097/icb.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the proportion of patients developing endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents according to the mode of povidone-iodine (PI) antisepsis. METHODS A retrospective review of the anti-vascular endothelial growth factor injections given in a 7-year period at a community-based retinal practice. Endophthalmitis was diagnosed to have occurred if an eye developed intraocular inflammation and was given antibiotics with or without supportive culture identification of an organism. As part of their habitual clinical practice, component physicians used 5% PI as two drops, one drop, or just a dot of PI administered with a cotton-tipped applicator to the site before injection. RESULTS There were 113,610 intravitreal injections administered and 23 cases were diagnosed with endophthalmitis over the 7-year period, for a rate of 1 case per 4,940 injections. The mode of PI antisepsis showed no significant relation to the rate of endophthalmitis ( P = 0.55, chi-square test). The proportion of endophthalmitis by physician demonstrated no significant difference ( P = 0.39, chi-square test). CONCLUSION The use of PI has been associated with decreased incidence of endophthalmitis, but the mode of application has not been standardized. The results of this study suggest that "more is not better" in PI antisepsis in endophthalmitis. Moreover, the toxicity of PI on the ocular surface is known to be dose-related.
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Affiliation(s)
- Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York
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Gazel D, Erinmez M, Çalışkantürk G, Saadat KASM. In Vitro and Ex Vivo Investigation of the Antibacterial Effects of Methylene Blue against Methicillin-Resistant Staphylococcus aureus. Pharmaceuticals (Basel) 2024; 17:241. [PMID: 38399456 PMCID: PMC10893340 DOI: 10.3390/ph17020241] [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: 12/20/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Methylene blue (MB) is a water-soluble dye that has a number of medical applications. Methicillin-resistant Staphylococcus aureus (MRSA) was selected as a subject for research due to the numerous serious clinical diseases it might cause and because there is a significant global resistance challenge. Our main goal was to determine and analyze the antibacterial effects of MB against S. aureus both in vitro and ex vivo to enhance treatment options. A total of 104 MRSA isolates recovered from various clinical specimens were included in this study. Minimum inhibitory concentration (MIC) values of MB against MRSA isolates were determined by the agar dilution method. One randomly selected MRSA isolate and a methicillin-susceptible S. aureus strain (S. aureus ATCC 25923) were employed for further evaluation of the antibacterial effects of MB in in vitro and ex vivo time-kill assays. A disc diffusion method-based MB + antibiotic synergy assay was performed to analyze the subinhibitory effects of MB on ten isolates. MICs of MB against 104 MRSA isolates, detected by the agar dilution method, ranged between 16 and 64 µg/mL. MB concentrations of 4 and 16 µg/mL showed a bactericidal effect at 24 h in the ex vivo time-kill assays and in vitro time-kill assays, respectively. We observed a significant synergy between cefoxitin and methylene blue at a concentration of 1-2 μg/mL in two (20%) test isolates. Employing MB, which has well-defined pharmacokinetics, bioavailability, and safety profiles, for the treatment of MRSA infections and nasal decolonization could be a good strategy.
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Affiliation(s)
- Deniz Gazel
- Department of Medical Microbiology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey
| | - Mehmet Erinmez
- Laboratory of Medical Microbiology, Gaziantep Abdülkadir Yüksel State Hospital, Gaziantep 27100, Turkey;
| | - Gönenç Çalışkantürk
- Department of Medical Microbiology, Gaziantep Public Health Laboratory, Gaziantep 27010, Turkey;
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Sreedhar SS, Rajalakshmi AR, Nagarajan S, Easow JM, Rajendran P. Comparison of preoperative prophylaxis with povidone-iodine (5%) and moxifloxacin (0.5%) versus povidone-iodine (5%) alone: a prospective study from India. Int Ophthalmol 2024; 44:48. [PMID: 38337066 DOI: 10.1007/s10792-024-03025-9] [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: 11/24/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To compare the effect of povidone-iodine (PI) 5% and moxifloxacin 0.5% solutions versus PI 5% solution alone on the conjunctival bacterial flora. METHODOLOGY This is a comparative study in which the study population comprised adult patients scheduled for elective small incision cataract surgery. The eye to be operated (control eye) received topical moxifloxacin 0.5% drops 4 times, 1 day before surgery and 2 applications on the day of surgery. As placebo, the contralateral eye (study eye) received saline 0.90% drops as per the same schedule. Before surgery, on table, PI 5% was instilled in the conjunctival sac in both eyes. Conjunctival swabs were taken before initiation of therapy and 3 min after instillation of PI. RESULTS Of the 96 pairs of eyes included in the study, conjunctival cultures before prophylaxis were similar between the two groups (p = 0.31), with 54 samples (56%) of the study group and 49 (51%) of the control group showing growth. With positive cultures reducing to 7 (14%) in the study group and 8 (16%) in the control group, both the prophylaxis methods appeared equally efficacious (p = 0.79). Both the groups showed a significant reduction in positive cultures following prophylaxis (p < 0.0001). CONCLUSIONS PI 5% alone as preoperative prophylaxis was as effective as its combination therapy with moxifloxacin 0.5% in the reduction in conjunctival bacterial colonization.
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Affiliation(s)
- Sanjana S Sreedhar
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - A R Rajalakshmi
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India.
| | - Swathi Nagarajan
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Joshy M Easow
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Prabha Rajendran
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
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Padalhin A, Ryu HS, Yoo SH, Abueva C, Seo HH, Park SY, Chung PS, Woo SH. Antiseptic, Hemostatic, and Wound Activity of Poly(vinylpyrrolidone)-Iodine Gel with Trimethyl Chitosan. Int J Mol Sci 2024; 25:2106. [PMID: 38396783 PMCID: PMC10889287 DOI: 10.3390/ijms25042106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Wound management practices have made significant advancements, yet the search for improved antiseptics persists. In our pursuit of solutions that not only prevent infections but also address broader aspects of wound care, we investigated the impact of integrating trimethyl chitosan (TMC) into a widely used poly(vinylpyrrolidone)-iodine gel (PVP-I gel). Our study assessed the antimicrobial efficacy of the PVP gel with TMC against Escherichia coli, Staphylococcus aureus, multidrug-resistant S. aureus MRSA, and Candida albicans. Additionally, we compared hemostatic effects using a liver puncture bleeding model and evaluated wound healing through histological sections from full-thickness dermal wounds in rats. The results indicate that incorporating TMC into the commercially available PVP-I gel did not compromise its antimicrobial activity. The incorporation of TMC into the PVP-I gel markedly improves its hemostatic activity. The regular application of the PVP-I gel with TMC resulted in an increased blood vessel count in the wound bed and facilitated the development of thicker fibrous tissue with a regenerated epidermal layer. These findings suggest that TMC contributes not only to antimicrobial activity but also to the intricate processes of tissue regeneration. In conclusion, incorporating TMC proves beneficial, making it a valuable additive to commercially available antiseptic agents.
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Affiliation(s)
- Andrew Padalhin
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan 31116, Republic of Korea; (A.P.); (H.S.R.); (C.A.); (S.Y.P.); (P.-S.C.)
| | - Hyun Seok Ryu
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan 31116, Republic of Korea; (A.P.); (H.S.R.); (C.A.); (S.Y.P.); (P.-S.C.)
| | - Seung Hyeon Yoo
- School of Medical Laser, Dankook University, Cheonan 31116, Republic of Korea; (S.H.Y.); (H.H.S.)
| | - Celine Abueva
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan 31116, Republic of Korea; (A.P.); (H.S.R.); (C.A.); (S.Y.P.); (P.-S.C.)
- Medical Laser Research Center, Dankook University, Cheonan 31116, Republic of Korea
| | - Hwee Hyon Seo
- School of Medical Laser, Dankook University, Cheonan 31116, Republic of Korea; (S.H.Y.); (H.H.S.)
| | - So Young Park
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan 31116, Republic of Korea; (A.P.); (H.S.R.); (C.A.); (S.Y.P.); (P.-S.C.)
| | - Phil-Sang Chung
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan 31116, Republic of Korea; (A.P.); (H.S.R.); (C.A.); (S.Y.P.); (P.-S.C.)
- Medical Laser Research Center, Dankook University, Cheonan 31116, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan 31116, Republic of Korea
| | - Seung Hoon Woo
- Beckman Laser Institute Korea, Dankook University College of Medicine, Cheonan 31116, Republic of Korea; (A.P.); (H.S.R.); (C.A.); (S.Y.P.); (P.-S.C.)
- Medical Laser Research Center, Dankook University, Cheonan 31116, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan 31116, Republic of Korea
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Itokawa T, Yamasaki K, Suzuki T, Koh S. Advances in Contact Lens Care Solutions: PVP-I Disinfectant and HAD Wetting Agents From Japan. Eye Contact Lens 2024; 50:91-101. [PMID: 38019569 DOI: 10.1097/icl.0000000000001060] [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] [Accepted: 10/28/2023] [Indexed: 11/30/2023]
Abstract
ABSTRACT Half of the individuals who wear contact lenses use reusable lenses that require proper care. Improper contact lens (CL) care and using inadequate disinfecting solutions can lead to lens contamination, CL-related microbial keratitis, and Acanthamoeba keratitis. Oxidative disinfecting solutions, such as hydrogen peroxide, show higher efficacy than multipurpose solutions. Povidone-iodine (PVP-I), an oxidative disinfectant used in ophthalmic surgery, has been proven to be safe and effective. The PVP-I system, a CL disinfecting solution developed in Japan, has demonstrated excellent antimicrobial and antiviral properties. Although CL discomfort does not have a risk of ocular disorders with poor visual prognosis, such as keratitis, CL discomfort can still lead to lens dropout and thus needs to be addressed. To mitigate CL discomfort, it is essential to use disinfecting solutions containing surfactants and wetting agents that improve wettability of the lens surface. A CL solution containing hyaluronic acid derivatives (HADs) as wetting agents that permanently adhere to the lens surface to improve wettability of the lens surface was developed in Japan. There is potential for HAD to be integrated into various solutions. This article reviews the efficacy of novel PVP-I-based disinfecting solution and HAD wetting agents.
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Affiliation(s)
- Takashi Itokawa
- Department of Ophthalmology (T.I., T.S.), Toho University, Tokyo, Japan; OPHTECS Corporation (K.Y.), Kobe Research Center, Kobe, Japan; Ishizuchi Eye Clinic (T.S.), Ehime, Japan; Department of Innovative Visual Science (S.K.), Osaka University Graduate School of Medicine, Osaka, Japan; and Department of Ophthalmology (S.K.), Osaka University Graduate School of Medicine, Osaka, Japan
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Oropallo A, Rao AS, Del Pin C, Ranire‐Maguire M, Mathew A. An objective comparative study of non-surgical cleansing techniques and cleanser types in bacterial burden management. Int Wound J 2024; 21:e14730. [PMID: 38332560 PMCID: PMC10853581 DOI: 10.1111/iwj.14730] [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: 12/07/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024] Open
Abstract
Cleansing is a vital component of effective wound hygiene and biofilm management, often accomplished through vigorous mechanical action or through soaking with moistened gauze. In the present study, a quantitative comparison of the effectiveness of different cleansing techniques and solutions in removing bacteria was conducted on 71 chronic wounds using bacterial fluorescence imaging as a real-time diagnostic for moderate to high bacterial loads. Vigorous gauze cleansing for 30 s proved most effective by reducing bacterial fluorescence by 33.99%, surpassing 10-min soaking in bacterial reduction (13.24%). Among different cleansers, no statistically significant differences in effectiveness were observed, but povidone-iodine showed the strongest trend towards bacterial reduction. Sub-analysis highlighted the superiority of antiseptic cleansers over saline and gentle soap (-33.30% vs. -1.80% bacterial reduction respectively). Five percent acetic acid was also shown to be more effective in removing specific bacterial strains (Pseudomonas aeruginosa). Findings from studies like this contribute to refining wound hygiene guidelines and clinical algorithms for bacterial and biofilm management.
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Affiliation(s)
- Alisha Oropallo
- Northwell Health Comprehensive Wound Health Center and HyperbaricsLake SuccessNew YorkUSA
- Donald and Barbara School of Medicine, Hofstra University/Northwell, Feinstein Institutes for Medical ResearchHempsteadNew YorkUSA
| | - Amit S. Rao
- Northwell Health Comprehensive Wound Health Center and HyperbaricsLake SuccessNew YorkUSA
| | - Christina Del Pin
- Northwell Health Comprehensive Wound Health Center and HyperbaricsLake SuccessNew YorkUSA
- Donald and Barbara School of Medicine, Hofstra University/Northwell, Feinstein Institutes for Medical ResearchHempsteadNew YorkUSA
| | - Marisa Ranire‐Maguire
- Northwell Health Comprehensive Wound Health Center and HyperbaricsLake SuccessNew YorkUSA
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Seema K, Shah A, Chansoria H, Sharma M, Kaur M, Varma PK, Tiwari RVC. Comparison of Different Betadine and Saline Combinations on Microorganisms: An Original Research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S219-S222. [PMID: 38595466 PMCID: PMC11000963 DOI: 10.4103/jpbs.jpbs_470_23] [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: 08/03/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Pathogenic bacteria in the oral cavity or a physiological microbiome imbalance can cause or maintain disease. Thus, this work examined a novel betadine-saline combination for antibacterial and antifungal activities. Materials and Methods This study was in vitro. Betadine, saline, and their mixtures were tested for Bacillus subtilis, Staphylococcus aureus (gram-positive), Pseudomonas aeruginosa, Escherichia coli, and Aspergillus niger (gram-negative). Pour plate and disc diffusion methods were used to test CFUs, DZI, and RZI for various agent combinations. Results For Lactobacillus acidophilus, Betadine 90% + saline 10% had the greatest DZI and RZI at 24 and 12 mm, respectively. For E. coli, Betadine 50% + saline 50% had the highest at 16 and 8 mm. Betadine 60% + saline 40% had 14 mm RZI and the highest antifungal activity. Conclusion The novel betadine-saline antibacterial and antifungal combination performed well. In vivo research should confirm the existing findings.
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Affiliation(s)
- Kumari Seema
- Department of Microbiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Ankit Shah
- MBBS, MS, Ophthalmology, Consultant Ophthalmologist, Manish Eye Institute, Ahmedabad, Gujarat, India
| | - Harsh Chansoria
- Department of Prosthodontics Crown and Bridge, Government College of Dentistry Indore, MP, United States of America
| | - Mayank Sharma
- Senior Dentist, Central Coast Dental Care, Seaside, CA, United States of America
| | | | - Praveen K. Varma
- Department of Orthodontics, Vishnu Dental College, Vishnupur, Bhimavaram, Andhra Pradesh, India
| | - Rahul VC Tiwari
- Department of Oral and Maxillofacial Surgery, Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
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Foja S, Heinzelmann J, Viestenz A, Rueger C, Hecht S, Viestenz A. Evaluation of the Possible Influence of Povidone Iodine (PVI) Solution and Polyhexanide (PHMB) on Wound Healing in Corneal Epithelial Regeneration. J Clin Med 2024; 13:588. [PMID: 38276094 PMCID: PMC10816162 DOI: 10.3390/jcm13020588] [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: 11/08/2023] [Revised: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
This study investigates the possible toxic effects of the preoperative antiseptic substances povidone iodine (PVI) and polyhexanide (PHMB; Serasept® 2) on wound healing in ophthalmology. To assess this impact, human telomerase-immortalized corneal epithelial (hTCEpi) cells and human telomerase-immortalized conjunctival epithelial (hCjE) cells were exposed to 1% and 5% PVI or 0.04% PHMB for different periods to evaluate the cytotoxicity of these two antiseptics. Furthermore, the toxicity of these antiseptics was investigated in a human tissue-specific corneal epithelial construct and porcine eye culture model. The results reveal the high cytotoxicity of PVI and PHMB in the hTCEpi and hCjE in monolayer cell culture models, independent of the incubation time and concentration of these substances. However, after hTCEpi cell differentiation into a tissue-specific corneal epithelial construct, contact with these antiseptics for the relevant preoperative time did not alter cPARP1 or Ki67 expression. Furthermore, the wound-healing process in the porcine cornea was not significantly influenced after incubation with these antiseptics. In summary, corneal and conjunctival epithelial cell lines are very sensitive to PVI and PHMB, whereas no significant alterations were found in intact tissue-specific corneal epithelial constructs or porcine corneas. Therefore, we could not identify PVI and PHMB as reasons for postoperative eye irritation.
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Eddy EP, Shet MS, Cataldo M, Grob D, Bhaskar S. Evaluation of dermal toxicity and toxicokinetics of povidone‑iodine in Göttingen minipigs. Toxicol Appl Pharmacol 2024; 482:116783. [PMID: 38061611 DOI: 10.1016/j.taap.2023.116783] [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: 07/24/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Povidone‑iodine (PVP-I) is an effective and commonly used broad-spectrum antiseptic; limited information exists around its long-term safety and impact on endocrine disruption. We assessed the dermal toxicity and toxicokinetics following a once-daily application of 7.5% (w/v) and 10% (w/v) PVP-I in Göttingen Minipigs® for up to 39 weeks. METHODS An in vivo study was conducted in male (n = 27) and female (n = 27) minipigs. Animals were randomized into untreated control, 7.5% and 10% PVP-I, and matching vehicle treatment groups. Animals were assessed for general in-life measurements, including skin irritation and organ weights. Serum samples were analyzed for PVP, total iodine, triiodothyronine [T3], thyroxine [T4], thyroid stimulating hormone [TSH], and toxicokinetic parameters. RESULTS Neither 7.5% nor 10% PVP-I affected general in-life measurements. Increased mean thyroid gland absolute weights were noted with 7.5% and 10% PVP-I. Serum levels of PVP, T3, T4, and TSH in the 7.5% and 10% PVP-I treatment group animals were similar to those in vehicle treatment group animals. Mean total serum iodine concentration was 52- and 13-fold higher with 7.5% and 10% PVP-I, respectively, vs respective vehicle treatments. There was no dose-dependent increase in mean maximum serum concentration and area under the curve from 0 to 24 h for PVP, T3, T4, and TSH, nor accumulation of PVP, T3, T4, or TSH in the study. CONCLUSION Once-daily dermal application of 7.5% and 10% PVP-I for up to 39 weeks was safe and well tolerated in Göttingen Minipigs® and was not associated with skin irritation, thyroid dysfunction, or endocrine disruption. As the anatomy and physiology of the minipig skin closely resembles that of human skin, the findings of this study suggest that 7.5% and 10% PVP-I may be translated into antimicrobial benefits for humans without the risk of endocrine disruption.
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Vijayakumar G, Sundaram GA, Kumar SP, Krishna VK, Krishnan M. Comparison of the Effectiveness of Four Different Irrigation Solutions on Postoperative Sequelae in Patients Undergoing Lower Third Molar Surgery: A Prospective Study. Cureus 2023; 15:e50816. [PMID: 38249289 PMCID: PMC10797225 DOI: 10.7759/cureus.50816] [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: 11/21/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Oral and maxillofacial surgeons frequently perform the removal of impacted mandibular third molars. The success of this surgical intervention depends on meticulous surgical technique and the use of appropriate irrigants to minimize complications in the postoperative period. Aim The aim of this study was to evaluate the efficacy of four different irrigation solutions (povidone-iodine, metronidazole, chlorhexidine gluconate (CHX), and normal saline) on postoperative sequelae like pain, trismus, swelling, and alveolar osteitis following surgical extraction of the impacted mandibular third molars. Materials and methods The current research was a randomized study carried out at Saveetha Dental College and Hospital in Chennai, India, from December 2022 to March 2023. The study population consisted of 112 participants who were referred to the Oral and Maxillofacial Surgery for the surgical removal of impacted mandibular third molars. The population was divided into four groups, with 28 in each group. They were categorized as A, B, C, and D based on the final irrigation solution used after surgical removal of the impacted teeth. In group A, patients received 0.5% povidone-iodine as the final irrigation solution; group B received 1% metronidazole; group C received 0.12% chlorhexidine gluconate (CHX); and group D received 0.9% normal saline. Patients were examined on the first and seventh postoperative days to assess pain, swelling, trismus, and alveolar osteitis. The results were analyzed with SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States) software for Windows (Microsoft Corporation, Redmond, Washington, United States). A p-value less than 0.05 was considered statistically significant. Results Group B experienced significantly less pain than groups A, C, and D on the first and seventh postoperative days (p<0.05). The facial swelling was significantly less on the first and seventh postoperative day in group B compared to groups A, B, and D (p<0.05). There was no statistically significant variation observed in trismus (mouth opening) across the groups on both the first postoperative and seventh postoperative days. The presence of alveolar osteitis was seen in groups A, C, and D, but no instances were reported in group B. Conclusion It can be concluded that among the four irrigation solutions used in the lower third molar surgery, metronidazole irrigation solution yielded the best results in terms of less pain, swelling, and alveolar osteitis followed by chlorhexidine. There was no difference between povidone-iodine irrigation and normal saline irrigation on the postoperative sequelae. Postoperative trismus does not depend on the irrigation solution used in the third molar surgery.
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Affiliation(s)
- Goutham Vijayakumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Gidean A Sundaram
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Santhosh P Kumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Vinod K Krishna
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Bayer G, Shayganpour A, Bayer IS. Efficacy of a New Alcohol-Free Organic Acid-Based Hand Sanitizer against Foodborne Pathogens. TOXICS 2023; 11:938. [PMID: 37999590 PMCID: PMC10674435 DOI: 10.3390/toxics11110938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Abstract
In light of the global health crisis triggered by the COVID-19 pandemic, numerous experts have deemed the utilization of hand sanitizers imperative as a precautionary measure against the virus. Consequently, the demand for hand sanitizers has experienced a substantial surge. Since the beginning of 2020, the utilization of alcohol-free hand sanitizers has been increasingly favored due to the potential risks associated with alcohol poisoning, flammability, as well as the adverse effects on skin lipid dissolution, dehydration, and sebum reduction, which can lead to severe cases of eczema and norovirus infections. In this study, we developed an aqueous hand sanitizer that does not contain alcohol. The sanitizer consists of naturally occurring, food-grade organic acids, including lactic, citric, and azelaic acids. Additionally, food-grade ammonium sulfate and a small amount of povidone-iodine (PVPI) were included in the formulation to create a synergistic and potent antibacterial effect. The effectiveness of the hand sanitizer was evaluated against four common foodborne pathogens, namely Clostridium botulinum, Escherichia coli, Listeria monocytogenes, and Staphylococcus aureus, via in vitro testing. The organic acids exhibited a synergistic inhibitory function, resulting in a 3-log reduction in CFU/mL. Furthermore, the presence of povidone-iodine and ammonium sulfate enhanced their antibacterial effect, leading to a 4-log reduction in CFU/mL. The hand sanitizer solution remained stable even after 60 days of storage. During this period, the detection of additional triiodide (I3-) ions occurred, which have the ability to release broad-spectrum molecular iodine upon penetrating the cell walls. This alcohol-free hand sanitizer may offer extended protection and is anticipated to be gentle on the skin. This is attributed to the presence of citric and lactic acids, which possess cosmetic properties that soften and smoothen the skin, along with antioxidant properties.
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Affiliation(s)
- Gözde Bayer
- DS Bio ve Nanoteknoloji A. Ş, Lavida City Plaza 45/7, 06530 Ankara, Türkiye;
| | - Amirreza Shayganpour
- Smart Materials, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy;
| | - Ilker S. Bayer
- Smart Materials, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy;
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Yang X, Chen NF, Huang XL, Lin S, Chen QQ, Wang WM, Chen JS. Iodine-doped TiO 2 nanotube coatings: a technique for enhancing the antimicrobial properties of titanium surfaces against Staphylococcus aureus. J Orthop Surg Res 2023; 18:854. [PMID: 37950251 PMCID: PMC10636994 DOI: 10.1186/s13018-023-04354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Implant-related infections are a challenging complication of orthopedic surgery, primarily due to the formation of bacterial biofilms on the implant surface. An antibacterial coating for titanium implants was developed to provide novel insights into the prevention and treatment of implant-related infections. METHODS Titanium plates were coated with TiO2 nanotubes by anodization, and iodine was doped onto the coating via electrophoretic deposition. The obtained plates were characterized using a range of analytical techniques. Subsequently, Staphylococcus aureus was inoculated onto the surfaces of untreated titanium plates (control group), TiO2-nanocoated titanium plates (TiO2 group), and iodine-doped TiO2-nanocoated titanium plates (I-TiO2 group) to compare their antibacterial properties. RESULTS Twenty-four hour in vitro antimicrobial activity test of the I-TiO2 group against Staphylococcus aureus was superior to those of the other groups, and this difference was statistically significant (P < 0.05). CONCLUSIONS This coating technology provides a new theoretical basis for the development of anti-infective implants against Staphylococcus aureus in orthopedics.
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Affiliation(s)
- Xiu Yang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, 350000, China
| | | | | | - Shun Lin
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China
| | - Qing-Quan Chen
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China
| | - Wan-Ming Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China.
| | - Jin-Shui Chen
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350000, China.
- The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, 350000, China.
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Smith M, Herwaldt L. Nasal decolonization: What antimicrobials and antiseptics are most effective before surgery and in the ICU. Am J Infect Control 2023; 51:A64-A71. [PMID: 37890955 DOI: 10.1016/j.ajic.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Staphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units. METHODS We reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited. DISCUSSION/CONCLUSIONS Mupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research.
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Affiliation(s)
- Matthew Smith
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA.
| | - Loreen Herwaldt
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
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Huang SS, Septimus EJ, Kleinman K, Heim LT, Moody JA, Avery TR, McLean L, Rashid S, Haffenreffer K, Shimelman L, Staub-Juergens W, Spencer-Smith C, Sljivo S, Rosen E, Poland RE, Coady MH, Lee CH, Blanchard EJ, Reddish K, Hayden MK, Weinstein RA, Carver B, Smith K, Hickok J, Lolans K, Khan N, Sturdevant SG, Reddy SC, Jernigan JA, Sands KE, Perlin JB, Platt R. Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs: A Randomized Clinical Trial. JAMA 2023; 330:1337-1347. [PMID: 37815567 PMCID: PMC10565599 DOI: 10.1001/jama.2023.17219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 08/17/2023] [Indexed: 10/11/2023]
Abstract
Importance Universal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization. Objective To compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing. Design, Setting, and Participants Two-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) and intervention (November 1, 2017-April 30, 2019) were included. Intervention Universal decolonization involving switching to iodophor-CHG (intervention) or continuing mupirocin-CHG (baseline). Main Outcomes and Measures ICU-attributable S aureus clinical cultures (primary outcome), MRSA clinical cultures, and all-cause bloodstream infections were evaluated using proportional hazard models to assess differences from baseline to intervention periods between the strategies. Results were also compared with a 2009-2011 trial of mupirocin-CHG vs no decolonization in the same hospital network. The prespecified noninferiority margin for the primary outcome was 10%. Results Among the 801 668 admissions in 233 ICUs, the participants' mean (SD) age was 63.4 (17.2) years, 46.3% were female, and the mean (SD) ICU length of stay was 4.8 (4.7) days. Hazard ratios (HRs) for S aureus clinical isolates in the intervention vs baseline periods were 1.17 for iodophor-CHG (raw rate: 5.0 vs 4.3/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 4.1 vs 4.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 18.4% [95% CI, 10.7%-26.6%] for mupirocin-CHG, P < .001). For MRSA clinical cultures, HRs were 1.13 for iodophor-CHG (raw rate: 2.3 vs 2.1/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 2.0 vs 2.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 14.1% [95% CI, 3.7%-25.5%] for mupirocin-CHG, P = .007). For all-pathogen bloodstream infections, HRs were 1.00 (2.7 vs 2.7/1000) for iodophor-CHG and 1.01 (2.6 vs 2.6/1000) for mupirocin-CHG (nonsignificant HR difference in differences, -0.9% [95% CI, -9.0% to 8.0%]; P = .84). Compared with the 2009-2011 trial, the 30-day relative reduction in hazards in the mupirocin-CHG group relative to no decolonization (2009-2011 trial) were as follows: S aureus clinical cultures (current trial: 48.1% [95% CI, 35.6%-60.1%]; 2009-2011 trial: 58.8% [95% CI, 47.5%-70.7%]) and bloodstream infection rates (current trial: 70.4% [95% CI, 62.9%-77.8%]; 2009-2011 trial: 60.1% [95% CI, 49.1%-70.7%]). Conclusions and Relevance Nasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus clinical cultures in adult ICU patients in the context of daily CHG bathing. In addition, the results were consistent with nasal iodophor being inferior to nasal mupirocin. Trial Registration ClinicalTrials.gov Identifier: NCT03140423.
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Affiliation(s)
- Susan S. Huang
- University of California Irvine School of Medicine, Irvine
| | - Edward J. Septimus
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
- Texas A&M College of Medicine and Memorial Hermann Health System, Houston
| | | | - Lauren T. Heim
- University of California Irvine School of Medicine, Irvine
| | | | - Taliser R. Avery
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | | | - Syma Rashid
- University of California Irvine School of Medicine, Irvine
| | | | - Lauren Shimelman
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | | | | | - Selsebil Sljivo
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Ed Rosen
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | | | - Micaela H. Coady
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
| | | | | | | | | | - Robert A. Weinstein
- Rush Medical College, Chicago, Illinois
- John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | | | | | | | | | | | - S. Gwynn Sturdevant
- University of Massachusetts Amherst
- now with Wharton School of the University of Pennsylvania, Philadelphia
| | - Sujan C. Reddy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Jonathan B. Perlin
- HCA Healthcare, Nashville, Tennessee
- now with The Joint Commission, Oakbrook Terrace, Illinois
| | - Richard Platt
- Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
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Chen S, Jiang Y, Wang W, Chen J, Zhu J. The effect and mechanism of iodophors on the adhesion and virulence of Staphylococcus aureus biofilms attached to artificial joint materials. J Orthop Surg Res 2023; 18:756. [PMID: 37798766 PMCID: PMC10557172 DOI: 10.1186/s13018-023-04246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Iodophors are known to be a treatment for biofilm-related periprosthetic joint infection. However, the efficacy and mechanism of eradicating biofilms from different artificial joint materials after iodophor treatment are unknown. This study was conducted to understand the effect and mechanism of iodophors with respect to the adhesion and virulence of Staphylococcus aureus biofilms attached to artificial joint materials. METHODS Biofilms of Staphylococcus aureus strains were grown on titanium alloy, cobalt chromium molybdenum and polyethylene coupons, which are commonly used materials for artificial joints, for 24 h. Afterward, all coupons were divided into experimental and control groups: (1) exposed to a 0.5 ± 0.05% iodophor for 5 min and (2) exposed to phosphate-buffered saline for 5 min. To gauge the level of biofilm, colony forming units (CFU), live/dead staining confocal microscopy and crystal violet staining were used. Meanwhile, the expression of icaACDR and clfA, which are related to virulence and adhesion, was examined in both the experimental and control groups. RESULTS A roughly three-log decrease in CFU/cm2 was seen in the viable plate count compared to the control group. Confocal imaging and crystal violet staining verified the CFU data. Moreover, the expression of icaACDR was reduced on three different orthopaedic implant materials, and the expression of clfA was also inhibited on titanium alloy coupons exposed to the iodophor. CONCLUSIONS Our results indicated that exposure to an iodophor for 5 min could significantly eliminate biofilms. When Staphylococcus aureus that had adhered to these three materials, which were used for artificial joints, was treated with an iodophor for 5 min, the expression of icaACDR was significantly reduced. This provides strong evidence for clinically clearing periprosthetic joint infections without removing the artificial joints.
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Affiliation(s)
- Sihui Chen
- Department of Orthopaedics, First Hospital of Jiaxing, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China
- College of Medicine, Jiaxing University, Guangqiong Avenue No. 899, Jiaxing, 314000, People's Republic of China
| | - Yi Jiang
- Department of Orthopaedics, First Hospital of Jiaxing, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China
- College of Medicine, Jiaxing University, Guangqiong Avenue No. 899, Jiaxing, 314000, People's Republic of China
| | - Wei Wang
- College of Medicine, Jiaxing University, Guangqiong Avenue No. 899, Jiaxing, 314000, People's Republic of China
- Department of Clinical Laboratory, First Hospital of Jiaxing, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China
| | - Junjie Chen
- Zhejiang Chinese Medical University Master Degree Cultivation Base in Jiaxing University, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China
| | - Jinyu Zhu
- Department of Orthopaedics, First Hospital of Jiaxing, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China.
- College of Medicine, Jiaxing University, Guangqiong Avenue No. 899, Jiaxing, 314000, People's Republic of China.
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Basha NA, Karkoutly M, Bshara N. Comparative efficacy of topical povidone-iodine and chlorhexidine gel on dental plaque regrowth in toddlers: A randomized controlled trial. Clin Exp Dent Res 2023; 9:764-771. [PMID: 37345210 PMCID: PMC10582209 DOI: 10.1002/cre2.755] [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: 03/21/2023] [Revised: 05/27/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES This study aimed to compare and evaluate the efficacy of topical use of povidone-iodine (PVP-I) solution and chlorhexidine (CHX) gel on dental plaque regrowth after 3 and 7 days in toddlers aged 24-36 months. MATERIALS AND METHODS A randomized controlled trial that included 45 healthy toddlers aged 24-36 months, who were randomly assigned to three groups. The first group received a placebo (distilled water (DW)) (negative control). The second group received topical CHX gel (0.2% w/v) (positive control). The third group received topical PVP-I solution (10% w/v). Plaque accumulation was measured at the baseline (t0 ), after 3 days (t1 ) and after 7 days (t2 ) using the Turesky-modified Quigley-Hein plaque index (TMQHPI). Oral hygiene practices were prohibited during the trial period. The trial ID is ACTRN12623000567628. RESULTS In the DW group, the mean of the TMQHPI score was 1.89 ± 0.67 at t0 and decreased to 1.45 ± 0.66 at t1 (p = .028). Similarly, in the CHX group, the mean of the TMQHPI score was 1.83 ± 1.06 at t0 and decreased to 1.02 ± 0.99 at t1 (p = .033). Regarding the PVP-I group, the mean of the TMQHPI score went from 1.84 ± 0.85 to 1.01 ± 0.61 at t1 and then increased to 1.57 ± 0.74 at t2 . Those changes were statistically significant (p = .001) and (p = .002), respectively. No statistically significant difference was noted between TMQHPI scores at t0 (p = .789). Regarding t1 and t2 , no statistically significant difference was found between the three groups (p > .05). CONCLUSION CHX and PVP-I efficacy lasted only for 3 days, and PVP-I was not superior to CHX in terms of plaque control in toddlers. However, further studies are needed to determine the long-term efficacy of these antiplaque agents in toddlers.
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Affiliation(s)
- Nour Al Basha
- Department of Pediatric DentistryDamascus UniversityDamascusSyrian Arab Republic
| | - Mawia Karkoutly
- Department of Pediatric DentistryDamascus UniversityDamascusSyrian Arab Republic
| | - Nada Bshara
- Department of Pediatric DentistryDamascus UniversityDamascusSyrian Arab Republic
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Trovato Battagliola E, Riveros Cabral RJ, Manco G, Puggioni G, Brancato C, Mangiantini P, Testa F, Malvasi M, Raponi G, Turchetti P, Pacella F, Pacella E. Topical antibiotic prophylaxis before intravitreal injections: a pilot study. Graefes Arch Clin Exp Ophthalmol 2023; 261:2953-2959. [PMID: 37199800 DOI: 10.1007/s00417-023-06113-1] [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: 10/03/2022] [Revised: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To explore whether topical antibiotic prophylaxis in patients scheduled for intravitreal injections achieves surface sterility in a greater proportion of subjects as compared to povidone-iodine alone. MATERIAL AND METHODS A randomized, triple-blind clinical trial. POPULATION patients scheduled for intravitreal injections for maculopathy. INCLUSION CRITERIA any sex and race, age 18 years and above. Subjects were randomized into 4 groups: the first group applied chloramphenicol (CHLORAM), the second netilmicin (NETILM), the third a commercial ozonized antiseptic solution (OZONE), and the fourth applied no drops (CONTROL). OUTCOME VARIABLE percentage of non-sterile conjunctival swabs. Specimens were collected before and after the application of 5% povidone-iodine moments before the injection. RESULTS Ninety-eight subjects (33.7% females, 64.3% males), mean age: 70.2 ± 9.3 years (54-91). Before povidone-iodine, both the CHLORAM and NETILM group showed a lower percentage of non-sterile swabs (61.1% and 31.3% respectively), as compared to the OZONE (83.3%) and CONTROL (86.5%) groups (p < .04). However, this statistical difference was lost after the application of povidone-iodine for 3 min. Percentage of non-sterile swabs in each group after applying 5% povidone-iodine: CHLORAM 11.1%, NETILM 12.5%, CONTROL 15.4%, OZONE 25.0%. This was not statistically significant (p > .05). CONCLUSIONS Topical antibiotic prophylaxis with chloramphenicol or netilmicin drops decreases the bacterial load on the conjunctiva. However, after the application of povidone-iodine, all groups showed a significant reduction in the percentage of non-sterile swabs, and this value was comparable among all groups. For this reason, authors conclude that povidone-iodine alone is sufficient and prior topical antibiotic prophylaxis is not indicated.
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Affiliation(s)
- Edoardo Trovato Battagliola
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Rodolfo Javier Riveros Cabral
- Department of Diagnostic Medicine and Radiology, UOC Microbiology and Virology, Azienda Policlinico Umberto I, Rome, Italy
| | - Gregorio Manco
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Gianluca Puggioni
- Department of Diagnostic Medicine and Radiology, UOC Microbiology and Virology, Azienda Policlinico Umberto I, Rome, Italy
| | - Claudio Brancato
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Pietro Mangiantini
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Floriana Testa
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Mariaelena Malvasi
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Turchetti
- National Institute for Health Migration and Poverty, Rome, Italy
| | - Fernanda Pacella
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Elena Pacella
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy.
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Min K, Kim EK, Han HH, Eom JS. The effect of intraoperative immersion solutions on acellular dermal matrix: Biofilm formation and mechanical property. J Plast Reconstr Aesthet Surg 2023; 84:191-202. [PMID: 37339544 DOI: 10.1016/j.bjps.2023.05.025] [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: 07/03/2022] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Acellular dermal matrix (ADM) is generally used on implant-based breast operations; However, it can increase surgical site infection. Many immersion solutions are applied to ADM, however, the most effective solution is unknown. The purpose of this study is to determine the effect of different solutions on the biofilm formation and mechanical properties of ADM. METHODS Aseptic porcine-derived ADMs were immersed in 5 different solutions for 30 min; sterile normal saline, 10% povidone-iodine, 0.5% chlorhexidine, antibiotics (cefazolin, gentamicin, and vancomycin), and taurolidine. They are transferred to 10 ml suspension of methicillin-sensitive/resistant Staphylococcus aureus (MSSA/MRSA) or Staphylococcus epidermidis and an overnight culture was performed. After rinsing and sonication to obtain the biofilm on ADM, colony forming unit (CFU) was measured. In addition, the maximum load before ADM deformation and the elongation length of ADM at the start of the maximum load was determined. RESULTS Regardless of strains, povidone-iodine, chlorhexidine, and taurolidine group had lower CFUs than the saline group with statistical significance. Meanwhile, the antibiotics group did not show statistical difference from the saline group. Moreover, only taurolidine group showed higher tensile strength (MRSA, p = 0.0003; S. epidermidis, p = 0.0023) and elongation length (MSSA, p = 0.0015) than the saline group. The antibiotics and chlorhexidine group yielded lower tensile strength and elongation length than the povidone-iodine and taurolidine groups. CONCLUSIONS It was suggested that the 10% povidone-iodine or taurolidine solution is effective. In contrast, the antibiotics solution could be considered as an effective intraoperative solution.
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Affiliation(s)
- Kyunghyun Min
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Hyun Ho Han
- Department of Plastic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Ulsan, Republic of Korea.
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, School of Medicine, University of Ulsan, Ulsan, Republic of Korea.
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Coombs K, Rodriguez-Quijada C, Clevenger JO, Sauer-Budge AF. Current Understanding of Potential Linkages between Biocide Tolerance and Antibiotic Cross-Resistance. Microorganisms 2023; 11:2000. [PMID: 37630560 PMCID: PMC10459251 DOI: 10.3390/microorganisms11082000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Antimicrobials (e.g., antibiotics and biocides) are invaluable chemicals used to control microbes in numerous contexts. Because of the simultaneous use of antibiotics and biocides, questions have arisen as to whether environments commonly treated with biocides (e.g., hospitals, food processing, wastewater, agriculture, etc.) could act as a reservoir for the development of antibiotic cross-resistance. Theoretically, cross-resistance could occur if the mechanism of bacterial tolerance to biocides also resulted in antibiotic resistance. On the other hand, biocides would likely present a higher evolutionary barrier to the development of resistance given the different modes of action between biocides and antibiotics and the broad-based physicochemical effects associated with most biocides. Published studies have shown that the induction of biocide tolerance in a laboratory can result in cross-resistance to some antibiotics, most commonly hypothesized to be due to efflux pump upregulation. However, testing of environmental isolates for biocide tolerance and antibiotic cross-resistance has yielded conflicting results, potentially due to the lack of standardized testing. In this review, we aim to describe the state of the science on the potential linkage between biocide tolerance and antibiotic cross-resistance. Questions still remain about whether the directed evolution of biocide tolerance and the associated antibiotic cross-resistance in a laboratory are or are not representative of real-world settings. Thus, research should continue to generate informative data to guide policies and preserve these tools' utility and availability.
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Ebrahimi T, Shamshiri AR, Alebouyeh M, Mohebbi SZ. Effectiveness of mouthwashes on reducing SARS-CoV-2 viral load in oral cavity: a systematic review and meta-analysis. BMC Oral Health 2023; 23:443. [PMID: 37400836 PMCID: PMC10318743 DOI: 10.1186/s12903-023-03126-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/10/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The risk of SARS-COV-2 transmission is relatively high during dental procedures. A study was conducted to investigate the effects of mouthwashes on SARS-COV-2 viral load reduction in the oral cavity. METHODS A systematic search was performed in PubMed, EMBASE, Scopus, Web of Science, and Cochrane library for relevant studies up to 20 July, 2022. Randomized and non-randomized clinical trial and quasi-experimental studies evaluating patients with Covid-19 infection (patients) who used mouthwashes (intervention) compared to the same patients before using the mouthwash (comparison) for reducing the SARS-COV-2 load or increasing the cycle threshold (Ct) value (outcome) were searched according to PICO components. Three independent reviewers conducted literature screening and data extraction. The Modified Downs and Black checklist was used for quality assessment. A meta-analysis was performed with a random effects model in the Revman 5.4.1software using the mean difference (MD) of cycle threshold (Ct) values. RESULTS Of 1653 articles, 9 with a high methodological quality were included. A meta-analysis indicated that 1% Povidone-iodine (PVP-I) was an effective mouthwash for reducing the SARS-COV-2 viral load [MD 3.61 (95% confidence interval 1.03, 6.19)]. Cetylpyridinium chloride (CPC) [MD 0.61 (95% confidence interval -1.03, 2.25)] and Chlorhexidine gluconate (CHX) [MD -0.04 95% confidence interval (-1.20, 1.12)] were not effective against SARS-COV-2. CONCLUSION Using mouthwashes containing PVP-I may be recommended for reducing the SARS-COV-2 viral load in the oral cavity of patients before and during dental procedures, while the evidence is not sufficient for such effects for CPC and CHX-containing mouthwashes.
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Affiliation(s)
- Tayebe Ebrahimi
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Alebouyeh
- Pediatric Infections Research Centre, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Simin Z Mohebbi
- Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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Yousuf SJ, Alfaqih M, Hicken R, Ramadan A. TEMPORAL EFFICACY AND STERILITY TESTING OF POVIDONE-IODINE FROM AN OPEN BOTTLE. Retina 2023; 43:1160-1164. [PMID: 36930891 DOI: 10.1097/iae.0000000000003783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/13/2022] [Indexed: 03/19/2023]
Abstract
PURPOSE To investigate the temporal efficacy and sterility of povidone-iodine (PI) against bacteria associated with postinjection endophthalmitis in an in vitro study. METHODS A single PI bottle was opened and tested for sterility and antibacterial efficacy. Povidone-iodine from the open bottle was inoculated onto a blood agar plate and evaluated for growth 24 hours later to test sterility; this was repeated for five consecutive days. To test for antibacterial efficacy, PI was instilled onto the surface of plates of Staphylococcus , Streptococcus , Enterococcus , Pseudomonas , and Haemophilus species. The plates were then evaluated 24 hours later for a clear zone of inhibition (i.e., no growth) where the PI was placed. This process was repeated for five consecutive days. RESULTS Sterility testing showed no growth of organisms on the blood agar plates for each of the five days of testing. For antibacterial efficacy testing, zones of inhibition of growth were seen on each plate of bacterial colonies only where PI was placed, for each of the five days of testing. CONCLUSION In this study, PI from an open bottle maintained its sterility and antibacterial efficacy for five days. These data could help support repeated use of the same bottle, reducing waste and costs for retina practices.
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Affiliation(s)
- Salman J Yousuf
- Department of Ophthalmology, Howard University College of Medicine, Washington, District of Columbia
| | - Murad Alfaqih
- Howard University College of Medicine, Washington, District of Columbia; and
| | - Rachel Hicken
- Department of Pathology, Howard University College of Medicine, Washington, District of Columbia
| | - Ali Ramadan
- Department of Pathology, Howard University College of Medicine, Washington, District of Columbia
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Stern RA, Harris BD, DeVault M, Talbot TR. Identifying barriers to compliance with a universal inpatient protocol for Staphylococcus aureus nasal decolonization with povidone-iodine. Infect Control Hosp Epidemiol 2023; 44:1167-1170. [PMID: 36155109 PMCID: PMC10369204 DOI: 10.1017/ice.2022.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/07/2022]
Abstract
Academic hospital nurses were surveyed to assess adherence barriers to a universal povidone-iodine nasal decolonization protocol to prevent Staphylococcus aureus infection. Low training rates, inadequate supplies, documentation and tracking challenges, patient refusal, and burnout contributed to suboptimal adherence. Prioritizing education is essential but alone is insufficient for successful protocol adoption.
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Affiliation(s)
- Rebecca A. Stern
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bryan D. Harris
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary DeVault
- Department of Infection Prevention, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas R. Talbot
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Parker DM, Koch JA, Gish CG, Brothers KM, Li W, Gilbertie J, Rowe SE, Conlon BP, Byrapogu VKC, Urish KL. Hydrogen Peroxide, Povidone-Iodine and Chlorhexidine Fail to Eradicate Staphylococcus aureus Biofilm from Infected Implant Materials. Life (Basel) 2023; 13:1230. [PMID: 37374013 DOI: 10.3390/life13061230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Hydrogen peroxide, povidone-iodine, and chlorhexidine are antiseptics that are commonly added to irrigants to either prevent or treat infection. There are little clinical data available that demonstrate efficacy of adding antiseptics to irrigants in the treatment of periprosthetic joint infection after biofilm establishment. The objective of the study was to assess the bactericidal activity of the antiseptics on S. aureus planktonic and biofilm. For planktonic irrigation, S. aureus was exposed to different concentrations of antiseptics. S. aureus biofilm was developed by submerging a Kirschner wire into normalized bacteria and allowing it to grow for forty-eight hours. The Kirschner wire was then treated with irrigation solutions and plated for CFU analysis. Hydrogen peroxide, povidone-iodine, and chlorhexidine were bactericidal against planktonic bacteria with over a 3 log reduction (p < 0.0001). Unlike cefazolin, the antiseptics were not bactericidal (less than 3 log reduction) against biofilm bacteria but did have a statistical reduction in biofilm as compared to the initial time point (p < 0.0001). As compared to cefazolin treatment alone, the addition of hydrogen peroxide or povidone-iodine to cefazolin treatment only additionally reduced the biofilm burden by less than 1 log. The antiseptics demonstrated bactericidal properties with planktonic S. aureus; however, when used to irrigate S. aureus biofilms, these antiseptics were unable to decrease biofilm mass below a 3 log reduction, suggesting that S. aureus biofilm has a tolerance to antiseptics. This information should be considered when considering antibiotic tolerance in established S. aureus biofilm treatment.
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Affiliation(s)
- Dana M Parker
- Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - John A Koch
- Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Charles G Gish
- Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Kimberly M Brothers
- Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - William Li
- Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Jessica Gilbertie
- Center for One Health Research, Edward Via College of Osteopathic Medicine, Blacksburg, VA 24060, USA
| | - Sarah E Rowe
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brian P Conlon
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Venkata K C Byrapogu
- Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Kenneth L Urish
- Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Budiawan A, Purwanto A, Puradewa L, Cahyani ED, Purwaningsih CE. Wound healing activity and flavonoid contents of purslane ( Portulaca grandiflora) of various varieties. RSC Adv 2023; 13:9871-9877. [PMID: 36998519 PMCID: PMC10043994 DOI: 10.1039/d3ra00868a] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Purslane has various varieties with different active metabolite contents that need to be explored further to find each variety's activity in wound healing. Different purslane herbs showed different antioxidant activities, suggesting they will have different flavonoid content and wound healing activity. This research aimed to evaluate purslane's total flavonoid content and wound-healing activity. The wounds induced on the rabbit back skin were divided into 6 treatment groups such as negative control, positive control, 10 and 20% purslane herbs extract varieties A, and 10 and 20% purslane herbs extract varieties C. Wounds were treated twice daily for 2 weeks, and measured on day 0, 7, 11, and 14. Total flavonoid content was measured with the AlCl3 colorimetric method. The wounds treated with 10 and 20% purslane herbs extract varieties A (Portulaca grandiflora magenta flower) have 0.32 ± 0.55 and 1.63 ± 1.96 mm wound diameters on day 7 and healed on day 11. The wounds treated with 10 and 20% purslane herbs extract varieties C (Portulaca grandiflora pink flower) showed 2.88 ± 0.51 and 0.84 ± 1.45 mm diameter and healed on day 11. The purslane herb A showed the highest wound healing activity, and purslane varieties A and C total flavonoid contents were 0.55 ± 0.02 and 1.58 ± 0.02% w/w, respectively.
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Affiliation(s)
- Antonius Budiawan
- Pharmacy Diploma III Department, Widya Mandala Surabaya Catholic University Manggis 15-17 Madiun City 63131 East Java Indonesia
| | - Agus Purwanto
- Biology Department, Widya Mandala Surabaya Catholic University Manggis 15-17 Madiun City 63131 East Java Indonesia
| | - Levi Puradewa
- Pharmacy Diploma III Department, Widya Mandala Surabaya Catholic University Manggis 15-17 Madiun City 63131 East Java Indonesia
| | - Erlien Dwi Cahyani
- Pharmacy Diploma III Department, Widya Mandala Surabaya Catholic University Manggis 15-17 Madiun City 63131 East Java Indonesia
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Dattilo S, Spitaleri F, Aleo D, Saita MG, Patti A. Solid-State Preparation and Characterization of 2-Hydroxypropylcyclodextrins-Iodine Complexes as Stable Iodophors. Biomolecules 2023; 13:biom13030474. [PMID: 36979409 PMCID: PMC10046614 DOI: 10.3390/biom13030474] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
The use of iodine as antiseptic poses some issues related to its low water solubility and high volatility. Stable solid iodine-containing formulations are highly advisable and currently limited to the povidone-iodine complex. In this study, complexes of molecular iodine with 2-hydroxypropyl α-, β- and γ-cyclodextrins were considered water-soluble iodophors and prepared in a solid state by using three different methods (liquid-assisted grinding, co-evaporation and sealed heating). The obtained solids were evaluated for their iodine content and stability over time in different conditions using a fully validated UV method. The assessment of the actual formation of an inclusion complex in a solid state was carried out by thermal analysis, and the presence of iodine was further confirmed by SEM/EDX and XPS analyses. High levels of iodine content (8.3–10.8%) were obtained with all the tested cyclodextrins, and some influence was exerted by the employed preparation method. Potential use as solid iodophors can be envisaged for these iodine complexes, among which those with 2-hydroxypropyl-α-cyclodextrin were found the most stable, regardless of the preparation technique. The three prepared cyclodextrin–iodine complexes proved effective as bactericides against S. epidermidis.
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Affiliation(s)
- Sandro Dattilo
- CNR-Istituto per i Polimeri, Compositi e Biomateriali, Via Paolo Gaifami 18, I-95126 Catania, Italy
| | | | - Danilo Aleo
- MEDIVIS-Via Carnazza 34 C, I-95030 Catania, Italy
- Correspondence: (D.A.); (A.P.)
| | | | - Angela Patti
- CNR-Istituto di Chimica Biomolecolare, Via Paolo Gaifami 18, I-95126 Catania, Italy
- Correspondence: (D.A.); (A.P.)
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Monstrey SJ, Govaers K, Lejuste P, Lepelletier D, de Oliveira PR. Evaluation of the role of povidone‑iodine in the prevention of surgical site infections. Surg Open Sci 2023; 13:9-17. [PMID: 37034245 PMCID: PMC10074992 DOI: 10.1016/j.sopen.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
Background The occurrence of surgical site infections (SSIs) is associated with increased risk of mortality, development of other infections, and the need for reintervention, posing a significant health burden. The aim of this review was to examine the current data and guidelines around the use of antiseptic povidone‑iodine (PVP-I) for the prevention of SSIs at each stage of surgical intervention. Methods A literature search for selected key words was performed using PubMed. Additional papers were identified based on author expertise. Results Scientific evidence demonstrates that PVP-I can be used at every stage of surgical intervention: preoperative, intraoperative, and postoperative. PVP-I is one of the most widely used antiseptics on healthy skin and mucous membranes for preoperative surgical site preparation and is associated with a low SSI rate. For intraoperative irrigation, aqueous PVP-I is the recommended agent and has been demonstrated to decrease SSIs in a range of surgical settings, and for postoperative wound healing, there is a growing body of evidence to support the use of PVP-I. Conclusions There is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation. The use of a single agent (PVP-I) at each stage of surgical intervention could potentially provide advantages, including economic benefits, over agents that can only be used at discrete stages of the surgical procedure. Key message Evidence supports the use of PVP-I at all stages of surgical intervention, from preoperative measures (including skin preparation, preoperative washing, and nasal decolonization) to intraoperative irrigation, through to postoperative wound management. However, there is a need for more stringent study designs in clinical trials to enable meaningful comparisons between antiseptic agents, particularly for preoperative skin preparation.
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Lee CM, Jeong YIL, Lim YK, Kook JK, Yang SW, Kook MS, Kim BH. The effect of cold atmospheric plasma (CAP) on the formation of reactive oxygen species and treatment of Porphyromonas gingivalis biofilm in vitro for application in treatment of peri-implantitis. KOREAN J CHEM ENG 2023. [DOI: 10.1007/s11814-022-1337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Li H, Wang D, Zhang W, Xu G, Xu C, Liu W, Li J. Potential side effects of antibacterial coatings in orthopaedic implants: A systematic review of clinical studies. Front Bioeng Biotechnol 2023; 11:1111386. [PMID: 36845182 PMCID: PMC9947536 DOI: 10.3389/fbioe.2023.1111386] [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: 11/29/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
Objective: The systematic review aimed to determine the potential side effects of antibacterial coatings in orthopaedic implants. Methods: Publications were searched in the databases of Embase, PubMed, Web of Science and Cochrane Library using predetermined keywords up to 31 October 2022. Clinical studies reporting side effects of the surface or coating materials were included. Results: A total of 23 studies (20 cohort studies and three case reports) reporting the concerns about the side effects of antibacterial coatings were identified. Three types of coating materials, silver, iodine and gentamicin were included. All of studies raised the concerns regarding safety of antibacterial coatings, and the occurrence of adverse events was observed in seven studies. The main side effect of silver coatings was the development of argyria. For iodine coatings, only one anaphylactic case was reported as an adverse event. No systemic or other general side effects were reported for gentamicin. Conclusion: Clinical studies on the side effects of antibacterial coatings were limited. Based on the available outcomes, the most reported side effects of antibacterial coatings in clinical use were argyria with silver coatings. However, researchers should always pay attention to the potential side effects of antibacterial materials, such as systematic or local toxicity and allergy.
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Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,School of Medicine, Nankai University, Tianjin, China
| | - Gaoxiang Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,*Correspondence: Cheng Xu, ; Wanheng Liu, ; Jiantao Li,
| | - Wanheng Liu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,*Correspondence: Cheng Xu, ; Wanheng Liu, ; Jiantao Li,
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,*Correspondence: Cheng Xu, ; Wanheng Liu, ; Jiantao Li,
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Fidelis CE, de Freitas Leite R, Garcia BLN, Gonçalves JL, Good L, Dos Santos MV. Antimicrobial activities of polyhexamethylene biguanide against biofilm-producing Prototheca bovis causing bovine mastitis. J Dairy Sci 2023; 106:1383-1393. [PMID: 36526458 DOI: 10.3168/jds.2022-22468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/07/2022] [Indexed: 12/15/2022]
Abstract
Prototheca spp. is a frequent cause of bovine mastitis and is highly resistant to commonly used disinfectants. This study aimed to: (1) evaluate the antimicrobial activity of polyhexamethylene biguanide (PHMB) against mastitis-causing Prototheca spp., and (2) evaluate the biofilm production ability of Prototheca spp. A total of 85 Prototheca bovis and 2 Prototheca blaschkeae isolates from bovine mastitis cases were submitted to biofilm production assays and antimicrobial susceptibility tests against PHMB and disinfectants commonly used in dairy herds (chlorhexidine digluconate, povidone-iodine, sodium dichloroisocyanurate, and sodium hypochlorite). The minimal inhibitory concentration (MIC) and minimal algicidal concentration (MAC) were determined by microdilution assays. We observed that PHMB (MIC90: ≥2 µg/mL and MAC90: ≥4 µg/mL) and chlorhexidine gluconate (MIC90 and MAC90: ≥2 µg/mL) presented the highest antimicrobial activity against P. bovis isolates, followed by sodium dichloroisocyanurate (MIC90 and MAC90: ≥1,400 µg/mL), sodium hypochlorite (MIC90 and MAC90: ≥2,800 µg/mL), and povidone-iodine (MIC90 and MAC90: ≥3,200 µg/mL). Concerning P. blaschkeae isolates, PHMB (MIC and MAC ≥1 µg/mL) and chlorhexidine gluconate (MIC and MAC ≥1 µg/mL) were the disinfectants that presented the lowest concentration values required to inhibit the isolates. Regarding biofilms formation, 63.5% (n = 54/85) of the P. bovis isolates were classified as strong, 28.3% (n = 24/85) moderate, and 8.2% (n = 7/85) weak biofilm producers. In contrast, the P. blaschkeae isolates were classified as weak and moderate biofilm producers. These findings suggest that PHMB has the potential to be used for teat and milking-equipment disinfection for the prevention of mastitis-causing Prototheca spp. in dairy herds.
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Affiliation(s)
- Carlos Eduardo Fidelis
- Department of Nutrition and Animal Production, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), São Paulo, Pirassununga, SP, Brazil 13635
| | - Renata de Freitas Leite
- Department of Nutrition and Animal Production, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), São Paulo, Pirassununga, SP, Brazil 13635
| | - Breno Luis Nery Garcia
- Department of Nutrition and Animal Production, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), São Paulo, Pirassununga, SP, Brazil 13635
| | - Juliano Leonel Gonçalves
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing 48824-1046
| | - Liam Good
- Royal Veterinary College, University of London, London, NW1 0TU, United Kingdom
| | - Marcos Veiga Dos Santos
- Department of Nutrition and Animal Production, School of Veterinary Medicine and Animal Sciences, University of São Paulo (USP), São Paulo, Pirassununga, SP, Brazil 13635.
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Aftab R, Dodhia VH, Jeanes C, Wade RG. Bacterial sensitivity to chlorhexidine and povidone-iodine antiseptics over time: a systematic review and meta-analysis of human-derived data. Sci Rep 2023; 13:347. [PMID: 36611032 PMCID: PMC9825506 DOI: 10.1038/s41598-022-26658-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is concern that resistance to topical biocides may be emergeing, although the potential clinical implications remain unclear. The objective of this systematic review was to determine whether the minimum bactericidal concentration (MBC) of topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. We included studies reporting the MBC of laboratory and clinical isolates of common microbes to CHX and PVI. We excluded studies using non-human samples and antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses and the change in MBC over time was explored using meta-regression. Seventy-nine studies were included, analysing 6218 microbes over 45 years. Most studies investigated CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in the MBC of CHX to Staphylococci or Streptococci over time. Overall, we find no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. This provides reassurance and confidence in the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.
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Affiliation(s)
- Raiyyan Aftab
- Department of Plastic Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Vikash H Dodhia
- Royal Hampshire County Hospital, Hampshire Hospitals Foundation Trust, Winchester, UK
| | - Christopher Jeanes
- Department of Microbiology, Norfolk and Norwich University Hospital, Norfolk, UK
| | - Ryckie G Wade
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK.
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Tran P, Kopel J, Luth K, Dong H, Dev A, Mehta D, Mitchell K, Moeller KW, Moeller CD, Reid T. The in vitro efficacy of betadine antiseptic solution and colloidal silver gel combination in inhibiting the growth of bacterial biofilms. Am J Infect Control 2023; 51:23-28. [PMID: 35439543 DOI: 10.1016/j.ajic.2022.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Betadine (Povidone-Iodine) solution is a topically applied antiseptic, which has been used routinely used in wound care and general surgery to prevent skin and wound infections. However, several studies have documented the ineffectiveness of betadine. Other topical antimicrobial dressings, including those that contain silver, have been used in the management of infected wounds. The present study was undertaken to determine if the combination of 5% betadine solution and silver colloidal gel (Ag-gel) is more effective than either substance alone in inhibiting the growth gram-negative and gram-positive bacteria. METHODS The effectiveness of 5% betadine solution and Ag-gel as anti-microbial agents were assessed using both colony forming unit (CFU) assay and confocal laser scanning microscopy (CLSM). RESULTS Ag-gel showed complete inhibition on all the bacteria species examined except the Klebsiella pneumoniae clinical isolate (CL) strain while 5% betadine concentrations did not completely kill any of the tested bacteria. In contrast, K. pneumoniae was completely eliminated in the presence of both 5% betadine solution and Ag-gel together. The CLSM showed similar findings to the CFU results examining the 5% betadine solution and Ag-gel combination. CONCLUSIONS This study demonstrated that while the individual treatments using either 5% betadine solution and Ag-gel alone were infective antimicrobial agents, the combination of 5% betadine solution and Ag-gel was superior at eliminating all tested bacteria, including K. pneumoniae CL.
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Affiliation(s)
- Phat Tran
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jonathan Kopel
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Keaton Luth
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Huy Dong
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Ameesh Dev
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | - Kelly Mitchell
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | | | - Ted Reid
- Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Alves PJ, Gryson L, Hajjar J, Lepelletier D, Reners M, Rodríguez Salazar J, Simon A. Role of antiseptics in the prevention and treatment of infections in nursing homes. J Hosp Infect 2023; 131:58-69. [PMID: 36216172 DOI: 10.1016/j.jhin.2022.09.021] [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: 06/09/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
Inadequate infection control, wound care, and oral hygiene protocols in nursing homes pose challenges to residents' quality of life. Based on the outcomes from a focus group meeting and a literature search, this narrative review evaluates the current and potential roles of antiseptics within nursing home infection management procedures. We examine contemporary strategies and concerns within the management of meticillin-resistant Staphylococcus aureus (MRSA; including decolonization regimes), chronic wound care, and oral hygiene, and review the available data for the use of antiseptics, with a focus on povidone-iodine. Compared with chlorhexidine, polyhexanide, and silver, povidone-iodine has a broader spectrum of antimicrobial activity, with rapid and potent activity against MRSA and other microbes found in chronic wounds, including biofilms. As no reports of bacterial resistance or cross-resistance following exposure to povidone-iodine exist, it may be preferable for MRSA decolonization compared with mupirocin and chlorhexidine, which can lead to resistant MRSA strains. Povidone-iodine oral products have greater efficacy against oral pathogens compared with other antiseptics such as chlorhexidine mouthwash, highlighting the clinical benefit of povidone-iodine in oral care. Additionally, povidone-iodine-based products, including mouthwash, have demonstrated rapid in-vitro virucidal activity against SARS-CoV-2 and may help reduce its transmission if incorporated into nursing home coronavirus 2019 control protocols. Importantly, povidone-iodine activity is not adversely affected by organic material, such as that found in chronic wounds and the oral cavity. Povidone-iodine is a promising antiseptic agent for the management of infections in the nursing home setting, including MRSA decolonization procedures, chronic wound management, and oral care.
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Affiliation(s)
- P J Alves
- Wounds Research Laboratory, Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Portugal.
| | - L Gryson
- Belgian Defence Medical Component, Brussels, Belgium
| | - J Hajjar
- Infection Control Practitioner, Consultant, Pau, France
| | - D Lepelletier
- Hospital Hygiene Department, Nantes University Hospital, Nantes, France
| | - M Reners
- Private Dental Practice, Liège, Belgium
| | | | - A Simon
- Infection Control Team, Groupe Hospitalier Jolimont, Haine Saint-Paul, Belgium
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Basiry D, Entezari Heravi N, Uluseker C, Kaster KM, Kommedal R, Pala-Ozkok I. The effect of disinfectants and antiseptics on co- and cross-selection of resistance to antibiotics in aquatic environments and wastewater treatment plants. Front Microbiol 2022; 13:1050558. [PMID: 36583052 PMCID: PMC9793094 DOI: 10.3389/fmicb.2022.1050558] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
The outbreak of the SARS-CoV-2 pandemic led to increased use of disinfectants and antiseptics (DAs), resulting in higher concentrations of these compounds in wastewaters, wastewater treatment plant (WWTP) effluents and receiving water bodies. Their constant presence in water bodies may lead to development and acquisition of resistance against the DAs. In addition, they may also promote antibiotic resistance (AR) due to cross- and co-selection of AR among bacteria that are exposed to the DAs, which is a highly important issue with regards to human and environmental health. This review addresses this issue and provides an overview of DAs structure together with their modes of action against microorganisms. Relevant examples of the most effective treatment techniques to increase the DAs removal efficiency from wastewater are discussed. Moreover, insight on the resistance mechanisms to DAs and the mechanism of DAs enhancement of cross- and co-selection of ARs are presented. Furthermore, this review discusses the impact of DAs on resistance against antibiotics, the occurrence of DAs in aquatic systems, and DA removal mechanisms in WWTPs, which in principle serve as the final barrier before releasing these compounds into the receiving environment. By recognition of important research gaps, research needs to determine the impact of the majority of DAs in WWTPs and the consequences of their presence and spread of antibiotic resistance were identified.
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Affiliation(s)
- Daniel Basiry
- Department of Chemistry, Bioscience and Environmental Engineering, Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - Nooshin Entezari Heravi
- Department of Chemistry, Bioscience and Environmental Engineering, Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - Cansu Uluseker
- School of Biosciences, University of Birmingham, Birmingham, United Kingdom
| | - Krista Michelle Kaster
- Department of Chemistry, Bioscience and Environmental Engineering, Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - Roald Kommedal
- Department of Chemistry, Bioscience and Environmental Engineering, Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - Ilke Pala-Ozkok
- Department of Chemistry, Bioscience and Environmental Engineering, Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
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Lim NA, Teng O, Ng CYH, Bao LXY, Tambyah PA, Quek AML, Seet RCS. Repurposing povidone-iodine to reduce the risk of SARS-CoV-2 infection and transmission: a narrative review. Ann Med 2022; 54:1488-1499. [PMID: 35594333 PMCID: PMC9132411 DOI: 10.1080/07853890.2022.2076902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/22/2022] [Accepted: 05/08/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Accumulating data suggest antiviral effects of povidone-iodine against the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. This narrative review aims to examine the antiviral mechanisms of povidone-iodine, efficacy of povidone-iodine against the SARS-CoV-2 virus, and safety of povidone-iodine to human epithelial cells and thyroid function. METHODS We searched the electronic databases PubMed, Embase, Cochrane Library, ClinicalTrials.gov and World Health Organization's International Clinical Trials Registry Platform for articles containing the keywords "povidone-iodine", "SARS-CoV-2" and "COVID-19" from database inception till 3 June 2021. RESULTS Despite in vitro data supporting the anti-SARS-CoV-2 effects of povidone-iodine, findings from clinical studies revealed differences in treatment response depending on study settings (healthy vs. hospitalized individuals), treatment target (nasal vs. oral vs. pharynx), method of administration (oral rinse vs. gargle vs. throat spray) and choice of samples used to measure study endpoints (nasopharyngeal vs. saliva). One large-scale clinical trial demonstrated reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak. Povidone-iodine is also used to disinfect the oro-pharyngeal space prior to dental or otolaryngology procedures. Although existing data suggest minimal impact of povidone-iodine on thyroid function, high-quality safety data are presently lacking. CONCLUSIONS Povidone-iodine application to the oropharyngeal space could complement existing non-pharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.Key messagesAccumulating data suggest antiviral effects of povidone-iodine against the SARS-CoV-2 virus.Findings from clinical studies reveal differences in treatment response depending on study settings, treatment target, method of administration and choice of samples used to measure study endpoints. One large-scale clinical trial observed reduction in the incidence of SARS-CoV-2 infection among participants who administered povidone-iodine 3 times daily during an active outbreak.Povidone-iodine application to the oropharyngeal space could complement existing non-pharmacological interventions to reduce SARS-CoV-2 infection especially in high exposure settings.
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Affiliation(s)
- Nicole-Ann Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ooiean Teng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chester Yan Hao Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lena X. Y. Bao
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Paul Anantharajah Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amy M. L. Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Raymond C. S. Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Houshyar S, Yin H, Pope L, Zizhou R, Dekiwadia C, Hill-Yardin EL, Yeung JMC, John S, Fox K, Tran N, Cole I, Elbourne A, Truong VK, Truskewycz A. Smart Suture with Iodine Contrasting Nanoparticle for Computed Tomography. OPENNANO 2022. [DOI: 10.1016/j.onano.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Kaur M, Karadia P, Singh S. Povidone-iodine-induced disseminated irritant contact dermatitis. BMJ Case Rep 2022; 15:e251926. [PMID: 36351674 PMCID: PMC9644306 DOI: 10.1136/bcr-2022-251926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Maninder Kaur
- Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priyanka Karadia
- Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Saurabh Singh
- Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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An in vitro Study of Betadine’s Ability to Eliminate Live Bacteria on the Eye: Should It Be Used for Protection against Endophthalmitis? Antibiotics (Basel) 2022; 11:antibiotics11111549. [PMID: 36358204 PMCID: PMC9686744 DOI: 10.3390/antibiotics11111549] [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: 09/21/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Povidone-iodide (Betadine) is an antiseptic that is applied topically and has many uses in the medical community, such as in wound care and pre- and post-operative surgical procedures. This study was done to measure the effectiveness of Betadine solutions in inhibiting the growth of Gram-negative and Gram-positive bacteria. Methods: The ability of 2.5 and 10% Betadine solutions to inhibit bacterial growth was measured against Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Acinetobacter baumannii. We grew the bacteria independently and together to simulate a hospital environment. Results: All the bacteria showed zones of inhibition. However, discs were also tested for live bacteria using the colony-forming unit assay. Complete killing was only seen for S. aureus with the 10% Betadine solution. All other bacteria showed growth on the disc. Conclusions: This study showed several things. First, the zone of inhibition assay does not give an accurate assessment of antimicrobial properties when used alone and should be followed by a colony-forming unit assay. Second, 2.5% and 5% Betadine do not have effective antimicrobial properties against any of the bacteria tested, and 10% Betadine is only effective against S. aureus and not effective against the other bacteria tested.
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50
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Wang Y, Teng W, Zhang Z, Ma S, Jin Z, Zhou X, Ye Y, Zhang C, Gou Z, Yu X, Ye Z, Ren Y. Remote Eradication of Bacteria on Orthopedic Implants via Delayed Delivery of Polycaprolactone Stabilized Polyvinylpyrrolidone Iodine. J Funct Biomater 2022; 13:jfb13040195. [PMID: 36278664 PMCID: PMC9589933 DOI: 10.3390/jfb13040195] [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: 09/21/2022] [Revised: 10/08/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
Bacteria-associated late infection of the orthopedic devices would further lead to the failure of the implantation. However, present ordinary antimicrobial strategies usually deal with early infection but fail to combat the late infection of the implants due to the burst release of the antibiotics. Thus, to fabricate long-term antimicrobial (early antibacterial, late antibacterial) orthopedic implants is essential to address this issue. Herein, we developed a sophisticated MAO-I2-PCLx coating system incorporating an underlying iodine layer and an upper layer of polycaprolactone (PCL)-controlled coating, which could effectively eradicate the late bacterial infection throughout the implantation. Firstly, micro-arc oxidation was used to form a microarray tubular structure on the surface of the implants, laying the foundation for iodine loading and PCL bonding. Secondly, electrophoresis was applied to load iodine in the tubular structure as an efficient bactericidal agent. Finally, the surface-bonded PCL coating acts as a controller to regulate the release of iodine. The hybrid coatings displayed great stability and control release capacity. Excellent antibacterial ability was validated at 30 days post-implantation via in vitro experiments and in vivo rat osteomyelitis model. Expectedly, it can become a promising bench-to-bedside strategy for current infection challenges in the orthopedic field.
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Affiliation(s)
- Yikai Wang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan 430060, China
| | - Wangsiyuan Teng
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310009, China
| | - Zengjie Zhang
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310009, China
| | - Siyuan Ma
- Department of Orthopedics, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan 430060, China
| | - Zhihui Jin
- Department of Orthopedics, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan 430060, China
| | - Xingzhi Zhou
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310009, China
| | - Yuxiao Ye
- School of Material Science and Engineering, University of New South Wales, Sydney 2052, Australia
| | - Chongda Zhang
- New York University Medical Center, New York University, New York, NY 10016, USA
| | - Zhongru Gou
- Bio-Nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou 310058, China
| | - Xiaohua Yu
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310009, China
| | - Zhaoming Ye
- Department of Orthopedics, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou 310009, China
- Correspondence: (Z.Y.); (Y.R.); Tel.: +86-571-8778-3777 (Z.Y.); +86-027-8804-1911 (ext. 83380) (Y.R.)
| | - Yijun Ren
- Department of Orthopedics, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan 430060, China
- Correspondence: (Z.Y.); (Y.R.); Tel.: +86-571-8778-3777 (Z.Y.); +86-027-8804-1911 (ext. 83380) (Y.R.)
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