povidone-iodine and Abscess

Surgical site infections (SSIs) are wound infections that occur after an operative procedure. A preventable complication, they are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates. Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken prior to wound closure or postoperatively. Intracavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery.. To assess the effects of wound irrigation and intracavity lavage on the prevention of surgical site infection (SSI).. In February 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions on language, date of publication or study setting.. We included all randomised controlled trials (RCTs) of participants undergoing surgical procedures in which the use of a particular type of intraoperative washout (irrigation or lavage) was the only systematic difference between groups, and in which wounds underwent primary closure. The primary outcomes were SSI and wound dehiscence. Secondary outcomes were mortality, use of systemic antibiotics, antibiotic resistance, adverse events, re-intervention, length of hospital stay, and readmissions.. Two review authors independently assessed studies for inclusion at each stage. Two review authors also undertook data extraction, assessment of risk of bias and GRADE assessment. We calculated risk ratios or differences in means with 95% confidence intervals where possible.. We included 59 RCTs with 14,738 participants. Studies assessed comparisons between irrigation and no irrigation, between antibacterial and non-antibacterial irrigation, between different antibiotics, different antiseptics or different non-antibacterial agents, or between different methods of irrigation delivery. No studies compared antiseptic with antibiotic irrigation. Surgical site infectionIrrigation compared with no irrigation (20 studies; 7192 participants): there is no clear difference in risk of SSI between irrigation and no irrigation (RR 0.87, 95% CI 0.68 to 1.11; I. The evidence base for intracavity lavage and wound irrigation is generally of low certainty. Therefore where we identified a possible difference in the incidence of SSI (in comparisons of antibacterial and non-antibacterial interventions, and pulsatile versus standard methods) these should be considered in the context of uncertainty, particularly given the possibility of publication bias for the comparison of antibacterial and non-antibacterial interventions. Clinicians should also consider whether the evidence is relevant to the surgical populations under consideration, the varying reporting of other prophylactic antibiotics, and concerns about antibiotic resistance.We did not identify any trials that compared an antibiotic with an antiseptic. This gap in the direct evidence base may merit further investigation, potentially using network meta-analysis; to inform the direction of new primary research. Any new trial should be adequately powered to detect a difference in SSIs in eligible participants, should use robust research methodology to reduce the risks of bias and internationally recognised criteria for diagnosis of SSI, and should have adequate duration and follow-up.

Topics: Abscess; Anti-Bacterial Agents; Anti-Infective Agents, Local; Drug Combinations; Humans; Hypochlorous Acid; Incidence; Povidone-Iodine; Randomized Controlled Trials as Topic; Sodium Hypochlorite; Surgical Wound Dehiscence; Surgical Wound Infection; Therapeutic Irrigation

Infection remains a severe complication after pacemaker implantation. The purpose of our prospective study was to evaluate the role of the local bacteriologic flora in its occurrence.. Specimens were collected at the site of implantation for culture from the skin and the pocket before and after insertion in a consecutive series of patients who underwent elective permanent pacemaker implantation. Microorganisms isolated both at the time of insertion and of any potentially infective complication were compared by using conventional speciation and ribotyping. There were 103 patients (67 men and 36 women) whose age ranged from 16 to 93 years (mean+/-SD, 67+/-15). At the time of pacemaker implantation, a total of 267 isolates were identified. The majority (85%) were staphylococci. During a mean follow-up of 16.5 months (range, 1 to 24), infection occurred in four patients (3.9%). In two of them, an isolate of Staphylococcus schleiferi was recognized by molecular method as identical to the one previously found in the pacemaker pocket. In one patient, Staphylococcus aureus, an organism that was absent at the time of pacemaker insertion, was isolated. In another patient, a Staphylococcus epidermidis was identified both at the time of pacemaker insertion and when erosion occurred; however, their antibiotic resistance profiles were different.. This study strongly supports the hypothesis that pacemaker-related infections are mainly due to local contamination during implantation. S schleiferi appears to play an underestimated role in infectious colonization of implanted biomaterials and should be regarded as an important opportunistic pathogen.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Axilla; Bacteremia; Baths; Disinfection; Equipment Contamination; Female; France; Humans; Male; Middle Aged; Opportunistic Infections; Pacemaker, Artificial; Povidone-Iodine; Prospective Studies; Skin; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection; Thorax

To determine the effect of povidone-iodine soaks on outcomes of hand infections after operative drainage.. We performed a single-center, prospective, randomized trial to evaluate 100 consecutive hand infections. Forty-nine patients received povidone-iodine soaks 3 times daily, and 51 patients received only daily dressing changes. Outcome measures were the number of operations, readmissions, reoperations for wound complications, and days spent in the hospital.. Patients treated with povidone soaks averaged 1.6 operations, and patients treated with daily dressing changes averaged 1.4 operations, a statistically insignificant difference. The mean number of operations was also not different between groups for the dorsal hand or dorsal finger abscess subcategories. No significant differences were found in length of stay, number of readmissions, or number of reoperations for wound complications.. Povidone-iodine soaks are not helpful in the postoperative management of hand infections. Therapeutic II.

Topics: Abscess; Adult; Anti-Infective Agents, Local; Female; Hand; Humans; Male; Povidone-Iodine; Prospective Studies; Surgical Wound Infection; Treatment Outcome

To assess whether infectious morbidity after total abdominal hysterectomy is decreased by the addition of 20 cc povidone-iodine gel at the vaginal apex after the usual vaginal preparation with povidone-iodine solution.. Randomised controlled trial.. Fifteen secondary and tertiary hospitals in Canada.. A total of 1570 women undergoing planned total abdominal hysterectomy.. Computer-generated randomisation using a centralised telephone service was stratified by study centre with variable block size. In the operating room, a swab for bacterial vaginosis was taken before vaginal antisepsis. Study group remained concealed until the standard surgical preparation in the operating room was complete. Then povidone-iodine gel 20 cc was placed at the vaginal apex in the intervention group only. Participants were followed for one month post-operative.. The primary outcome was post-operative infectious morbidity during the 30 days after surgery, defined as: febrile morbidity with hospital stay greater than five days or antibiotic treatment, or infection requiring readmission to hospital or additional visit. Other outcomes included abdominal wound infection, pelvic abscess and other pelvic infections.. Post-operative infectious morbidity within 30 days occurred in 128/780 (16%) women receiving povidone-iodine gel preparation and 142/790 (18%) women not receiving gel (RR 0.9, 95% CI 0.7 to 1.1). Pelvic abscess was diagnosed in 0 patients in the gel group and in seven patients in the control group (P < 0.01). No significant difference was found in pelvic cellulitis (eight in each group) or abdominal wound infection (51 in the gel group and 58 in the control group, P= 0.5).. Povidone-iodine vaginal gel antisepsis led to a 9% relative decrease in overall infectious morbidity after abdominal hysterectomy, which was not statistically significant. Povidone-iodine vaginal gel decreased the risk of pelvic abscess after total abdominal hysterectomy.

Topics: Abscess; Administration, Intravesical; Anti-Infective Agents, Local; Antisepsis; Female; Gels; Humans; Hysterectomy; Middle Aged; Pelvic Infection; Povidone-Iodine; Risk Factors; Surgical Wound Infection; Treatment Outcome

A prospective randomized investigation was undertaken, involving 168 consecutive patients undergoing laparotomy for conditions accompanying bacterially contaminated peritoneal cavities, to evaluate the effectiveness of povidone-iodine irrigation of the peritoneum in preventing the development of intra-abdominal abscesses. In the treatment group irrigated with povidone-iodine solution, 0.1 per cent available iodine, one of 80 patients had an abscess, 1.3 per cent, while, in the saline solution irrigated control group, nine of 88 patients had abscesses, 10.2 per cent, p less than 0.05. Although the serum iodine levels were elevated 24 hours after intraperitoneal irrigation with povidone-iodine solution, iodine levels returned to near normal by 72 hours. Thyroxine levels showed no major changes. No complications resulting from the use of povidone-iodine were recognized.

Topics: Abscess; Clinical Trials as Topic; Female; Humans; Iodine; Laparotomy; Male; Peritoneal Cavity; Peritoneal Diseases; Povidone; Povidone-Iodine; Prospective Studies; Random Allocation; Therapeutic Irrigation

The aim of this study is to evaluate the thyroid function tests in order to examine whether 10 % of Povidone-Iodine(PI), the medication we applied in 1/5 ratio diluted with 0.9 %NaCl, joins the systemic circulation during clean contaminated, contaminated and dirty operations for solid organ hydatid cysts in abdominal area to avoid abscess formation and spreading. 7 men and 6 women were included to the present study, prospectively. The mean age was 33.69(± 13.49). TSH, free T3 (fT3) and free T4 (fT4) hormone levels were measured before the operation and at the third day of postoperative period. Amount of used povidone-iodine for patients was recorded. As a result of statistical analysis applied, the preoperative and post operative values were not significantly different regarding with the measured hormone levels (preTSH vs postTSH: p= 0.984; prefT3 vs postfT3: p= 0.101; prefT4 vs postfT4: p=0.146). Thus, it has been shown that the dose we used is effective, and it does not enters at all or at quite low levels into the systemic circulation. Patients whom this application performed, abscess and intestinal adhesions have not been observed in our clinical experience. We recommend the use of suggested doses of Povidone-Iodine in the presence of intraabdominal perforation and abscess or in cases such as carrying a risk of cyst spreading to intraabdominal area in hydatid cysts.. Povidone-iodine, Surgical adhesions, Surgical wound infections, Thyroid function tests.. Scopo di questo studio è quello di valutare i test di funzione tiroidea per indagare se una soluzione di Povidone- Iodine (PI) al 10%, che usiamo nella diluizione 1/5 con 0,9% NaCl in area addominale durante interventi puliti- contaminati, contaminati e sporchi in caso di idatidosi in organi parenchimatosi, al fine di evitare la formazione di ascessi e la disseminazione, raggiunge la circolazione sistemica. In questo studio sono stati inclusi 7 uomini e 6 donne in maniera prospettica. L’età media era di 33,69 (± 13.49). Preoperatoriamente ed al terzo giorno postoperatorio sono stati dosati i livelli ormonali di TSH, T3 libero (FT3) e T4 libero (FT4). È stata presa nota della quantità di PI usata per ogni paziente. Dall’analisi statistica non sono risultati valori significativamente differenti tra il preoperatorio ed il postoperatorio relativamente al livello degli ormoni tiroidei (preTSH vs postTSH: p= 0.984; preFT3 vs postFT3: p= 0.101; preFT4 vs postFT4: p=0.146). Così si è dimostrato che la dose di PI usata è efficace e non entra, o quanto meno a livello piuttosto basso, nella circolazione sistemica. I pazienti in cui tale procedura è stata usata non sono andati incontro in questa nostra esperienza ad ascessi addominali o aderenze intestinali. Raccomnadiamo dunque l’uso di queste dosi suggerite di PI in caso di perforazioni intestinali o ascessi, o in caso di possibile rischio di disseminazione in area intraaddominale di cisti idatidee.

Topics: Abdomen; Abscess; Adolescent; Adult; Anti-Infective Agents, Local; Dose-Response Relationship, Drug; Echinococcosis; Female; Humans; Male; Middle Aged; Postoperative Complications; Postoperative Period; Povidone-Iodine; Prospective Studies; Skin Absorption; Surgical Wound Infection; Thyroid Gland; Thyroxine; Tissue Adhesions; Triiodothyronine; Young Adult

Topics: Abscess; Adult; Anti-Bacterial Agents; Antifungal Agents; Aortic Aneurysm, Abdominal; Aspergillosis; Aspergillus fumigatus; Blood Vessel Prosthesis; Combined Modality Therapy; Coronary Sinus; Coronary Vessels; Debridement; Drug Therapy, Combination; Fever; Heart Valve Prosthesis; Humans; Male; Postoperative Complications; Povidone-Iodine; Prosthesis-Related Infections; Pyrimidines; Replantation; Tomography, X-Ray Computed; Triazoles; Voriconazole

Infection after strabismus surgery is rare. Here we describe a 5-year-old girl who developed bilateral staphylococcal sub-Tenon's abscess resistant to fourth-generation fluoroquinolones that resolved completely after surgical drainage and irrigation with povidone iodine followed by administration of oral amoxicillin and clavulanic acid. A lost muscle required exploration and reattachment to the sclera.

Topics: Abscess; Anti-Bacterial Agents; Child, Preschool; Combined Modality Therapy; Connective Tissue Diseases; Eye Infections, Bacterial; Female; Functional Laterality; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Postoperative Complications; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Strabismus; Suction; Therapeutic Irrigation

The authors report a series of thirty-six perforating ulcers of the foot in diabetic patients, evaluated using M.R.I. M.R.I. showed osteomyelitis in 16 cases, cellulitis in 15 cases, osteoarthropathies in 21 cases, tenosynovitis of flexor tendons in 2 cases, oedema in 2 cases and abscess in one case. In 19 cases, M.R.I. was used to improve diagnostic accuracy. The medical treatment made use of thermo-moulded soles allowing for the recovery of walking, with a hole facing the perforating ulcer of the foot. The application of insulin-soaked sponges in the event of clean perforating ulcer of the foot and iodized solution in the event of infected perforating ulcer of the foot promoted healing. The treatment was only conservative, when the lesions were limited to the soft tissues. Surgical treatment was performed in 19 cases due to a global involvement of soft and osteoarticular tissues. In fourteen cases the surgical treatment was limited and was performed through the perforating ulcer. Resection of metatarsal heads or metatarso-phalangeal joints was performed in 10 cases, with resection of surrounding pathologic tissue. The surgical treatment was limited to the soft tissues in 6 cases. In 4 cases, M.R.I. findings resulted into a transmetatarsal amputation because the vascular plexus was of poor quality and infection spread from the perforating ulcer to the dorsal aspect of the foot. In our opinion, dorsal infectious involvement in a perforating ulcer of the foot, is a factor of poor prognosis. A below-knee amputation has been performed in one patient.

Topics: Abscess; Administration, Cutaneous; Adult; Aged; Amputation, Surgical; Anti-Infective Agents, Local; Bacterial Infections; Cellulitis; Diabetic Foot; Edema; Equipment Design; Follow-Up Studies; Foot Diseases; Humans; Hypoglycemic Agents; Insulin; Magnetic Resonance Imaging; Metatarsal Bones; Metatarsophalangeal Joint; Middle Aged; Osteoarthritis; Osteomyelitis; Povidone-Iodine; Prognosis; Shoes; Tenosynovitis; Walking; Wound Healing

Infectious complications of spinal or epidural anaesthesia are rare, particularly after spinal anaesthesia. Most of them consist of a meningitis. We report a case of epidural abscess due to Staphylococcus aureus following spinal anaesthesia in a 62-year-old diabetic patient, diagnosed 45 days after the puncture with bacterial samples and magnetic resonance imaging. The pejorative neurological outcome required a laminectomy in spite of an efficient anti-staphylococcal treatment.

Topics: 4-Quinolones; Abscess; Amikacin; Anesthesia, Spinal; Anti-Infective Agents; Diabetes Mellitus, Type 2; Disease Susceptibility; Drainage; Drug Therapy, Combination; Epidural Space; Fluoroquinolones; Humans; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Oxacillin; Pefloxacin; Postoperative Complications; Povidone-Iodine; Punctures; Quinolones; Spinal Diseases; Staphylococcal Infections

The mechanism of epidural infection associated with epidural block is not clearly understood. Resident organisms in skin specimens were studied after skin was prepared with disinfectants.. Sixty-nine paired skin specimens were excised at incisional sites after skin disinfection with 10% povidone-iodine (10% PVP-I) or 0.5% chlorhexidine in 80% ethanol (0.5% CHE) from 60 patients having back surgery. One of the specimen pairs was placed in 10 ml brain-heart infusion broth and incubated in air at 37 degrees C for 96 h. The other specimen was sectioned at 3 microns and prepared with Gram's stain for examination with the microscope.. Thirteen gram-positive staphylococcal species (Staphylococcus epidermidis, 69.2%; S. hyicus, 15.4%; and S. capitis, 15.4%) were isolated from cultures. The isolates were found in a significantly greater proportion of the skin specimens disinfected with 10% PVP-I than in those disinfected with 0.5% CHE (11 of 34 cultures [32.4%] vs. 2 of 35 cultures [5.7%]; P < 0.01). Many gram-positive cocci were observed with the microscope in 4 (11.8%) and 5 (14.3%) of 34 and 35 skin specimens disinfected with 10% PVP-I and 0.5% CHE, respectively. The cocci formed a dense colony in each follicle and in the stratum corneum. No organism was present in any of 17,584 sweat glands examined.. In a large proportion of patients, isolation of viable organisms from excised skin specimens after disinfection with 10% PVP-I suggests that contamination of the epidural space by the skin flora may be a potential mechanism of epidural infection associated with epidural block.

Topics: Abscess; Anesthesia, Epidural; Anti-Infective Agents, Local; Back; Chlorhexidine; Ethanol; Humans; Povidone-Iodine; Skin; Staphylococcus aureus; Staphylococcus epidermidis

This study compares CO2 laser sterilization with iodine surgical scrub in infected pseudomonas wounds in the rabbit, and on frequency of wound breakdown secondary to sepsis. Thirty-three New Zealand rabbits underwent bilateral flank incisions and infection with a standard solution of pseudomonas aeruginosa. After 4 days of incubation, the wounds were randomized to receive laser sterilization and routine iodine surgical scrub respectively. Following sterilization, excision of the wound, and suturing was carried out. After 12 days, the wounds were assessed for evidence of residual infection as well as wound breakdown in a double blind fashion. Clinical observation, qualitative microbiology, and in some cases histology, were used to document the presence of infection. Statistical analysis of wound breakdown secondary to infection revealed a significant difference in breakdown rates. Three laser and 12 iodine treated wounds displayed breakdown secondary to sepsis. We conclude that the CO2 laser sterilization technique is more effective than routine iodine surgical scrub.

Topics: Abscess; Animals; Carbon Dioxide; Double-Blind Method; Epithelium; Laser Therapy; Light Coagulation; Male; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Rabbits; Skin; Sterilization; Suppuration; Surgical Wound Infection; Wound Healing

Intraovarian abscess is an unusual form of pelvic inflammatory disease usually managed with laparotomy. A patient with prolonged morbidity from an intraovarian abscess following pelvic inflammatory disease associated with an intrauterine contraceptive device was managed with laparoscopically guided needle aspiration of the abscess and povidone-iodine lavage. Laparoscopy should play a greater role in the management of pelvic inflammatory disease.

Topics: Abscess; Adult; Female; Humans; Laparoscopy; Pelvic Inflammatory Disease; Povidone-Iodine; Suction; Therapeutic Irrigation; Ultrasonography

An infected graft in the ascending aorta was managed by use of an omental pedicel graft and local irrigation with a dilute suspension of aqueous providone iodine. This conservative approach is an alternative to the high risk procedure of graft replacement. The large abscess cavity associated with the aortic prosthesis was diagnosed by computed tomography.

Topics: Abscess; Aged; Aortic Valve Insufficiency; Combined Modality Therapy; Female; Heart Valve Prosthesis; Humans; Infections; Omentum; Postoperative Complications; Povidone; Povidone-Iodine; Therapeutic Irrigation; Tomography, X-Ray Computed

Infection is an uncommon but unfortunate complication of prosthetic arterial bypass grafting. Because previously described methods of treatment of such infections which do not involve excision of the graft have not met with uniform success, we undertook a study of the efficacy of silver sulfadiazine cream in the treatment of Staphylococcus aureus infections of polytetrafluoroethylene carotid artery bypass grafts in dogs. At the time of bilateral grafts placement in 14 dogs, wounds were inoculated with at least 2 X 10(7) organisms. Three days later all wounds were opened. The wounds of seven dogs were treated with daily applications of silver sulfadiazine cream and the wounds of the other dogs were treated with daily applications of povidone iodine ointment. The dogs were sacrificed at 30 days or at the earliest evidence of arterial beeding from the wounds, whichever came first. Cultures of the wound were taken, and graft and artery histologic findings were studied at the time of sacrifice. Although survival of the dogs treated with silver sulfadiazine was marginally better than that of the dogs treated with povidone iodine, viable bacteria were present in microabscesses in many apparently healed wounds in the former group. We conclude that daily applications of silver sulfadiazine cream does not reliably eradicate staphylococcal infections involving polytetrafluoroethylene arterial bypass grafts.

Topics: Abscess; Administration, Topical; Animals; Blood Vessel Prosthesis; Dogs; Female; Male; Ointments; Polytetrafluoroethylene; Povidone-Iodine; Silver Sulfadiazine; Staphylococcal Infections; Sulfadiazine; Surgical Wound Infection