povidone-iodine and Appendicitis

A randomized controlled trial was conducted to test the hypothesis that povidone-iodine (PVI) irrigation versus no irrigation (NI) reduces postoperative intra-abdominal abscess (IAA) in children with perforated appendicitis.. A 100 patient pilot randomized controlled trial was conducted. Consecutive patients with acute perforated appendicitis were randomized (1:1) to PVI or NI from April 2016 to March 2017 and followed for 1 year. Patients and postoperative providers were blinded to allocation. The primary endpoint was 30-day image-confirmed IAA. Secondary outcomes included initial and total 30-day length of stay (LOS), emergency department (ED) visits, and readmissions. Intention-to-treat analyses were performed to estimate the probability of clinical benefit using Bayesian regression models (an optimistic prior for the primary outcome and neutral priors for secondary outcomes). Frequentist statistics were also used.. Baseline characteristics were similar between treatment arms. The PVI arm had 12% postoperative IAA versus 16% in the NI arm (relative risk 0.72, 95% credible interval 0.38-1.23). Bayesian analysis estimates 89% probability that PVI reduces IAA. High probability of benefit was seen in all secondary outcomes for the PVI arm: fewer ED visits and readmissions, and shorter initial and total 30-day LOS. The probability of benefit in reduction of total 30-day LOS in PVI patients was 96% and was significant (P = 0.05) on frequentist analysis.. PVI irrigation for perforated appendicitis in children demonstrated a strong probability of reduction in postoperative IAA with a high probability of decreased LOS. With the favorable probability of benefit in all outcomes, this pilot study serves as evidence to continue a definitive trial.

Topics: Abdominal Abscess; Adolescent; Anti-Infective Agents, Local; Appendicitis; Bayes Theorem; Child; Child, Preschool; Female; Humans; Infant; Intention to Treat Analysis; Intestinal Perforation; Length of Stay; Male; Patient Readmission; Peritoneal Lavage; Pilot Projects; Postoperative Complications; Povidone-Iodine; Texas

The role of prophylactic antibiotics is well established for contaminated wounds, but the use of antiseptic wound wicks is controversial. The aim of this work was to study the potential use of wound wicks to reduce the rate of infection following appendectomy. This prospective randomized controlled clinical trial was conducted at a university hospital in the department of surgery. The subjects were patients undergoing appendectomy for definite acute appendicitis. They were randomized by computer to primary subcuticular wound closure or use of an antiseptic wound wick. For the latter, ribbon gauze soaked in povidone-iodine was placed between interrupted nylon skin sutures. Wicks were soaked daily and removed on the fourth postoperative day. All patients received antibiotic prophylaxis. They were reviewed while in hospital and 4 weeks following operation for evidence of wound infection. The main outcome measures were wound infection, wound discomfort, and cosmetic result. The overall wound infection rate was 8.6% (15/174). In patients with wound wicks it was 11.6% (10/86) compared to 5.6% (5/88) in those whose wounds were closed by subcuticular sutures (p = NS). We concluded that the use of wound wicks was not associated with decreased wound infection rates following appendectomy. Subcuticular closure is therefore appropriate in view of its greater convenience and safety.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Appendectomy; Appendicitis; Child; Child, Preschool; Female; Humans; Length of Stay; Male; Middle Aged; Postoperative Period; Povidone-Iodine; Prospective Studies; Risk Factors; Surgical Wound Infection; Suture Techniques; Treatment Outcome

The purpose of this work was to compare the efficacy and safety of the collagen-gentamicin sponge with conventional treatment (wound open, maintaining a close observation, and cleaning it daily with antiseptics) for the prophylaxis of infection in "dirty" abdominal wounds. Seventy-three patients with dirty abdominal wounds caused by gastrointestinal tract surgery were studied. The patients were randomized in two groups: group A, open wounds, treated with local cleansing, metronidazole 20 to 40 mg/kg/day IV and gentamicin 5 mg/kg/day IV for 7 days. Group B, primary closure with collagen-gentamicin implant plus metronidazole 20 to 40 mg/kg/day IV for 7 days. Surgical wound infections were significantly reduced by the collagen-gentamicin implant. Polymicrobial infections were observed in group A, whereas the infections were caused only by a single organism in group B. In conclusion, the collagen-gentamicin implant is effective and well tolerated in the treatment of "dirty" surgical abdominal wounds because it significantly reduces the wound infection rate (p < 0.01) and shortens healing time (p < 0.001) and the period of disability.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Appendicitis; Bacterial Infections; Collagen; Colonic Diseases; Drug Implants; Female; Gallbladder Diseases; Gelatin Sponge, Absorbable; Gentamicins; Humans; Intestinal Perforation; Male; Metronidazole; Middle Aged; Povidone-Iodine; Rupture, Spontaneous; Surgical Wound Infection; Wound Healing

Single doses of clindamycin hydrochloride and gentamicin sulfate given preoperatively, combined with intraoperative topical application of povidone-iodine were given to patients with perforated or gangrenous appendicitis. The incidence of wound sepsis was reduced from 36% to 5%; severe infections were reduced from 25% to 0% when compared with a control untreated group of patients. When used alone, povidone-iodine had little effect in these patients. No toxic effects of the antibiotics or antiseptic were recorded nor were any resistant strains of pathogenic organisms grown from cultures.

Topics: Administration, Topical; Adolescent; Adult; Appendectomy; Appendicitis; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Emergencies; Gentamicins; Humans; Intraoperative Care; Middle Aged; Povidone; Povidone-Iodine; Premedication; Surgical Wound Infection

A study conducted into 91 appendectomised patients revealed wound infection rates to worsen from eight to 26 per cent (p less than 0.05) in the wake of locally delimited intra-operative application of povidone-iodine solution, two per cent in concentration. No other factors were found to be responsible for that aggravation. Tissue toxicity was found to outweight bactericidal effects, even with application in diluted and PVP-bonded form. Hence, povidone-iodine solutions not even in diluted form should ever be applied to wound treatment.

Topics: Adult; Appendectomy; Appendicitis; Female; Humans; Intestinal Perforation; Male; Peritoneal Lavage; Povidone; Povidone-Iodine; Rupture, Spontaneous; Surgical Wound Infection

In dogs with appendicitis-peritonitis, intraperitoneal povidone-iodine caused death more rapidly than the instillation of saline solution. The bacterial content of canine peritoneal fluid increased with time. Although fewer bacteria were found in fluid from povidone-iodine-treated dogs, the differences were not statistically significant. Qualitative chemical analysis of peritoneal fluid revealed iodide, but not free iodine, 15 to 30 minutes after instillation of povidone-iodine. Iodine was present in the peritoneum at 2 hours but not at 3 or 6 hours. The antibacterial effect of povidone-iodine was demonstrated in mice challenged intraperitoneally with lethal doses of Escherichia coli. Povidone-iodine diminished mortality when injected immediately (p less than 0.005) but not when given 1 to 3 hours later. Immediate injection of povidone-iodine into mice lowered the number of E. coli by 3 logs. Injection of povidone-iodine 3 hours after bacterial challenge lowered the number of E. coli by only 1/3 log. This lesser bactericidal effect in mice is attributed to greater dispersal and sequestration of bacteria throughout the peritoneal cavity with time and with inactivation of povidone-iodine by reduction to iodide in vivo. In dogs with appendicitis-peritonitis, the more rapid death after treatment with povidone-iodine was not associated with differences in peritoneal microflora but with peritoneal absorption of excessive amounts of iodide.

Topics: Animals; Appendicitis; Ascitic Fluid; Bacteroides; Clostridium; Dogs; Escherichia coli; Escherichia coli Infections; Female; Injections, Intraperitoneal; Iodides; Male; Mice; Peritonitis; Povidone; Povidone-Iodine

Topics: Acute Disease; Appendicitis; Humans; Postoperative Complications; Povidone-Iodine; Surgical Wound Infection

Topics: Administration, Topical; Ampicillin; Anti-Inflammatory Agents; Appendicitis; Humans; Penicillin Resistance; Povidone; Povidone-Iodine; Surgical Wound Infection; Tetracycline

Topics: Acute Disease; Ampicillin; Appendectomy; Appendicitis; Cross Infection; Humans; Povidone; Povidone-Iodine; Surgical Wound Infection; Tetracycline