povidone-iodine and Endocarditis--Bacterial

Topics: Administration, Topical; Anti-Bacterial Agents; Bacteremia; Chlorhexidine; Dentistry, Operative; Endocarditis, Bacterial; Humans; Iodine; Povidone-Iodine; Premedication; Sodium Chloride

Due to the great number of different micro-organisms present, the oral cavity is an important source of infection. Infections caused by these micro-organisms can occur as local infections of the oral mucous membrane, local infections of the soft tissues or the bones following surgical intervention, or endocarditis due to bacteraemia following dental surgery. In the therapy of periodontal diseases, the application of antiseptic solutions is indicated to inhibit or reduce plaque accumulation. Povidone-iodine (PVP-I) solution will reduce inflammation and the progression of periodontal disease. The application of antiseptics in the oral mucous membrane is also indicated to prevent wound infections following surgical intervention in patients with leukaemia, AIDS, immunosuppressant therapy and patients undergoing anti-neoplastic radiation or chemotherapy. Some trials on the antibacterial efficacy of PVP-I in vivo showed reduction factors of log 2-3. PVP-I may therefore be recommended as an oral antiseptic. The irrigation of the gingival sulcus with an antiseptic solution is a useful complement to antibiotic prophylaxis in patients at risk of bacterial endocarditis. Many trials on the effectiveness of PVP-I on dental extraction bacteraemia have shown a significant benefit in the active group in comparison with the control group.

Topics: Administration, Topical; Antisepsis; Bacterial Infections; Endocarditis, Bacterial; Humans; Mouth Diseases; Periodontitis; Povidone-Iodine; Wound Infection

Cardiac implantable electronic device (CIED) implantation is complicated by infection still at a worrisome rate of 2-5%. Since early on during device implantation procedures, we have adopted an infection-preventive technique which has hitherto resulted in effective prevention of infections. Herein we present our results of applying this technique by a single operator in a prospective series of 762 consecutive patients undergoing device implantation.. A meticulous search for and treatment of active, occult, or smoldering infection was undertaken preoperatively. An aseptic/antiseptic technique was used for implantation of each device. Skin preparation is thorough with initial cleansing performed with alcohol followed by povidone-iodine 10% solution, which is also used in the wound and inside the pocket. In addition, we routinely use double gloving, and IV antibiotic prophylaxis 1 hour before and for 48 hours afterwards followed by oral antibiotic for 2-3 days after discharge. The skin is closed with absorbable sutures. The study includes 382 patients having a new pacemaker (n = 333) or battery change, system upgrade or lead revision (n = 49), and 380 patients having a new implantable cardioverter-defibrillator (ICD) (n = 296) or device replacement/upgrade/lead revision (n = 84).. The pacemaker group, aged 70.2 ± 16.5 years, includes 18% VVI, 49% DDD, 29% VDD, and 4% cardiac resynchronization therapy (CRT) devices. The ICD group, aged 61.3 ± 13.0 years, with a mean ejection fraction of 36 ± 13%, includes 325 ICD and 55 CRT implants. Over 26.6 ± 33.4 months for the pacemaker group and 36.6 ± 38.3 months for the ICD group, infection occurred in one patient in each group (0.26%) having a device replacement.. A consistent and strict approach of aseptic/antiseptic technique with the use of double gloving and povidone-iodine solution within the pocket plus a 4-day regimen of antibiotic prophylaxis minimizes infections in CIED implants.

Topics: Administration, Cutaneous; Administration, Intravenous; Aged; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Causality; Comorbidity; Defibrillators, Implantable; Endocarditis, Bacterial; Female; Gloves, Surgical; Greece; Hand Hygiene; Humans; Male; Pacemaker, Artificial; Povidone-Iodine; Prevalence; Prosthesis-Related Infections; Risk Factors; Surgical Wound Infection; Treatment Outcome

It is well known that the occurrence of bacteremia after dental procedures can place certain patients at risk for bacterial endocarditis. The authors compared the efficacy of two antiseptic agents in the prevention of post-treatment bacteremia in 120 dental patients. Before treatment, dentists irrigated the gingival sulcus of each patient with 10 percent povidone-iodine, 0.2 percent chlorhexidine or sterile water. The authors report lower levels of bacteremia among patients treated with the povidone-iodine solution.

Topics: Adult; Aged; Anti-Infective Agents, Local; Bacteremia; Chlorhexidine; Dental Care; Endocarditis, Bacterial; Female; Gingiva; Humans; Male; Middle Aged; Povidone-Iodine; Single-Blind Method; Streptococcal Infections; Therapeutic Irrigation

This article indicates that using local degerming agents in conjunction with traditional antibiotics prevents dental bacteremia more effectively than either procedure alone. In many patients at risk for endocarditis who practice home-care procedures than can produce bacteremia from gingival bleeding, daily antibiotic prophylaxis is impractical and contraindicated. This article discusses an effective method to control daily bacteremia with 0.2% chlorhexidine mouthwash. The article also attempts to identify patients at risk, determine the degree that they are exposed to potentially bacteremic situations, and encourage an aggressive team approach of physician and dentist to protect such patients adequately. Recommendations to prevent bacteremia are offered to supplement traditional antibiotic regimens.

Topics: Animals; Chlorhexidine; Dental Care; Endocarditis, Bacterial; Humans; Mouthwashes; Povidone-Iodine; Rabbits; Sepsis

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Endocarditis, Bacterial; Gingiva; Humans; Male; Middle Aged; Mouthwashes; Povidone; Povidone-Iodine; Sepsis; Therapeutic Irrigation; Tooth Extraction