povidone-iodine and Intestinal-Perforation

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 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

A prospective randomized trial compared antiseptic solutions and normal saline as a means of preventing morbidity and mortality from residual sepsis in patients with generalized peritonitis. Fifty-three patients, all given broad-spectrum antibiotics, were entered into the study. Twenty patients received a saline lavage, 19 lavage with chlorhexidine-gluconate and 14 a saline lavage with instillation of povidone-iodine. All deaths were due either to the severity of the presenting disease or co-existing complicating conditions. The incidence of postoperative pyrexia, wound infection and duration of hospital stay of the surviving patients were unaffected by lavage grouping.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Appendectomy; Child; Chlorhexidine; Drug Evaluation; Female; Humans; Intestinal Perforation; Male; Middle Aged; Peritonitis; Postoperative Complications; Povidone-Iodine; Random Allocation; Sodium Chloride; Surgical Wound Infection; Therapeutic Irrigation

Anaphylaxis during anaesthesia is a rare event which is mainly related to neuromuscular blocking agents. Latex and antibiotics are less frequently incriminated. However, allergy may be triggered by other less frequent and hidden allergen. Among these, povidone is largely used in numerous therapeutics and cosmetics. We report here an exceptional case of grade 3 anaphylactic shock with iodinated povidone administered via a rectal route.

Topics: Administration, Rectal; Anaphylaxis; Anti-Infective Agents, Local; Colectomy; Colonic Diseases; Combined Modality Therapy; Crystalloid Solutions; Diagnostic Errors; Drug Hypersensitivity; Epinephrine; Food Hypersensitivity; Humans; Intestinal Perforation; Isotonic Solutions; Male; Methylprednisolone; Middle Aged; Povidone-Iodine; Preanesthetic Medication; Shock, Septic; Wernicke Encephalopathy

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

Topics: Adolescent; Adult; Female; Humans; Intestinal Perforation; Intestine, Small; Intraoperative Care; Male; Middle Aged; Peritonitis; Postoperative Care; Povidone; Povidone-Iodine; Therapeutic Irrigation