povidone-iodine and Neoplasms

Purpose Cancer therapy-associated paronychia (CAP) is a frequent adverse event associated with cytotoxic and targeted therapies that may impact dosing of anticancer therapies and patient quality of life (QoL). There are currently no evidence-based management strategies or approved treatments for CAP. Materials and Methods This was a prospective, multicenter, randomized, double-blind, vehicle-controlled phase 2 study that evaluated the efficacy and safety of 6 to 8 weeks of 1% or 2% povidone-iodine (PVP-I) topical solution versus vehicle-control in adult patients with CAP. Patients were randomized to one of three treatment arms administered twice daily: 1% PVP-I (Cohort A), 2% PVP-I (Cohort B), or vehicle-control (Cohort C). The primary endpoint was a two-grade reduction (or reduction to grade 0 if involved nails were grade 1) on the six-point Paronychia Severity Grading (PSG) scale. Secondary endpoints included safety and the effect on QoL and microbiota. Results A total of 102 patients with cancer were randomized to the study. In Cohort A, 83 of 205 (40.5%, P = 0.6059) affected nails met the primary endpoint versus Cohort C. In Cohort B, 88 of 167 (52.7%, P = 0.0063) affected nails met the primary endpoint versus 64 of 169 (37.9%) in Cohort C. Nineteen of 29 patients (65.5%) in Cohort B reported moderately or very painful nails at baseline that decreased to 15 patients (51.7%) at visit 2 and five patients (17.2%) at visit 3. Conclusions Treatment with twice-daily topical 2% PVP-I was safe and resulted in improvement in CAP compared with control. Clinicaltrials.gov identifier: NCT03207906. https://clinicaltrials.gov/ct2/show/NCT03207906.

Topics: Antineoplastic Agents; Double-Blind Method; Female; Humans; Male; Middle Aged; Neoplasms; Paronychia; Povidone-Iodine; Quality of Life; Severity of Illness Index; Treatment Outcome

To evaluate the preventive effects of topical skin disinfection with chlorhexidine on bloodstream infection (BSI) associated with totally implantable venous port (Port-A).. Two consecutive cohorts of solid cancer patients were prospectively followed for the occurrence of Port-A associated BSI (PABSI). The first cohort used povidone-iodine as topical skin disinfection and the second cohort used chlorhexidine. The primary endpoint was the time to first PABSI. Propensity score analysis was applied. The preventive effects of chlorhexidine were analyzed by Cox proportional hazards models.. There were 396 patients (81,752 catheter-days) in the iodine cohort and 497 (99,977 catheter-days) in the chlorhexidine cohort. Gram-negative bacteria were the most common pathogens to cause first episode of PABSI (iodine cohort (I) vs chlorhexidine cohort (C) and 0.404 vs 0.450 per 1,000 catheter-day), followed by Gram-positive bacteria (I vs C and 0.269 vs 0.110 per 1,000 catheter-day), and fungi (I vs C and 0.098 vs 0.070 per 1,000 catheter-day). Three hundred forty-three patients were selected from each cohort by propensity score match analysis. Chlorhexidine use was associated with a significant improvement on time to first PABSI caused by Gram-positive bacteria (log-rank test, p=0.00175; HR=0.35, 95 % CI, 0.14-0.85, p=0.02). No significant preventive effects of chlorhexidine on time to first PABSI caused by Gram-negative bacteria or fungi was found.. Chlorhexidine topical skin disinfection may prevent PABSI caused by Gram-positive bacteria in patients with solid cancers. The nonsignificant effect on preventing overall PABSI may be attributed to the high incidence of Gram-negative bacteria related PABSI.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Catheters, Indwelling; Chlorhexidine; Cohort Studies; Female; Humans; Male; Middle Aged; Neoplasms; Povidone-Iodine; Young Adult

We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. This single-center, prospective observational study of 249 consecutive patients aged ≥ 20 years proceeded in the ED of a university hospital in Japan during 6 months. Pairs of blood samples were collected for aerobic and anaerobic culture from all patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. We found 50 (20.1%) patients with potentially contaminated blood cultures. Fifty-six (22.5%) patients were true bacteremia and 143 (57.4%) patients were true negatives. Multivariate analysis associated more frequent contamination when puncture sites were disinfected with povidone-iodine than with alcohol/chlorhexidine (adjusted risk difference, 12.9%; 95% confidence interval [CI] 8.8-16.9; P < 0.001). Sites of blood collection were also associated with contamination. Femoral and central venous with other sites were associated with contamination more frequently than venous sites (adjusted risk difference), 13.1% (95% CI 8.2-17.9; P < 0.001]) vs. 17.3% (95% CI 3.6-31.0; P = 0.013). Rates of contaminated blood cultures were significantly higher when blood was collected from femoral sites and when povidone-iodine was the topical antiseptic.

Topics: Aged; Aged, 80 and over; Bacteremia; Blood Culture; Blood Specimen Collection; Chlorhexidine; Diabetes Complications; Diabetes Mellitus; Disinfectants; Emergency Service, Hospital; Ethanol; False Positive Reactions; Female; Femoral Vein; Hospitals, University; Humans; Hypertension; Japan; Male; Middle Aged; Neoplasms; Povidone-Iodine; Prospective Studies

Povidone-iodine (PVP-I) is widely used in clinical practice as an antiseptic and flushing agent after surgery to remove a tumor. Our present study was designed to determine whether diluted PVP-I is cytotoxic to colon cancer cells and ascetic tumor cells in vitro and to examine its antitumor effects in vivo. In vitro, CT26 and H22 cells treated with different concentrations of diluted PVP-I (0-1.56 µg/ml) were analyzed using the mononuclear cell direct cytotoxicity assay (MTT) and a flow cytometry assay. In vivo, Balb/c mice injected in the abdominal cavity with CT26 cells or H22 cells were treated intraperitoneally with different concentrations of PVP-I (0-312.5 µg/mouse), cisplatin (40 mg/kg) or 5'-FU (30 mg/kg) or left untreated. In vitro, the studies demonstrated the antiproliferative and significant apoptosis-inducing effects of PVP-I in a dose- and time-dependent manner. In vivo, PVP-I significantly repressed the growth of H22 and CT26 cells in Balb/c mice compared to controls. To explore the mechanism of the antitumor effect of PVP-I, the superoxide dismutase (SOD) activity of ascites extracted from a mouse model and the supernatant of CT26 cells was detected by an SOD kit. The activity of SOD was significantly inhibited in the experimental groups. Taken together, our data suggest that PVP-I exhibits a strong inhibitory effect on tumor growth in colon cancer (CT26) and hepatoma (H22) resulting from apoptosis, both in vitro and in vivo, suggesting a new potential therapeutic approach after tumor excision surgery to colon cancer and hepatoma.

Topics: Animals; Antineoplastic Agents; Apoptosis; Cell Line, Tumor; Cell Proliferation; Enzyme Activation; Humans; Male; Mice; Mice, Inbred BALB C; Neoplasms; Povidone-Iodine; Superoxide Dismutase

To evaluate the efficacy of multifaceted interventions in reducing complications of peripherally inserted central venous catheter (PICC) in adult oncology patients.. Multifaceted interventions were implemented in our department in December 2006. These interventions include: (1) A mandatory nurse reeducation was developed by a multidisciplinary task force; (2) Modification of peripherally inserted central catheter insertion: take a chest X-ray before removal of the guidewire and cutting of the catheter. The guidewire in the catheter facilitates the accurate location of the tip of PICC on chest X-ray and make the malposition correction (withdrawing, reinsertion, even reinsertion following withdrawal) easily; (3) Using a 2% chlorhexidine preparation, replace 10% povidone iodine for skin antisepsis; (4) Maintenance of maximum sterile barrier precautions during PICC insertion and aftercare; (5) Designing of a PICC archive form and establishing a PICC archive for each patient. The PICC complication rates of groups before and after interventions were evaluated and compared.. Sixty-nine PICC lines were inserted before these interventions, and 165 were inserted after implementation of these interventions. Compared with preintervention group, the postintervention group was associated with a 62.14% decrease in the overall complication rate (11.52% vs 30.43% [P = 0.0004]; incidence density, 1.82 vs 4.62 per 1,000 PICC days) with a 67.48% decrease in the infective complications rate (4.24% vs 13.04% [P = 0.015]) with a 58.19% decrease in the noninfective complications rate (7.27% vs 17.39% [P = 0.0199]).. The results suggest that these interventions implemented in this study may be help in reducing complications of PICC in adult oncology patients.

Topics: Adult; Aged; Anti-Infective Agents, Local; Catheter-Related Infections; Catheterization, Central Venous; Catheterization, Peripheral; Chlorhexidine; Education, Nursing, Continuing; Female; Humans; Middle Aged; Neoplasms; Povidone-Iodine; Radiography, Thoracic; Skin; Skin Diseases, Infectious

Using an ionized iodine compound, it may be possible to transmit a weak effect of the digestive enzymes from the duodenal lumen to the cytoplasmic structures beyond the cell membrane in general organic tissues. Povidone-iodine is easily obtainable at present, and may be the most suitable ionized material for the transmission of the enzymatic effects to body tissues. Consequently, to remove certain cellular byproducts accumulated abnormally in cancerous cytoplasm, and to achieve cancer prevention and eradication, a method of using povidone-iodine, as a conceptual model, should be devised and developed in the future.

Topics: Animals; Anticarcinogenic Agents; Antineoplastic Agents; Cell Transformation, Neoplastic; Cytoplasm; Duodenum; Gastrointestinal Contents; Humans; Hydrophobic and Hydrophilic Interactions; Intestinal Mucosa; Lipids; Lymphatic System; Lymphocytes; Milk; Mitosis; Neoplasms; Povidone-Iodine; Protons; Solubility

Topics: Bandages; Catheterization, Central Venous; Child; Chlorhexidine; Humans; Neoplasms; Nursing Evaluation Research; Povidone-Iodine; Sepsis