povidone-iodine and Peritonitis

The use of intraperitoneal povidone iodine as an agent for peritoneal lavage in colorectal surgery is controversial. Although it possesses a wide range of antimicrobial activity and is rapidly lethal to dissociated colorectal cancer cells in vitro, concern about its potential toxicity remains.. Two cases of sclerosing encapsulating peritonitis (SEP) following elective colorectal surgery are presented. In each case the peritoneal cavity was lavaged with an aqueous povidone iodine solution. The surgical literature on the intraperitoneal use of povidone iodine is reviewed.. Significant morbidity resulted from the postoperative development of SEP in both of our patients. In one patient an ileo-anal pouch could not be fashioned following an initial colectomy, and in the second patient a small-bowel obstruction required a laparotomy and a period of intravenous nutrition before an oral diet could be tolerated.. The use of povidone iodine for peritoneal lavage in colorectal surgery is to be cautioned against in concentrations of > 1%.

Topics: Adult; Aged; Animals; Anti-Infective Agents, Local; Female; Humans; Intestinal Obstruction; Intestines; Male; Peritoneal Lavage; Peritonitis; Povidone-Iodine; Rats; Sclerosis

The use of antiseptics was reappraised because of the increasing problem of antibiotic-resistant bacteria. A formaldehyde (noxythiolin) and a halogen (povidone-iodine) were investigated, these being the most appropriate antiseptic groups. Povidone-iodine solution significantly reduced the mortality of mice (P less than 0.01) and rats (P less than 0.01) with peritonitis. Noxythiolin (1% and 0.5%) did not. Antiseptic irrigation of the rat colon before and after anastomosis resulted in significantly fewer 'poor' anastomoses (P less than 0.05) without inhibiting healing. Noxythiolin 2.5% and 1% significantly reduced peritoneal adhesion formation in rats, but a newly formulated povidone-iodine solution with increased polyvinylpyrrolidone content was superior to noxythiolin 1% and 0.5%. Povidone-iodine neither inhibited rat abdominal wound healing nor induced bacterial resistance. In 3 subsequent controlled clinical trials a dry-powder povidone-iodine formulation halved wound infection after grid-iron appendicectomy (P less than 0.025), reduced infection in elective 'clean' surgery, and significantly reduced infection after a wide variety of 'potentially contaminated' abdominal procedures (P less than 0.01). A return to the principles of Lister is advocated.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Clinical Trials as Topic; Drug Resistance; Guinea Pigs; Humans; Mice; Noxythiolin; Peritonitis; Povidone-Iodine; Rats; Surgical Wound Infection; Tissue Adhesions

Topical antibiotic and antiseptic agents have been documented to reduce exit-site infection (ESI) and peritonitis in PD. The aim of this randomized controlled study was to evaluate the efficacy of polyhexanide in the prevention of ESI and peritonitis. Patients were excluded if they had active infection, > 18 years of age, ESI and peritonitis within the previous 4 weeks, received PD for less than 3-months and history of allergy to either drug. All patients were followed up until catheter removal, death, switch to dialysis, transplantation or the end of the study. ESI, tunnel infection, peritonitis, catheter removal and microorganism cause of catheter-related infection were recorded prospectively during clinic follow-up. A total of 88 patients (41 povidone-iodine group; 47 polyhexanide group) were enrolled with a total follow-up duration of 480 and 555 patient-months for povidone-iodine and alternating group, respectively. There were no significant differences in the age, sex, BMI, time of PD, rate of DM, and S. aureus carriage state. A total of 8 ESI and 25 peritonitis episodes were detected during the study. ESI and peritonitis rates tended to be lower in polyhexanide group compared with the povidone-iodine group (0.06 episodes/patient-year vs. 0.12 episodes/patient-year; 0.26 episodes/patient-year vs. 0.32 episodes/patient-year, respectively), but were not significant statistically. Moreover, catheter removal was similar in both groups (0.04 / patient-year vs. 0.05 / patient-year). Polyhexanide is efficient and safe for the prevention of ESI and peritonitis and it may be used as an alternative procedure for the care of healthy exit sites.

Topics: Adult; Anti-Infective Agents, Local; Biguanides; Catheter-Related Infections; Device Removal; Female; Follow-Up Studies; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Povidone-Iodine; Prospective Studies

Exit-site infection (ESI), tunnel infection and associated peritonitis are major causes of morbidity and catheter loss in chronic peritoneal dialysis patients. Meticulous exit-site care is vital in preventing ESI. Avoiding trauma to the exit-site and daily cleaning of the exit-site with a dedicated antimicrobial soap is essential for the longevity of the peritoneal dialysis catheter. Antibiotics cream and disinfectant agents including povidone-iodine, chlorhexidine, electrolytic chloroxidizing solutions (Amuchina 10% - ExSept Plus, Amuchina 5% - ExSept) are useful to keep the resident micro-organisms inhibited. ESI rates in peritoneal dialysis patients treated with Amuchina 10% (ExSept Plus) and Amuchina 5% (ExSept) for the exit-site care are similar or lower compared to povidone-iodine or chlorhexidine. Electrolytic chloroxidizing (Amuchina 10% - ExSept Plus and Amuchina 5% - ExSept) solutions for exit-site care are effective for prevention and treatment of ESI.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bandages; Catheters, Indwelling; Chlorhexidine; Equipment Contamination; Humans; Hypochlorous Acid; Infection Control; Kidney Failure, Chronic; Middle Aged; Peritoneal Dialysis; Peritonitis; Povidone-Iodine; Skin Care; Soaps; Sodium Chloride

A prospective randomized trial was performed comparing the efficacy of intraperitoneal irrigation with low molecular weight povidone-iodine solution ('Betadine LMW') (PVP-I LMW) in reducing the risk of intra-abdominal infectious complications. Seventy-five patients who were undergoing surgical procedures in the face of bacterial contamination were studied. Patients were intra-operatively randomized to receive intraperitoneal irrigation prior to abdominal closure with PVP-I LMW or with saline. Patients were maintained on peri-operative systemic antibiotics, and surgical incisions were drained and were closed primarily or left open according to the practice of the surgeon responsible. If incisions were closed, the subcutaneous tissue was irrigated prior to skin closure with the same irrigant as used intraperitoneally, PVP-I LMW or saline. Patients were followed for abnormal wound healing, peritonitis, intra-abdominal abscesses, or other infectious complications. Serum iodine levels were monitored in some patients. Intra-abdominal infectious complications developed in two of 37 patients receiving PVP-I LMW irrigation as compared to complications in nine of 38 patients receiving saline irrigation (P less than 0.05). When infectious complications were excluded that were possibly due to surgical technical failures (such as anastomotic leakage), peritonitis or intra-abdominal abscesses were observed in one of 37 PVP-I LMW patients and in seven of 38 saline control patients (P less than 0.05). Wound infections developed in one of 37 PVP-I LMW patients and in three of 38 control patients. A broad range of serum iodine levels were observed in control patients preoperatively and at 24 h and 7 days postoperatively. Serum iodine levels in 'Betadine LMW' patients rose approximately nine-fold by 24 h postoperatively and returned to pre-operative levels by 7 days. It was concluded that PVP-I LMW solution can reduce the incidence of intra-abdominal infectious complications when used as an intraperitoneal irrigant in patients undergoing bacterially-contaminated surgical procedures.

Topics: Abdomen; Adult; Aged; Anti-Infective Agents, Local; Clinical Trials as Topic; Female; Humans; Infection Control; Male; Middle Aged; Peritoneal Cavity; Peritonitis; Postoperative Complications; Povidone; Povidone-Iodine; Prospective Studies; Random Allocation; Solutions; Surgical Wound Infection; Therapeutic Irrigation

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

The use of antiseptics was reappraised because of the increasing problem of antibiotic-resistant bacteria. A formaldehyde (noxythiolin) and a halogen (povidone-iodine) were investigated, these being the most appropriate antiseptic groups. Povidone-iodine solution significantly reduced the mortality of mice (P less than 0.01) and rats (P less than 0.01) with peritonitis. Noxythiolin (1% and 0.5%) did not. Antiseptic irrigation of the rat colon before and after anastomosis resulted in significantly fewer 'poor' anastomoses (P less than 0.05) without inhibiting healing. Noxythiolin 2.5% and 1% significantly reduced peritoneal adhesion formation in rats, but a newly formulated povidone-iodine solution with increased polyvinylpyrrolidone content was superior to noxythiolin 1% and 0.5%. Povidone-iodine neither inhibited rat abdominal wound healing nor induced bacterial resistance. In 3 subsequent controlled clinical trials a dry-powder povidone-iodine formulation halved wound infection after grid-iron appendicectomy (P less than 0.025), reduced infection in elective 'clean' surgery, and significantly reduced infection after a wide variety of 'potentially contaminated' abdominal procedures (P less than 0.01). A return to the principles of Lister is advocated.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Clinical Trials as Topic; Drug Resistance; Guinea Pigs; Humans; Mice; Noxythiolin; Peritonitis; Povidone-Iodine; Rats; Surgical Wound Infection; Tissue Adhesions

This study sought to determine in a district general hospital (a) the frequency and nature of bacterial contamination at operation, (b) the incidence of consequent infection and (c) the prophylactic effect, if any, of interparietal povidone-iodine against postoperative wound infection. Bacterial contamination was shown in 49 per cent of all the abdominal surgical wounds at the end of operation. From 61 per cent of the subsequently infected wounds, organisms identified as contaminants at operation were again found. Interparietal instillation of povidone-iodine resulted in a statistically significant reduction in wound infection (P less than 0.01) in treated patients compared with untreated, randomized, matched controls. It was of significant value in cases of intestinal resection and peritonitis, in obese patients and in those with paramedian incisions. Laboratory studies indicate that povidone-iodine does not induce bacterial resistance. This chemical antibacterial agent may thus provide a preferable alternative to antibiotics in preventing such infections.

Topics: Abdomen; Adult; Aerosols; Age Factors; Appendectomy; Biliary Tract Diseases; Drug Resistance, Microbial; Enterococcus faecalis; Escherichia coli; Female; Humans; Intestines; Male; Middle Aged; Obesity; Peritonitis; Povidone; Povidone-Iodine; Sex Factors; Skin; Staphylococcus; Surgical Wound Infection

Peritonitis and catheter exit- site infections (ESI) are important causes of hospitalization and catheter loss in patients undergoing chronic peritoneal dialysis (CPD). The frequency of infection can be reduced by scrupulous exit- site care with or without topical antiseptics. There are no studies showing any benefit in the use of povidone-iodine or normal saline for care of exit- sites in long- term CPD patients. In this study, we aimed to determine the potential effectiveness of the application of povidone-iodine or normal saline at the catheter exit- site in preventing ESI and peritonitis in children on CPD. A total of 98 patients treated with either povidone-iodine or normal saline were included in this study. Group I (34 patients) used povidone-iodine and group II (64 patients) simply cleansed the exit- site with normal saline (0.9% NaCl). Dressings were changed 2 to 3 times in a week. The total cumulative follow- up time was 3233 patient- months. ESIs occurred in 10 (29.4%) of 34 patients using povidone-iodine and in 10 (15.6%) of 64 patients using normal saline. The frequency of ESI was significantly high in group I (povidone-iodine) patients. The mean rate of ESI was 1 episode/60.8 patient- months for group I versus 1 episode/144 patient- months for group II (P < 0.05). The rate of peritonitis was similar in each group (1 episode/21.3 patient- months for group I versus 1 episode/20.17 patient- months for group II) (P > 0.05). In conclusion, exit- site care with normal saline is an effective strategy in reducing the incidence of ESI in children on CPD. It can thus significantly reduce morbidity, catheter loss, and the need to transfer patients on peritoneal dialysis to hemodialysis.

Topics: Adolescent; Anti-Infective Agents, Local; Catheters, Indwelling; Child; Female; Humans; Male; Peritoneal Dialysis; Peritonitis; Povidone-Iodine; Sodium Chloride; Surgical Wound Infection

In peritoneal dialysis (PD) the dialysate is introduced into the peritoneal cavity, and the peritoneal membrane is used as the dialysis membrane. In PD, patients exchange the dialysate by themselves through the connection tube attached to the indwelling catheter that is inserted into the peritoneal cavity. Microbes may enter the peritoneal cavity during dialysate exchange, and, therefore, peritonitis is a potential complication of PD. To prevent microbial contamination, the connection tube tip is generally sealed with a protection cap containing povidone-iodine (PVP-I) during the dwelling time. This cap is designed to make direct contact with the tube tip so that microbes attached during dialysate exchange are killed by the next dialysate exchange. However, if excess PVP-I flows into the peritoneal cavity and is absorbed into the body, the complications, including thyroid dysfunction, peritoneal inflammation, and fibrous thickening, can develop. Therefore, in this study, a new manual connection system (Zero System, JMS Co., Ltd., Hiroshima, Japan) for continuous ambulatory peritoneal dialysis was investigated to confirm that the PVP-I solution within the protection cap of the new system would not flow into the fluid passing through the tube. An experiment was also performed to confirm that the microbes on the connector tip become completely nonviable after attachment of the cap for 3 hours. The cap is fitted with a sponge containing a 10% PVP-I solution, the same as for the conventional cap system. However, the system is designed to achieve disinfection without contact, unlike with the conventional system, in which disinfection is achieved by direct contact of the PVP-I-containing sponge with the open end of the attached connector. The test results demonstrated that adequate disinfection with this system can be achieved by the next exchange, while avoiding entry of PVP-I into the peritoneal cavity from the cap. The results suggest that the use of this connection system can avoid adverse reactions arising from the absorption of PVP-I and prevent the onset of peritonitis caused by microbial invasion of the peritoneal cavity.

Topics: Anti-Infective Agents; Candida albicans; Colony Count, Microbial; Disinfection; Equipment Contamination; Equipment Design; Humans; Materials Testing; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Povidone-Iodine; Pseudomonas aeruginosa; Staphylococcus aureus; Staphylococcus epidermidis

Topics: Aged; Anti-Infective Agents, Local; Equipment Design; Equipment Failure; Equipment Failure Analysis; Female; Humans; Medical Device Recalls; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Povidone-Iodine; Silicones

To evaluate the effectiveness of the use of the povidone-iodine (PVI) added to the liquid of wash of the peritoneal cavity in the reduction of bacterial absorption and in the remainder non-phagocyted bacteria in the circulating blood of rat.. Thirty four Wistar females rats were used, distributed in the following groups: A (n=10), non-treated; B (n=9), wash of the peritoneal cavity with solution of PVI to 1% in saline solution; C (n=15), wash of the cavity with saline solution. After anesthesia, it was made intraperitoneal infusion of solution of Escherichia coli labeled with 99mTc containing 10(8) CFU/ml. After 40 minutes, it was made the treatment, in the group A, manipulation of the viscera; in the group B, irrigation of the peritoneal cavity with warm solution of 1% PVPI to 37,5 degrees C, and in the group C irrigation with warm saline (37,5 degrees C). After 15 minutes of the treatment, blood samples and fragments of liver, spleen and lung was obtained for count of the radioactivity, and animals killed by abdominal aorta section. There were determined the bacterial absorption index and the remainder index in the bloodstream.. Of the total of bacteria infused in the peritoneum, there was absorption of 0,92% (0,14% to 2,13%) in the animals of the group A (controls), 0,49% (0,18% to 0,71%) after use of topical PVPI (group B) and 0,80% (0,04% to 3,8%) after wash with saline solution (group C). There was significant reduction of the absorption when compared the treated animals with PVPI and the controls (p=0,003). Of the total of bacteria absorbed for the circulatory current, the percentile amount of bacteria non-phagocyted in the outlying blood was of 2,9% (1,1% to 17,7%) in the control group, 15,2% (8,3% to 21,4%) in those treated with PVPI (group B) and 6,9% (0,8% to 29,7%) after wash with saline solution (group C), with difference among controls and treated with PVPI (p=0,01).. The wash of the cavity peritoneal of mice with solution containing PVPI showed to be capable to reduce the absorption of bacteria by peritoneum of rat; however it seems to interfere with the function of the phagocytic cells for the observation of the increase of viable bacteria in the outlying blood of those animals.

Topics: Animals; Anti-Infective Agents, Local; Disease Models, Animal; Drug Evaluation, Preclinical; Escherichia coli Infections; Female; Macrophages, Peritoneal; Peritoneal Cavity; Peritoneal Lavage; Peritonitis; Phagocytosis; Povidone-Iodine; Rats; Rats, Wistar; Solutions

The goal of this study was to compare the safety and efficacy of Amuchina 50% solution versus that of povidone-iodine 10% solution for transfer-set change in peritoneal dialysis (PD) patients in a tertiary referral university hospital. The transfer sets were changed using povidone-iodine 10% solution as disinfectant prior to March 1995. Thereafter Amuchina 50% solution was used. Thus data were collected on all the transfer sets changed between January 1993 and August 1997. Amuchina is an electrolytic chloroxidizer. Chlorine is the active ingredient with a pH of 9.5-10.5. Amuchina 50% solution contains chlorine (0.55%). One hundred ninety-nine transfer sets were changed using povidone-iodine 10% solution in 60 PD patients from January 1993 to March 1995. One hundred twenty-eight transfer sets were changed using Amuchina 50% solution in 65 patients from April 1995 to August 1997. The soaking times and nursing times were 2 and 5 minutes, respectively, with Amuchina, and 10 and 20 minutes, respectively, with povidone-iodine 10%. No episode of peritonitis occurred related to transfer-set change in either group. The transfer-set change using Amuchina 50% solution is safe and cost-effective in PD patients.

Topics: Anti-Infective Agents, Local; Disinfection; Humans; Hypochlorous Acid; Peritoneal Dialysis; Peritonitis; Povidone-Iodine; Sodium Chloride

With standardized operating strategies, a lethality rate of 10.2% was achieved following intra-abdominal administration of taurolidine in 352 cases of severe intra-abdominal infection. The extent and type of antibacterial therapy were determined on the basis of the clinical severity, the patient's age, and the original site of the infection. Local antisepsis includes tactical surgery and the use of locally and systemically acting taurolidine. Antibiotics were used for systemic antibacterial therapy. After laparoscopical clearance of the focus of infection (appendix, gall bladder) the operating time was significantly extended compared with that required for open surgery, while the postoperative complication rate and the length of stay in hospital were significantly reduced.

Topics: Adult; Aged; Bacterial Infections; Combined Modality Therapy; Drainage; Endotoxins; Female; Humans; Laparoscopy; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Povidone-Iodine; Reoperation; Surgical Wound Infection; Survival Analysis

Since the bacterial ability to develop resistance against various factors of their surroundings is a well-known phenomenon, resistance against iodine and specifically against povidone-iodine (PVP-I) has been widely investigated. Yet there is little known about bacterial resistance in long-term daily use of disinfectants in continuous ambulatory peritoneal dialysis (CAPD) patients. The aim of our study was to investigate whether on daily use of PVP-I over a period of at least 6 months coagulase-negative staphylococci (CNS)--the predominant infective organisms of peritonitis--developed resistance against PVP-I. At the catheter exit site of 40 CAPD patients we isolated 36 CNS. 23 CNS (CNS + PVP) orginate from patients using PVP-I, 13 CNS (CNS + CI) from patients using sodium hypochlorite (NaOCl) as disinfectant. The strains were biotyped, antibiotic resistance patterns were determined and resistance against PVP-I or NaOCl was calculated as reduction factor using the quantitative suspension test combined with a turbidimetric standardization. Resistance against PVP-I 0.01% and against NaOCl 0.005% was determined at two contact times (30 and 300 s) for each patient group. In addition, we investigated the effects of plasmid loss on sensitivity to PVP-I. Out of 5 multiple-antibiotic-resistant CNS, 3 strains showed no difference in reduction factor against PVP-I before and after curing. There was no significant difference in reduction factor against NaOCl. CNS + PVP were even significantly more sensitive to PVP-I than CNS + Cl. Taken together, our results demonstrate that long-term use of PVP-I does not cause any bacterial resistance in CNS of CAPD patients.

Topics: Anti-Infective Agents, Local; Bacterial Typing Techniques; Catheters, Indwelling; Colony Count, Microbial; Disinfectants; Drug Resistance, Microbial; Female; Humans; Iodophors; Male; Nephelometry and Turbidimetry; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Plasmids; Povidone-Iodine; Sodium Hypochlorite; Staphylococcal Infections; Staphylococcus; Time Factors

The optimal approach to catheter exit-site care and catheter design in terms of catheter-related infections (e.g., exit-site infections, peritonitis) in children remains elusive. We retrospectively compared the incidence of exit-site infections and peritonitis in 33 pediatric peritoneal dialysis patients who used one of three exit-site care/catheter combinations. The catheters used were single-cuffed, curled Tenckhoff (T), and double-cuffed Swan neck (SN). Exit-site care included either povidone-iodine (PI) or chlorhexidine (CHL) as cleansing agents. Our data suggest that the use of chlorhexidine versus povidone-iodine is associated with a significant decrease (p < 0.05) in the frequency of catheter exit-site infections in children. The use of the Swan-neck double-cuffed catheter does not appear to have any further impact on the frequency of exit-site infections. Neither the use of chlorhexidine nor Swan neck catheters had an effect on our peritonitis rate. Our review suggests that a prospective evaluation of a chlorhexidine-based exit-site care regimen in children should be encouraged.

Topics: Anti-Infective Agents, Local; Bacterial Infections; Catheters, Indwelling; Child; Chlorhexidine; Equipment Design; Humans; Peritoneal Dialysis; Peritonitis; Povidone-Iodine; Retrospective Studies

In 1989 we investigated the first instance of Pseudomonas cepacia infections due to intrinsic contamination of a povidone-iodine product. Six patients in a Texas pediatric facility had P. cepacia infection or pseudoinfection (three, peritonitis; one, pseudoperitonitis; and two, pseudobacteremia). Epidemiological studies showed one risk factor for infection of peritoneal fluid with P. cepacia: performance of peritoneal dialysis in the dialysis unit with use of one lot of povidone-iodine later found to be intrinsically contaminated (4/5 vs. 0/16, P = .001). Blood cultures yielded P. cepacia after nurses wiped the tops of blood culture bottles with the povidone-iodine solution before inoculation. P. cepacia was cultured from three povidone-iodine containers used at the hospital and from four containers of the same lot obtained from other health-care facilities in Texas and California. Isolates from patients and the povidone-iodine had similar antibiograms, identical plasmid profiles, and identical DNA banding patterns on the basis of results of ribonucleotide typing. This investigation demonstrates that intrinsic contamination of povidone-iodine solution with P. cepacia can result in infections in addition to colonization and/or pseudoinfection.

Topics: Bacteremia; Burkholderia cepacia; Child, Preschool; Cohort Studies; Cross Infection; Disease Outbreaks; Drug Contamination; Humans; Infant; Intensive Care Units, Pediatric; Peritoneal Dialysis; Peritonitis; Povidone-Iodine; Pseudomonas Infections; Retrospective Studies; Risk Factors; Texas

Peritonitis is the most common complication of peritoneal dialysis (PD). Staphylococcus epidermidis (S. epi), a common skin organism, is the microorganism that is identified is the majority of episodes of peritonitis. The PD catheter breaks the natural skin barrier and allows a periluminal migration of bacteria from the skin surface into the sterile peritoneal cavity. Exit site care is routinely performed to decrease the colony counts of microorganisms on the skin surrounding the PD catheter. Research data is limited to support any of the currently used protocols for exit site care. This study compared the effect of two antiseptic agents, povidone-iodine (P-I) and chlorhexidine gluconate (CG), on S. epi colony forming units (cfu) at the PD catheter exit site over a 24 hour period. Because the distribution of the research data was markedly non-normal, a descriptive approach was used to interpret the data. Results showed that there was no difference between P-I and CG immediately after exit site care. All patients had zero growth at Time I. One trend that emerged was that at 24 hours after exit site care with P-I, more patients (54%) had S. epi cfu than did patients (15%) cleaned with CG.

Topics: Adult; Aged; Chlorhexidine; Colony Count, Microbial; Female; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Povidone-Iodine; Prospective Studies; Skin; Staphylococcus epidermidis

Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Peritoneal Lavage; Peritonitis; Povidone; Povidone-Iodine

Topics: Drug Contamination; Humans; Peritonitis; Povidone; Povidone-Iodine; Pseudomonas; Pseudomonas Infections; Texas

Povidone-iodine caused peritonitis with neutrophilic leukocytosis and a minimal left shift at the dosage rate of 3.5 ml/kg body weight. A dosage rate of 2 ml/kg only caused slight neutrophilic leukocytosis. There was a significant increase in the levels of creatinine (p = 0.049) and BUN (p = 0.020) in dogs that received the higher dose rate. Two dogs died from povidone-iodine toxicity with a marked increase in ALT, AP, SDH and conjugated bilirubin. It is concluded that povidone-iodine is unsafe for use in the peritoneal cavity of dogs.

Topics: Animals; Blood Urea Nitrogen; Chemical and Drug Induced Liver Injury; Creatinine; Dog Diseases; Dogs; Female; Injections, Intraperitoneal; Leukocytosis; Liver Diseases; Male; Neutrophils; Peritonitis; Povidone; Povidone-Iodine

Intraperitoneal lavage with povidone-iodine solution has been reported by some to be beneficial in the treatment of peritonitis and by others to cause local and toxic side effects. In this study, 200 white mice, divided into four groups of 50, were subjected to bacterial peritonitis. The first group had no treatment; peritoneal lavage was carried out using povidone-iodine solution in the second group and a 0.9% sodium chloride solution in the third. In the fourth group, antibiotics (clindamycin and gentamicin) were instilled intraperitoneally without peritoneal lavage. The povidone-iodine solution had no beneficial effect, the death rate after 1 week (76%) being similar to that in the control group (78%) and much higher than that in mice treated with sodium chloride lavage (38%) and antibiotics without lavage (16%). A second series of experiments was, therefore, carried out to investigate the toxic effect of povidone-iodine solution intraperitoneally on mice without peritonitis; the solution was found to be toxic.

Topics: Animals; Escherichia coli Infections; Female; Male; Mice; Peritoneal Lavage; Peritoneum; Peritonitis; Povidone; Povidone-Iodine

A model of bacterial peritonitis, using mice infected with Escherichia coli, has been used to assess the protective effects of intraperitoneal treatment with antiseptics. Of the five antiseptics tested, only chlorhexidine gluconate had any protective effect, concentrations of 0.05 and 0.02 per cent reducing the mortality to 14 and 50 per cent respectively. The other antiseptics, taurolin, noxytiolin, povidone iodine and hypochlorite were all ineffective. Delayed treatment with chlorhexidine was not as effective as instillation immediately postinfection.

Topics: Animals; Anti-Infective Agents, Local; Chlorhexidine; Disease Models, Animal; Escherichia coli Infections; Hypochlorous Acid; Injections, Intraperitoneal; Male; Mice; Noxythiolin; Peritonitis; Povidone-Iodine; Taurine; Thiadiazines; Time Factors

Peritoneal infection progresses through defined stages: contamination, inflammation and abscess formation. An experimental model of established peritonitis without adjuvant in the rat was used to test the effect of various local and systemic agents on survival. There was significant improvement in all treatment groups except those treated with antiseptic lavage using PVP-I and noxythiolin. Intramuscular ampicillin improved survival from 40 to 60 per cent while intramuscular amikacin combined with local irrigation with metronidazole reduced mortality to nil (P less than 0.001). Both cephradine and metronidazole used as peritoneal lavage solutions improved survival (P less than 0.005) when compared with the controls but the difference was not significant when compared with irrigation with Hartmann's solution. Metronidazole given rectally also improved survival from 40 to 60 per cent but this difference was not significant. We conclude that survival in established peritonitis depends upon adequate antibiotic therapy.

Topics: Amikacin; Ampicillin; Animals; Cephradine; Disease Models, Animal; Injections, Intramuscular; Isotonic Solutions; Male; Metronidazole; Noxythiolin; Peritonitis; Povidone-Iodine; Rats; Rats, Inbred Strains; Rectum; Ringer's Lactate; Therapeutic Irrigation

In 36 patients, intraoperative peritoneal lavage with PVP-iodine solution (26 patients) or with the iodine free chemotherapeutic agent Taurolin (10 patients) was performed because of peritonitis. Total iodine serum levels increased considerably after peritoneal lavage with PVP-iodine. In the early postoperative phase, the resorbed iodine was mostly present as iodide in serum. Iodine serum values returned to normal after 30 days. A decrease in T4 and T3 could be observed with a concomitant reciprocal increase of rT3 in the acute phase of peritonitis. Normalization of the thyroid hormone took place after 8 days. A stronger increase in T4 occurred temporarily in 2 of 5 patients known to have thyroid function disorders. These changes in thyroid hormone may also be considered as the consequence of the severe primary disease. Normalization of hormone values was clearly delayed after PVP iodine lavage. The possible risk of an iodine-induced thyrotoxicosis after intraperitoneal application of PVP-iodine is pointed out, and objections are made to using this therapy.

Topics: Adult; Humans; Iodine; Peritoneal Cavity; Peritonitis; Povidone; Povidone-Iodine; Taurine; Therapeutic Irrigation; Thiadiazines; Thyroid Function Tests; Thyroid Gland; Thyroxine; Triiodothyronine

A controlled mixed peritoneal infection was produced by inoculation of bacteria into the peritoneum and peritonitis was allowed to become established. A laparotomy was performed and peritoneal toilet with a variety of agents was carried out. Local povidone-iodine in the inflamed peritoneum proved to be not only of no benefit but, in fact, to be toxic. In the standard concentrations recommended it proved lethal. Noxythiolin 2.5 per cent also had no beneficial effect. There was a significant difference between the effect of povidone-iodine when instilled into an inflamed peritoneum and instillation into the intact peritoneal cavity. We would advise caution in the use of these antiseptics in any situation in which local defence mechanisms have been compromised as a result of established infection.

Topics: Animals; Bacterial Infections; Disease Models, Animal; Male; Noxythiolin; Peritonitis; Povidone; Povidone-Iodine; Rats; Rats, Inbred Strains; Thiourea

Topics: Adolescent; Adult; Aged; Bacterial Infections; Drainage; Female; Humans; Male; Methods; Middle Aged; Peritonitis; Postoperative Complications; Povidone-Iodine; Time Factors

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

Two experimental studies were carried out upon dogs to clarify the efficacy of peritoneal povidone-iodine lavage in peritonitis. With an experimental model of peritonitis which closely resembles the clinical situation, we found that peritoneal lavage with povidone-iodine was not more effective than other lavage regimens in decreasing bacterial colony counts and was associated with an early 100 per cent mortality. Renal function was not affected by the treatment with this antiseptic solution. However, we found a statistically significant superimposed metabolic acidosis in the peritonitis group treated with povidone-iodine when compared with the other groups, by means of a significant decrease in base excess, p less than 0.01, at the two hour postlavage measures. This metabolic acidosis was also observed in normal dogs undergoing peritoneal lavage with povidone-iodine, showing a significant decrease in serum bicarbonate level one hour, p less than 0.05, and three hours, p less than 0.01, three hours postlavage, when compared with a sham laparotomy group in the nonperitonitis study. This has not previously been experimentally investigated. In view of these results, we do not recommend the clinical use of povidone-iodine solution for peritoneal lavage in peritonitis.

Topics: Acidosis; Animals; Bicarbonates; Disease Models, Animal; Dogs; Female; Humans; Ileum; Ligation; Peritonitis; Povidone; Povidone-Iodine; Prognosis; Solutions; Therapeutic Irrigation

To study the efficacy of several commonly used peritoneal lavage solutions in the treatment of experimental fecal peritonitis, lethal peritonitis was created in 100 rats by placing a gelatin capsule containing 0.1 ml of human stool and barium sulfate within the abdominal cavity. At reoperation up to eight hours after implantation, the rats had initial lavage with 30 ml/kg of sterile normal saline, followed by 15 ml/kg of one of four treatment regimens, all colored alike. These were 10% povidone-iodine (PVP-I), 1% PVP-I, 0.1% kanamycin, and sterile normal saline. A fifth group did not receive a second lavage. All survivors were sacrificed on the ninth day, at which time the study was unblinded. Twelve hours postoperatively there was a significantly greater mortality in the group irrigated with 10% PVP-I (83%) compared to all other groups (0-6%). At nine days, only the kanamycin group had survivors (29%); this was significantly better than any other group.

Topics: Animals; Disease Models, Animal; Feces; Humans; Kanamycin; Male; Peritonitis; Povidone-Iodine; Rats; Sodium Chloride; Therapeutic Irrigation

Topics: Bacterial Infections; Humans; Patient Compliance; Peritoneal Dialysis; Peritonitis; Povidone; Povidone-Iodine

Topics: Animals; Escherichia coli Infections; Hemoglobins; Male; Peritonitis; Povidone; Povidone-Iodine; Rats; Therapeutic Irrigation

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

Eight horses ranging in age from 4 days to 9 years were treated for peritonitis. Escherichia coli was isolated in four cases and Nocardia sp in one case. In each case, a catheter placed in the peritoneal cavity allowed drainage of a large amount of purulent fluid. Retrograde peritoneal lavage was performed through a Foley catheter or medical tubing, using Ringer's lactate solution containing kanamycin, povidone iodine, or nitrofurazone. All except two horses responded well to repeated lavage.

Topics: Animals; Escherichia coli Infections; Female; Horse Diseases; Horses; Male; Nitrofurazone; Peritoneum; Peritonitis; Povidone-Iodine; Therapeutic Irrigation

Topics: Aged; Child; Humans; Iodine; Middle Aged; Peritonitis; Postoperative Period; Povidone; Povidone-Iodine; Preoperative Care; Therapeutic Irrigation

Noxythiolin (Noxyflex, Geistlich), given intraperitoneally as a 2.5 per cent solution, protected mice from the lethal effects of an intraperitoneal injection of Escherichia coli. Povidone-iodine (Pevidine, Berk), containing 0.075 per cent iodine, gave no protection.

Topics: Animals; Escherichia coli; Injections, Intraperitoneal; Male; Mice; Noxythiolin; Peritonitis; Povidone; Povidone-Iodine; Thiourea

Topics: Animals; Dose-Response Relationship, Drug; Escherichia coli Infections; Female; Injections, Intraperitoneal; Lethal Dose 50; Mice; Mice, Inbred Strains; Peritonitis; Povidone; Povidone-Iodine; Rats

Intraoperative antibiotic peritoneal lavage was significantly better than systemic antibiotic in preventing death from induced faecal peritonitis in the rat. Its efficacy was due to the combined effects of lavage and intraperitoneal antibiotic, each factor alone being significantly inferior to the combined effect of both. Antiseptic lavage was less effective than antibiotic lavage.

Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Feces; Female; Peritonitis; Povidone-Iodine; Rats; Therapeutic Irrigation

In controlled experiments intraperitoneal povidone-iodine significantly reduced the mortality of mice (p less than 0.01) and rats (p less than 0.01) with induced peritonitis. Povidone-iodine irrigation of the rat colon before and after anastomosis did not interfere with healing or inhibit peritoneal adhesion formation. However, a newly formulated povidone-iodine solution containing increased PVP significantly reduced adhesion formation in a controlled study in rats.

Topics: Animals; Colonic Diseases; Female; Gastrointestinal Diseases; Injections, Intraperitoneal; Mice; Peritoneal Cavity; Peritoneal Diseases; Peritonitis; Postoperative Complications; Povidone; Povidone-Iodine; Rats; Tissue Adhesions; Wound Healing

Two experimental models were utilized to study the efficacy of intraperitoneal povidone-iodine in an established peritonitis. In both models, there was a 100% mortality in the povidone-iodine treated group. In laboratories which have reported favorable results, the animals were treated before peritonitis was allowed to develop. Clinical studies with povidone-iodine lavage have used dilute solutions which did not remain in the infected space. The effectiveness of this method was probably due to mechanical continuous irrigation. Our toxicity studies showed povidone-iodine to be fatal in normal animals in dosages exceeding 4.0 ml/kg. However, a dose of 2.0 ml/kg, which was nontoxic in normal animals, was fatal in animals with peritonitis. This study strongly suggests that the intraperitoneal administration of povidone-iodine can be fatal when the animal is compromised by peritonitis. The mechanism of this effect is unclear. On the basis of these studies, the intraperitoneal administration of povidone-iodine cannot be recommended for therapy of peritonitis.

Topics: Animals; Dogs; Drug Evaluation, Preclinical; Female; Injections, Intraperitoneal; Iodine; Male; Peritonitis; Povidone; Povidone-Iodine; Rats

Topics: Animals; Escherichia coli Infections; Humans; Injections, Intraperitoneal; Mice; Peritonitis; Povidone; Povidone-Iodine; Rats

Topics: Absorption; Animals; Cephalothin; Disease Models, Animal; Escherichia coli Infections; Injections, Intraperitoneal; Iodine; Kanamycin; Peritonitis; Povidone; Povidone-Iodine; Rats; Thyroid Function Tests; Tissue Adhesions