povidone-iodine and Pneumonia--Aspiration

Disinfection of the face and mucosa lined surfaces of the nose and mouth using a povidone-iodine (PI) or Betadine solution is common practice among head and neck surgeons. Povidone-iodine, which is a highly effective broad-spectrum antibiotic effective against bacteria, viruses, fungi, and protozoa, decreases the risk of postoperative surgical wound infection. We report a case of PI aspiration causing an acute chemical pneumonitis after preoperative disinfection of the oral cavity and nasopharynx in preparation for cleft palate repair. As a result of the inflammatory response, the patient required positive pressure mechanical ventilation and a prolonged stay in the pediatric intensive care unit. The patient was safely extubated on hospital day 7 and discharged on hospital day 10 without any long-term sequelae on follow-up. We also review the 3 other reported cases of PI aspiration pneumonitis. Based on our case report and literature review, we conclude that PI aspiration is associated with a high rate of morbidity; however, this should not preclude the use of PI before surgery, given its effectiveness as an oral disinfectant and the exceedingly low incidence of aspiration.

Topics: Anti-Infective Agents, Local; Child; Cleft Palate; Female; Humans; Iatrogenic Disease; Pierre Robin Syndrome; Pneumonia, Aspiration; Povidone-Iodine

Increasing evidence has linked the anaerobic bacteria forming periodontopathic biofilms with aspiration pneumonia in elderly persons. In experiments designed to eliminate the potent respiratory pathogens forming biofilms in the oral cavity, we have shown that the mechanical and chemical oral cleansing using povidone-iodine effectively reduced the detection rates and numbers of methicillin-sensitive Staphylococcus species, Streptococcus pneumoniae, and Haemophilus influenzae in patients scheduled to undergo oral surgery requiring endotracheal intubation. We confirmed the pathogenicity of periodontopathic anaerobic bacteria for aspiration pneumonia in an experimental mouse model. Based upon the finding of the coexistence of Porphyromonas gingivalis with Treponema denticola in chronic periodontitis lesions, we innoculated a mixed culture of P. gingivalis and T. denticola into the mouse trachea; the resulting infection induced inflammatory cytokine production and caused pneumonia. In another series of investigations, professional oral health care (POHC), mainly cleansing administered by dental hygienists once a week for 24 months to elderly persons requiring daily care, resulted in the reduction of the number of total anaerobes, Candida albicans, and Staphylococcus species and in the number of cases of fatal aspiration pneumonia. We also found that the POHC treatment of elderly persons for 6 months in the winter season reduced the salivary levels of protease, trypsin-like activity, and neuraminidase and also decreased the frequency of influenza cases.

Topics: Aged; Animals; Bacteria, Anaerobic; Dental Care for Aged; Dental Scaling; Humans; Influenza, Human; Mice; Pneumonia, Aspiration; Porphyromonas gingivalis; Povidone-Iodine; Toothbrushing; Treponema denticola

Povidone-iodine (PI) is thought to be an effective disinfectant and safe for many surgeons. Aspiration pneumonia is usually caused by gastric contents, but if PI solution will be aspirated, pneumonia or other complications may occur.. We present a case of pneumonia to aspiration of PI solution in a 91-year-old man patient who underwent oral-maxillofacial surgery. When surgeons used PI solution for disinfection into the oral cavity, the solution seems to be sinking gradually. The patient showed severe respiratory distress and developed hypoxia. There were much frothy fluids into a tracheal tube. We suctioned through the endotracheal tube and performed bronchoscopy, that revealed a redness which appeared associated to a chemical injury on the left trachea and bronchus. His condition was complicated by ARDS and DIC. Periodical bronchial suction and guideline-based treatments of ARDS were carried in ICU. He recovered without severe complication.. Although PI solution for an oral disinfection is used routinely, all operators need to be aware of the risk for PI aspiration.

Topics: Aged, 80 and over; Disinfection; Humans; Iodine; Male; Mouth; Pneumonia, Aspiration; Povidone-Iodine

Aspiration pneumonitis caused by aspiration of an oral disinfectant such as povidone-iodine during general anesthesia is rare and presents from a simple cough to a potentially fatal reaction. We present the case of a 15-year-old woman who developed aspiration pneumonitis as a complication due to aspiration of povidone-iodine during reduction with a fracture in her left anterior maxillary wall and orbital floor while under general anesthesia. Operators should consider the risks of aspiration pneumonitis during oral cleansing while patients are under general anesthesia.

Topics: Adolescent; Anesthesia, General; Female; Fracture Fixation; Humans; Intraoperative Complications; Maxillary Fractures; Orbit; Orbital Fractures; Pneumonia, Aspiration; Povidone-Iodine; Skull Fractures

A procedure to prevent silent aspiration, which results in frequent respiratory infections, was conducted on elderly bed-bound nursing home patients who suffered mainly from cerebral infarction and dementia. We cleaned the mouth with povidone iodine and kept them in a sitting position for 2 hr after each meal in order to restrict respiratory bacterial infection and to prevent aspiration of gastric juices, respectively. Patients with urinary tract infections were excluded from the present protocol. During the treatment for 103 days the number of febrile days was significantly decreased in the treated group compared with the control group, probably due to minimizing of respiratory infections.

Topics: Aged; Aged, 80 and over; Bed Rest; Eating; Female; Fever; Gastroesophageal Reflux; Homes for the Aged; Humans; Inhalation; Japan; Male; Nursing Homes; Pharynx; Pneumonia, Aspiration; Posture; Povidone-Iodine; Respiratory Tract Infections

We report a case of pneumonia secondary to aspiration of povidone-iodine, which was used as an oral antiseptic. The patient was 17 y.o. female (body weight: 70 kg) who underwent a transsphenoidal resection of pituitary adenoma. Although she had a history of asthma during her childhood, no asthmatic attacks occurred for the past 10 yrs. After satisfactory anesthesia induction and tracheal intubation, 60 ml of 0.7% povidone-iodine solution was used to clean the oral cavity by a surgeon. Insufficient sealing by the cuff occurred after suturing the tube, which had made a needle hole in the cuff. Arterial oxygen saturation dropped to 90% and an increased resistance in the lungs was noted. The trachea was reintubated and she was transferred to the ICU. Her chest X-ray revealed signs of pneumonia and atelectasis in the right upper lobe. Mechanical ventilation with PEEP and periodical bronchial toilet were performed during her stay in the ICU for 42 hrs. A week was needed for the improvement of her X-ray findings. Although povidone-iodine is thought to be safe and affective antiseptics, severe complications from its aspiration may occur in patients whose airways are sensitive as observed in this case.

Topics: Adolescent; Anesthesia; Female; Humans; Pneumonia, Aspiration; Povidone-Iodine

A case report of pneumonia secondary to aspiration of povidone-iodine, which was used as an oral preoperative antiseptic, is presented. Associated morbidity is described, along with suggested preventive measures.

Topics: Adult; Humans; Male; Pneumonia, Aspiration; Povidone; Povidone-Iodine