povidone-iodine and Shock--Septic

Although peritoneal lavage with povidone-iodine (PVPI) is frequently performed after surgery on the gastrointestinal tract, the effects of PVPI on the intestinal epithelial barrier are unknown. The purpose of this study was to investigate the effects of abdominal irrigation with PVPI on the intestinal epithelial barrier in a colorectal cancer (CRC)-induced rat model.. The CRC model was induced in rats with azoxymethane and dextran sodium sulfate. Next, a total of 24 male CRC-induced rats were randomly divided into three groups (n = 8): (1) a sham-operated group, (2) an NS group (peritoneal lavage 0.9% NaCl), and (3) a PVPI group (peritoneal lavage with 0.45%-0.55% PVPI). The mean arterial pressure was continuously monitored throughout the experiment. The levels of plasma endotoxin and D-lactate, blood gases, and protein concentration were measured. The ultrastructural changes of the epithelial tight junctions were observed by transmission electron microscopy.. The mean arterial pressure after peritoneal lavage was lower in the PVPI group than that in the NS group. The protein concentration and levels of endotoxin and D-lactate were higher in the PVPI group than they were in the PVPI group. In addition, PVPI treatment resulted in a markedly severe metabolic acidosis and intestinal mucosal injury compared with NS rats.. Peritoneal lavage with PVPI dramatically compromises the integrity of the intestinal mucosa barrier and causes endotoxin shock in CRC rats. It is unsafe for clinical applications to include peritoneal lavage with PVPI in colorectal operations.

Topics: Acidosis; Animals; Anti-Infective Agents, Local; Azoxymethane; Bacterial Translocation; Colorectal Neoplasms; Dextran Sulfate; Endotoxins; Gastrointestinal Microbiome; Humans; Intestinal Mucosa; Male; Microscopy, Electron, Transmission; Neoplasms, Experimental; Peritoneal Absorption; Peritoneal Lavage; Permeability; Povidone-Iodine; Rats; Rats, Sprague-Dawley; Shock, Septic; Tight Junctions

Topics: Anti-Infective Agents, Local; Bandages; Electroencephalography; Humans; Hydrocarbons, Iodinated; Hyperthyroidism; Magnetic Resonance Imaging; Male; Middle Aged; Nervous System Diseases; Povidone-Iodine; Shock, Septic; Thyrotropin; Thyroxine

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

Toxic shock syndrome (TSS) is a rare complication of a Staphylococcus aureus infection and is primarily seen in children with small burns. The true incidence of TSS in burns patients is not known and the number of presumptive cases rarely reported. This survey was undertaken to determine if the incidence of TSS in children with burns could be related to the type of dressing used to cover the wound. A questionnaire was compiled and sent to the Senior Nurse in charge of each of the UK burns units. General information on the number of admissions, age of the patient, cause of injury and burn wound management was sought. An 81% response was obtained after two mailshots and follow up telephone calls. Seventy percent (23/33) of units which answered the survey nursed children. Of these, eight units had either not encountered TSS previously or not had a case within the past two years. These units were small, admitting a maximum of 50 patients each year. Of the units where TSS was encountered, approximately 2.5% of children admitted showed symptoms of TSS. Of the units who nursed both adults and children, seven units had seen TSS in burned adult patients which has not been reported in the literature. Of the eight units where TSS had not been recently encountered, four routinely administered prophylactic antibiotics to prevent infection whereas routine administration of antibiotics occurred in only two of the 15 units where TSS was seen. Although wound management procedures differed slightly there were many similarities. These included wound cleaning with normal saline, covering with either silver sulphadiazine (1%) or povidone iodine (10%), depending upon the infection status, and dressing with a paraffin tulle, gauze and crepe bandages. No association between the management of the burn wound and subsequent development of TSS could be established.

Topics: Adult; Age Factors; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bandages; Burns; Child; Child, Preschool; Detergents; Humans; Incidence; Patient Admission; Povidone-Iodine; Shock, Septic; Silver Sulfadiazine; Sodium Chloride; Surveys and Questionnaires; United Kingdom; Wound Infection

Three hundred isolates of Staphylococcus aureus from wound swabs were examined for the production of toxic shock syndrome toxin 1 (TSST-1). The isolates were collected from community patients, surgical inpatients and from patients in the Regional Burns Unit, Booth Hall Children's Hospital, Manchester. The overall incidence of toxin production was 17% and there was no significant variation between the sources of the strains. All 55 TSST-1-producing strains were grown in sublethal concentrations of five topical antimicrobial compounds and the level of toxin produced was determined and compared with the amount produced in a control broth after incubation for 24 h. The effects of sublethal concentrations of the compounds on TSST-1 production were strain dependent; some compounds tended to increase production (at least four-fold) and some tended to decrease production (at least four-fold). Some of the strains showed an increase in toxin production in the presence of chlorhexidine gluconate/cetrimide solution and silver sulphadiazine cream whereas 18%, 42% and 47% of the strains showed a decrease in toxin production in the presence of povidone iodine solution, stabilised hydrogen peroxide cream and mupirocin ointment, respectively. Preliminary results suggest that silver sulphadiazine cream induces toxin formation earlier in the growth cycle.

Topics: Anti-Infective Agents, Local; Bacterial Toxins; Cetrimonium; Cetrimonium Compounds; Chlorhexidine; Colony Count, Microbial; Enterotoxins; Humans; Hydrogen Peroxide; Mupirocin; Povidone-Iodine; Shock, Septic; Silver Sulfadiazine; Staphylococcal Infections; Staphylococcus aureus; Superantigens

Topics: Administration, Topical; Adult; Female; Hernia, Inguinal; Humans; Postoperative Complications; Povidone; Povidone-Iodine; Shock, Septic; Surgical Wound Infection; Tampons, Surgical