povidone-iodine and Staphylococcal-Infections

Staphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units.. We reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited.. Mupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Humans; Intensive Care Units; Mupirocin; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Humans; Infection Control; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

In this study, we discuss a mechanism of development of access-related Staphylococcus aureus infections in patients on buttonhole (BH) method and logically construct a measure to prevent such infections on the basis of the mechanism.. S. aureus can colonize a BH track. Once S. aureus colonizes a BH track, access-related infections may develop when the equilibrium is upset between the factors of host resistance and a level of bacterial growth in a BH track. Thus, the logically constructed measure to prevent access-related infections are as follows: (1) decolonization of S. aureus from a BH track by applying mupirocin ointment to a BH entry site when a patient has been proven to be a carrier of S. aureus in the track, (2) prevention of bacterial invasion of the BH track by a new method to remove a scab completely, and (3) control of bacterial growth in the BH track by disinfecting the site with diluted povidone-iodine solution (0.1% povidone-iodine solution) before access vessel cannulation.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Catheter-Related Infections; Catheterization, Peripheral; Catheters, Indwelling; Female; Humans; Kidney Failure, Chronic; Male; Mupirocin; Povidone-Iodine; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Wound healing is a complex proces, which is influenced by multiple factors. Bacterial contamination and infection are frequent and severe complications. The treatment of such infected wounds is a major challenge to the plastic surgeon. The topical application of wound antiseptics is widely used as a therapeutic approach in the treatment of these wounds. This review provides an overview about their clinical application, their cytotoxic and antibacterial properties as well as interactions with commonly used wound dressings.. This article reviews current literature dealing with local antiseptics, antibacterial activity, cytotoxicity and compatibility with wound dressings.. Topical antiseptics are used on a daily basis in order to reduce bacterial wound contamination. However, few data exist concerning their antimicrobial activity, especially in relation to their cytotoxicity. Furthermore, their compatibility with wound dressings is barely investigated. Recent studies show significant toxic effects on cells and an incompatibility with certain wound dressings for some of these antiseptics.. Antiseptics are broadly used in healthcare to reduce, inactivate or eliminate bacterial pathogens. Recent studies show that many daily used antiseptics possess relevant cytotoxic properties as well as cross reactions with wound dressings. Additional studies are therefore needed to further investigate and characterize the properties of wound antiseptics in order to identify the optimal therapeutic agents for the treatment of infected wounds.

Topics: Anti-Infective Agents, Local; Biguanides; Cell Proliferation; Cell Survival; Dose-Response Relationship, Drug; Drug Resistance, Bacterial; Enterococcus faecalis; Escherichia coli; Humans; Imines; Microbial Sensitivity Tests; Plastic Surgery Procedures; Povidone-Iodine; Pseudomonas aeruginosa; Pyridines; Staphylococcal Infections; Surgical Wound Infection; Wound Healing

Central venous catheters (CVC) continue to play a prominent role in haemodialysis vascular access with 46% to 70% of patients commencing haemodialysis via a CVC. CVC access is associated with catheter-related infections, increased patient hospitalisations and death due to infection. A variety of interventions are used to prevent CVC infection.. To evaluate the benefits and harms of prophylactic topical antimicrobials, topical antiseptics, medicated and non-medicated dressings on infectious complications among haemodialysis patients with CVC.. We searched the Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles without language restriction.. We included randomised controlled trials (RCTs) and quasi-RCTs investigating any intervention that prevented infectious complications among haemodialysis patients with CVC. We excluded antimicrobial impregnated CVC or CVC using locking solutions with antimicrobial properties.. Two authors assessed study quality and extracted data. Dichotomous outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CI) and continuous outcomes as mean differences (MD).. Ten studies (786 patients) were included. Mupirocin ointment reduced the risk of catheter-related bacteraemia (RR 0.17, 95%CI 0.07 to 0.43) and had a significant effect on catheter-related infections caused by S. aureus. The risk of catheter-related bacteraemia was reduced by polysporin (RR 0.40, 95%CI 0.19 to 0.86) and povidone-iodine ointment (RR 0.10, 95%CI 0.01 to 0.72). Subgroup analysis suggested mupirocin (RR 0.12, 95%CI 0.01 to 2.13) and povidone-iodine ointment (RR 0.84, 95%CI 0.24 to 2.98) had no effect on all-cause mortality while polysporin ointment showed a significant reduction (RR 0.22, 95%CI 0.07 to 0.74). Mortality related to infection was not reduced by mupirocin, polysporin or povidone-iodine ointment. Topical honey did not reduce the risk of exit site infection (RR 0.45, 95%CI 0.10 to 2.11) or catheter-related bacteraemia (RR 0.80, 95%CI 0.37 to 1.73). Transparent polyurethane dressing compared to dry gauze dressing did not reduce the risk of CVC or exit site infection, or catheter-related bacteraemia.. Mupirocin ointment appears effective in reducing the risk of catheter-related bacteraemia. Insufficient reporting on mupirocin resistance was noted and needs to be considered in future studies. A lack of high quality data on the routine use of povidone-iodine ointment, polysporin ointment and topical honey warrant larger RCTs. Insufficient data were available to determine which dressing type (transparent polyurethane or dry gauze dressing) has the lowest risk of catheter-related infections.

Topics: Apitherapy; Bacitracin; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Drug Combinations; Gramicidin; Humans; Mupirocin; Polymyxin B; Povidone-Iodine; Randomized Controlled Trials as Topic; Renal Dialysis; Staphylococcal Infections

The treatment of MRSA (methocillin resistant staphylococcus aureus) colonized middle ear is difficult. According to the guidelines, a MRSA colonized Patient is not to be treated with systemic antibiotics. The topical treatment shows the problem of the ototoxicity of most of the used antiseptic as well as antibiotic substances.. Selective literature review and consideration of the author's own clinical experience.. Antibiotic treatment options include aequeous Tetracyclin drops, aequeous chloramphenicol drops and quinolon ear drops (unfortunately the MRSA is resistent mostly). Antiseptics without ototoxic effects are the Burow's solution, Povidone-iode, acetic acid solutions and aequeous dequalinium solutions.

Topics: Acetates; Acetic Acid; Administration, Topical; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chloramphenicol; Dequalinium; Guideline Adherence; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Ear Ventilation; Otitis Media with Effusion; Parotid Neoplasms; Pharmaceutical Solutions; Postoperative Complications; Povidone-Iodine; Quinolones; Staphylococcal Infections; Tetracycline

Infection remains a severe complication after pacemaker implantation. The purpose of our prospective study was to evaluate the role of the local bacteriologic flora in its occurrence.. Specimens were collected at the site of implantation for culture from the skin and the pocket before and after insertion in a consecutive series of patients who underwent elective permanent pacemaker implantation. Microorganisms isolated both at the time of insertion and of any potentially infective complication were compared by using conventional speciation and ribotyping. There were 103 patients (67 men and 36 women) whose age ranged from 16 to 93 years (mean+/-SD, 67+/-15). At the time of pacemaker implantation, a total of 267 isolates were identified. The majority (85%) were staphylococci. During a mean follow-up of 16.5 months (range, 1 to 24), infection occurred in four patients (3.9%). In two of them, an isolate of Staphylococcus schleiferi was recognized by molecular method as identical to the one previously found in the pacemaker pocket. In one patient, Staphylococcus aureus, an organism that was absent at the time of pacemaker insertion, was isolated. In another patient, a Staphylococcus epidermidis was identified both at the time of pacemaker insertion and when erosion occurred; however, their antibiotic resistance profiles were different.. This study strongly supports the hypothesis that pacemaker-related infections are mainly due to local contamination during implantation. S schleiferi appears to play an underestimated role in infectious colonization of implanted biomaterials and should be regarded as an important opportunistic pathogen.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Axilla; Bacteremia; Baths; Disinfection; Equipment Contamination; Female; France; Humans; Male; Middle Aged; Opportunistic Infections; Pacemaker, Artificial; Povidone-Iodine; Prospective Studies; Skin; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection; Thorax

Numerous studies conducted in different countries and in different populations of patients on dialysis have consistently documented that a large proportion of such patients carry Staphylococcus aureus in their nares and that the risk of them becoming infected with their own strains is quite high. Furthermore, S. aureus infections can cause considerable morbidity and mortality in these patients. Thus, decolonization of the nares may prevent S. aureus infections and the attendant complications. The published data that support the use of rifampicin, intranasal mupirocin and povidone-iodine to prevent S. aureus infections in patients on dialysis are reviewed in detail.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Cost-Benefit Analysis; Humans; Mupirocin; Nose; Peritoneal Dialysis, Continuous Ambulatory; Povidone-Iodine; Renal Dialysis; Rifampin; Staphylococcal Infections; Staphylococcus aureus

The natural element iodine has been used for more than 150 years to prevent infection and treat wounds. Yet only due to the development of iodophors has it become possible to use this highly efficient microbicide in a wide range of medical applications. The antimicrobial spectrum is universal. Its efficiency against clinically and epidemiologically significant new pathogens, such as methicillin-resistant Staphylococcus aureus and Enterococcus sp. has also been validated. No development of resistance has been determined. New data are also available on the excellent local tolerability of Betaisodona (povidone-iodine) preparations. On these grounds, a number of clinical fields exist in prophylaxis and therapy, for either once only or repeated applications: the disinfection of hands and skin, mucosa antisepsis, intra- and postoperative wound treatment, therapy of skin infections, burns and chronic wounds.

Topics: Anti-Infective Agents, Local; Antisepsis; Bacterial Infections; Burns; Chronic Disease; Enterococcus; Gram-Positive Bacterial Infections; Hand; Humans; Intraoperative Care; Iodophors; Methicillin Resistance; Mucous Membrane; Postoperative Care; Povidone-Iodine; Skin; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

In recent years, liposomes have been increasingly explored as novel drug delivery systems, and several liposome-based drug products have been approved in Europe, the USA and Japan. Depending on size, composition and surface characteristics, liposomes interact specifically with biological structures. Liposomal drug products provide a topical activity at the desired locus of action and are deemed more effective and less toxic than conventional drug formulations. The combination of povidone-iodine (PVP-I) and liposomes unites the exceptional microbicidal activity of the antiseptic substance with the excellent tolerability and lack of immunogenicity of liposomes; in addition, liposomes provide a moist molecular film for the wound environment. The multilamellar vesicles act as microreservoirs hence prolonging the release of the active ingredient. Although no commercial product for repeated application on the eye is currently available, PVP-I has been used in ophthalmology not only for pre- and postoperative antisepsis, but also for the treatment of bacterial and viral conjunctivitis and for prophylaxis against ophthalmia neonatorum. For these indications, liposomal formulations with 2.5 and 5.0% PVP-I were developed. These eye drops are isotonic with tear fluid at pH 6. First in vitro tests demonstrated an excellent antimicrobial efficacy, and a placebo-controlled clinical study on volunteers showed a very good local tolerability. A study on rabbits demonstrated positive results of the PVP-I liposome eye drops compared to placebo and the broadspectrum antibiotic Polyspectran in a standardized model of Staphylococcus aureus deep eye infection. The other aim is a well-tolerated liposomal PVP-I hydrogel for improved antiseptic wound treatment with moisturizer. It has been reported that liposomes are enriched at the wound bottom for direct action against infection and support of wound healing. An animal study on the efficacy and tolerability of different formulations of a hydrogel with PVP-I liposomes in deep dermal burn wounds has indicated an outstanding quality of wound healing with smooth granulation tissue, less inflammation, less wound contraction and no hyperkeratotic reactivity, especially with the 3% PVP-I liposome formulation.

Topics: Administration, Cutaneous; Administration, Topical; Animals; Anti-Infective Agents, Local; Burns; Clinical Trials as Topic; Conjunctivitis, Bacterial; Conjunctivitis, Viral; Delayed-Action Preparations; Drug Approval; Drug Carriers; Drug Delivery Systems; Europe; Eye Infections, Bacterial; Humans; Infant, Newborn; Iodophors; Japan; Liposomes; Ophthalmia Neonatorum; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Placebos; Povidone-Iodine; Rabbits; Skin; Staphylococcal Infections; United States; Wound Healing; Wound Infection

Mediastinitis is one of severe and fatal complications after cardiac surgery, especially in the presence of a prosthetic graft. A 70-year-old male, who was suffered from chronic sternal osteomyelitis and mediastinitis after ascending aorta and hemiarch reconstruction was reported. He developed high fever and leucocytosis on the 16th postoperative day. Wound culture was positive for Grampositive organisms. He was diagnosed as having sternal osteomyelitis and mediastinitis and treated by sternal bone debridement and irrigation with dilute povidone iodine solution with no effects. Total excision of the infected sternum, irrigation with non-diluted solution of povidone iodine and omental transfer were performed successfully. The literature regarding omental transfer for mediastinitis and infected prosthetic grafts was briefly reviewed.

Topics: Aged; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Chronic Disease; Humans; Male; Mediastinitis; Omentum; Osteomyelitis; Povidone-Iodine; Prosthesis-Related Infections; Staphylococcal Infections; Staphylococcus epidermidis; Sternum; Therapeutic Irrigation

This review summarizes the natural history, clinical relevance and basis of control of Staphylococcus aureus infection in UK hospitals, stressing the central role of asymptomatic carriage by patients and staff in persistence of this prolific and versatile nosocomial pathogen. The clinical relevance of methicillin-resistant and methicillin-sensitive S. aureus (MRSA and MSSA) is considered in terms of prevalence and spectrum of invasive and toxigenic infections produced, correlated with host and parasite risk factors. An assessment is made of arguments why the acquisition of methicillin-resistance or multiple antibiotic resistance might justify more than conventional methods of containment and how the control policy is influenced by the expression of enhanced virulence and epidemicity. Guidelines for control of epidemic MRSA (EMRSA) are discussed with reference to justification, feasibility and efficacy. As elimination of carriage is crucial to the success of any rational control policy the relative merits of topical antibiotics and antiseptic agents are compared. The bacterial efficacy of povidone-iodine, chlorhexidine and mupirocin are evaluated as a basis for eradication of MRSA.

Topics: Carrier State; Chlorhexidine; Cross Infection; Humans; Methicillin Resistance; Mupirocin; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Approximately 38% of haemodialysis patients carry. We will perform an open-label, stepped-wedge cluster randomised trial to assess the effectiveness of nasal PVI compared with standard care. Sixteen outpatient haemodialysis units will participate in the study. The 3-year trial period will be divided into a 4-month baseline period and eight additional 4-month time blocks. The primary outcome of the study will be. This study has received IRB approval from all study sites. A Data Safety and Monitoring Board will monitor this multicentre clinical trial. We will present our results at international meetings. The study team will publish findings in peer-reviewed journals and make each accepted peer-reviewed manuscript publicly available.. NCT04210505.

Topics: Humans; Multicenter Studies as Topic; Povidone-Iodine; Randomized Controlled Trials as Topic; Renal Dialysis; Sepsis; Staphylococcal Infections; Staphylococcus aureus

Pin site infection is the commonest complication of Ilizarov external fixation. The aim of the study was to examine if use of antiseptics was superior over control and further if daily dressing was superior to weekly dressing in regular pin site care in reducing the burden of pin site infection in Ilizarov fixators.. A total of 114 patients (2363 pin sites) were randomised to receive regular pin site care alone (30 patients, 638 pin sites) or with additional application of povidone iodine (27 patients, 561 pin sites), silver sulfadiazine (27 patients, 570 pin sites) and chlorhexidine (30 patients, 594 pin sites). The pin tracts were sub-randomised to receive daily (1212 pin sites) or weekly (1151 pin sites) dressings. The primary outcome was pin site infection days rate across all four groups. The secondary outcomes were - mean duration to first episode of infection, differences between daily and weekly dressing groups, mean duration of antibiotic therapy and incidence of re-interventions and sequelae. We also recorded frequency of bacterial pathogens in all microbiological samples submitted. Block randomization using computer-generated random numbers was used. The assessor of outcome was blinded.. All patients completed the study. Pin site infection rate days per 1000 pin site days observed was marginally less in chlorhexidine group, but was not statistically significant compared to other antiseptics and control group (Absolute value in control, povidone iodine, silver sulphadiazine and chlorhexidine groups were respectively 2.04 ± 4.27, 2.04 ± 3.65, 1.85 ± 3.37, 1.37 ± 2.35, p value 0.92). Daily dressing category showed slightly less pin site infection days rate within each group and overall, but this was also not statistically significant (1.56 ± 3.99 versus 2.10 ± 5.1, p value 0.35). There was no statistically significant difference among the groups with regard to other secondary outcomes. Methicillin Sensitive Staphylococcus aureus was the most common bacterial pathogen isolated.. Use of antiseptics does not offer any advantage in regular pin site care in Ilizarov external fixation and daily pin site care is not superior to weekly pin site care. Empirical therapy in early and low grade pin site infections must be targeted against Staphylococcus.

Topics: Adult; Aged; Anti-Infective Agents, Local; Bandages; External Fixators; Female; Humans; Ilizarov Technique; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Prosthesis-Related Infections; Single-Blind Method; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; Young Adult

Nasal Staphylococcus aureus decolonization reduces the risk of surgical site infections after orthopedic procedures. Povidone-iodine (PI)-based solutions have shown promising results in bacteria decolonization. The unique physiology of the nose may pose challenges for the bioactivity profiles of PI solutions. This study compared the antibacterial efficacy of an off-the-shelf PI product with a specifically manufactured PI-based skin and nasal antiseptic (SNA).. This randomized, placebo-controlled study was conducted at a single institution between April 2014 and July 2015. Four hundred and twenty-nine patients undergoing primary or revision total joint arthroplasty, femoroacetabular osteoplasty, pelvic osteotomy, or total shoulder arthroplasty were included. 10% off-the-shelf PI, 5% PI-based SNA, or saline (placebo) were used for nasal decolonization. Baseline cultures were taken immediately preoperatively, followed by treatment of both nares twice for 2 minutes with 4 applicators. Reculturing of the right nostril occurred at 4 hours and the left at 24 hours.. Ninety-five of the 429 patients (22.1%) had a positive culture result for S. aureus; 13 (3.03%) were methicillin-resistant S. aureus. Of these 95, 29 were treated with off-the-shelf PI, 34 with SNA, and 32 with saline swabs. At 4 hours post-treatment, S. aureus culture was positive in 52% off-the-shelf PI patients, 21% SNA patients, and 59% saline patients. After 24 hours posttreatment, S. aureus culture was positive in 72% off-the-shelf PI patients, 59% SNA patients, and 69% saline group. SNA was significantly more effective at decolonizing S. aureus over the 4-hour time interval (P = .003); no significant difference was observed over the 24-hour time interval between the 3 groups.. A single application of PI-based SNA before surgery may be effective in eliminating nasal S. aureus in over two-thirds of patients. Off-the-shelf PI swabs were not as effective at 4 hours as the specifically manufactured product for S. aureus decolonization.

Topics: Administration, Intranasal; Aged; Anti-Infective Agents, Local; Carrier State; Female; Humans; Male; Middle Aged; Nasal Mucosa; Orthopedic Procedures; Povidone-Iodine; Prospective Studies; Skin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Treatment of Staphylococcus aureus colonization before surgery reduces risk of surgical site infection (SSI). The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier. Nasal povidone-iodine solution may provide an alternative to mupirocin.. We conducted an investigator-initiated, open-label, randomized trial comparing SSI after arthroplasty or spine fusion in patients receiving topical chlorhexidine wipes in combination with either twice daily application of nasal mupirocin ointment during the 5 days before surgery or 2 applications of povidone-iodine solution into each nostril within 2 hours of surgical incision. The primary study end point was deep SSI within the 3 months after surgery.. In the modified intent-to-treat analysis, a deep SSI developed after 14 of 855 surgical procedures in the mupirocin group and 6 of 842 surgical procedures in the povidone-iodine group (P = .1); S. aureus deep SSI developed after 5 surgical procedures in the mupirocin group and 1 surgical procedure in the povidone-iodine group (P = .2). In the per protocol analysis, S. aureus deep SSI developed in 5 of 763 surgical procedures in the mupirocin group and 0 of 776 surgical procedures in the povidone-iodine group (P = .03).. Nasal povidone-iodine may be considered as an alternative to mupirocin in a multifaceted approach to reduce SSI.. ClinicalTrials.gov identifier: NCT01313182.

Topics: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Arthroplasty; Female; Humans; Intention to Treat Analysis; Male; Middle Aged; Mupirocin; Nose; Ointments; Povidone-Iodine; Spinal Fusion; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Young Adult

To report the incidence of endophthalmitis after intravitreal drug injection by means of a standardized procedure that does not require topical antibiotics, sterile gloves, or a sterile drape.. Intravitreal injections of preservative-free triamcinolone acetonide or ranibizumab were administered in 2 prospective randomized clinical trials performed by the Diabetic Retinopathy Clinical Research Network. The standardized procedure for these trials requires the use of a topical combination product of povidone-iodine, a sterile lid speculum, and topical anesthetic, but does not require the use of topical antibiotics before, on the day of, or after injection.. As of February 23, 2009, a total of 3226 intravitreal injections of ranibizumab and 612 injections of preservative-free triamcinolone had been administered. Topical antibiotics were given on the day of injection in 361 (9.4%) of the 3838 cases, for several days after injection in 813 cases (21.2%), on the day of injection and after injection in 1388 cases (36.2%), and neither on the day of injection nor after injection in 1276 cases (33.3%). Three cases of culture-positive endophthalmitis occurred after ranibizumab injections (0.09%), and no cases occurred after triamcinolone injections. In all 3 cases of endophthalmitis, topical antibiotics were given for several days after the injection but not before injection.. The results suggest that a low rate of endophthalmitis can be achieved by means of a protocol that includes use of topical povidone-iodine, a sterile lid speculum, and topical anesthetic, but does not require topical antibiotics, sterile gloves, or a sterile drape. Trial Registration clinicaltrials.gov Identifiers: NCT00444600 and NCT00445003.

Topics: Anesthetics, Local; Angiogenesis Inhibitors; Anti-Bacterial Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Disinfection; Endophthalmitis; Eye Infections, Bacterial; Glucocorticoids; Humans; Incidence; Injections; Laser Coagulation; Macular Degeneration; Methicillin-Resistant Staphylococcus aureus; Povidone-Iodine; Prospective Studies; Ranibizumab; Risk Factors; Staphylococcal Infections; Streptococcal Infections; Triamcinolone Acetonide; Vascular Endothelial Growth Factor A; Viridans Streptococci; Vitreous Body

The treatment of venous leg ulcers is often inadequate, because of incorrect diagnosis, overuse of systemic antibiotics and inadequate use of compression therapy. Stasis dermatitis related to chronic venous insufficiency accompanied by infected superficial ulcers must be differentiated from erysipelas, cellulitis and contact eczema.. To assess the effectiveness of (1) topical povidone-iodine with and (2) without compression bandages, (3) to compare the efficacy of systemic antibiotics and topical antimicrobial agents to prevent the progression of superficial skin ulcers.. 63 patients presenting ulcerated stasis dermatitis due to deep venous refluxes were included in the study. The clinical stage of all patients was homogeneous determined by clinical, aetiological, anatomical and pathological classification. They were examined by taking a bacteriological swab from their ulcer area. Compression bandages were used in a total of 42 patients. Twenty-one patients with superficial infected (Staphylococcus aureus) ulcers were treated locally with povidone-iodine (Betadine), and 21 patients were treated with systemic antibiotics (amoxicillin). Twenty-one patients were treated locally with Betadine but did not use compression. The end point was the time of ulcus healing. The healing process of the ulcers was related to the impact of bacterial colonization and clinical signs of infection.. Compression increases the ulcer healing rate compared with no compression. Using the same local povidone-iodine (Betadine) treatment with compression bandages is more effective (82%) for ulcus healing than without compression therapy (62%). The healing rate of ulcers treated with systemic antibiotics was not significantly better (85%) than that of the Betadine group. Using systemic antibiotics, the relapse rate of superficial bacterial infections (impetigo, folliculitis) was significantly higher (32%) than in patients with local disinfection (11%).. Compression is essential in the mobilization of the interstitial lymphatic fluid from the region of stasis dermatitis. Topical disinfection and appropriate wound dressings are important to prevent wound infection. Systemic antibiotics are necessary only in systemic infections (fever, lymphangitis, lymphadenopathy, erysipelas).

Topics: Aged; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bandages; Chronic Disease; Humans; Middle Aged; Povidone-Iodine; Prospective Studies; Quality Control; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Varicose Ulcer; Wound Healing; Wound Infection

To assess the incidence of anterior chamber bacterial contamination during cataract surgery, and compare results of injector implantation and forceps implantation of foldable intraocular lenses (IOLs).. Department of Ophthalmology and Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary.. This prospective randomized controlled clinical study comprised 97 eyes of 96 patients. Antibiotic eyedrops were not used; however, povidone-iodine 10% solution was used to prepare the eyebrow and eyelids and povidone-iodine 5% to disinfect the ocular surface. A Steri-Drape (3M) was used to surround the eye. Aqueous fluid samples were aspirated from the anterior chamber at the beginning and the end of surgery. The samples were cultured for 14 days under aerobic and anaerobic conditions simultaneously. Cataract surgery was performed using a sutureless, superotemporal, clear corneal phacoemulsification technique. The IOL was implanted with an injector (n = 47) or a forceps (n = 50), with the instrument randomly selected. The frequency of positive bacterial cultures with each implantation method was compared using the Fisher exact test.. Bacteria were found in the conjunctival samples in 21 eyes (21.65%) before povidone-iodine application and in 4 eyes (4.12%) after disinfection. The anterior chamber sample before surgery was culture positive for Staphylococcus epidermidis in 2 eyes and for Micrococcus luteus in 1 eye. After surgery, the culture was positive for S epidermidis in 1 eye (2.15%) in the injector group and 1 eye (2.00%) in the forceps group (P = .74). Neither sample came from an eye that had a positive culture preoperatively. There were no intraoperative complications.. In uneventful clear corneal phacoemulsification, meticulous technique can prevent antibiotic use during surgery. No difference in anterior chamber bacterial contamination was found between IOL implantation using an injector or a forceps.

Topics: Adult; Aged; Anterior Chamber; Anti-Infective Agents, Local; Conjunctiva; Eye Infections, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; Intraoperative Complications; Lens Implantation, Intraocular; Male; Micrococcus luteus; Middle Aged; Phacoemulsification; Povidone-Iodine; Prospective Studies; Staphylococcal Infections; Staphylococcus epidermidis

Prospective, single-blinded, randomized study.. To evaluate the efficacy of dilute betadine irrigation of spinal surgical wounds in prevention of postoperative wound infection.. Deep wound infection is a serious complication of spinal surgery that can jeopardize patient outcomes and increase costs. Povidoneiodine is a widely used antiseptic with bactericidal activity against a wide spectrum of pathogens, including methicillin-resistant Staphylococcus aureus. The aim of this study was to evaluate the efficacy of dilute betadine solution in the prevention of wound infection after spinal surgery.. Four hundred and fourteen patients undergoing spinal surgery were randomly assigned to two groups. In group 1 (208 patients), surgical wounds were irrigated with dilute betadine solution (3.5% betadine) before wound closure. Betadine irrigation was not used in group 2 (206 patients). Otherwise, perioperative management was the same for both groups.. Mean length of follow-up was 15.5 months in both groups (range, 6-24 months). No wound infection occurred in group 1. One superficial infection (0.5%) and six deep infections (2.9%) occurred in group 2. The differences between the deep infection rate (P = 0.0146) and total infection rate (P = 0.0072) were significant between the two groups.. Our report is the first prospective, single-blinded, randomized study to evaluate the clinical effectiveness of dilute betadine solution irrigation for prevention of wound infection following spinal surgery. We recommended this simple and inexpensive measure following spinal surgery, particularly in patients with accidental wound contamination, risk factors for wound infection, or undergoing surgery in the absence of routine ultraviolet light, laminar flow, and isolation suits.

Topics: Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Female; Follow-Up Studies; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Pharmaceutical Solutions; Postoperative Care; Povidone-Iodine; Prospective Studies; Proteus Infections; Single-Blind Method; Spinal Cord; Staphylococcal Infections; Surgical Wound Infection; Therapeutic Irrigation

Nosocomial pneumonia remains a common complication in patients undergoing endotracheal intubation. This study examined the transport of bacteria into the trachea during endotracheal intubation, and evaluated the effects of gargling with povidone-iodine on bacterial contamination of the tip of the intubation tube.. In the gargling group, patients gargled with 25 mL of povidone-iodine (2.5 mg.mL(-1)). In the control group, patients gargled with 25 mL of tap water. Before tracheal intubation, microorganisms were obtained from the posterior wall of the patient's pharynx using sterile cotton swabs. After anesthesia, all patients were extubated and bacteria contaminating the tip of the tracheal tube were sampled and cultured.. Before orotracheal intubation, all 19 patients who gargled with tap water (control group) had bacterial colonization on the posterior walls of the pharynx. This group included five patients who had methicillin-resistant staphylococcus aureus (MRSA) in their nasal cavity preoperatively and MRSA was also detected in the pharynx of four patients. Bacterial colonization was observed in all 19 patients who gargled with povidone-iodine (gargling group) and four patients carried MRSA in their nasal cavity, although no MRSA was detected in the pharynx. In the control group, all the patients had bacterial colonization at the tip of the tube after extubation. Additionally, MRSA was detected in two of the four patients. In the gargling group, povidone-iodine eradicated general bacteria and MRSA colonies in the pharynx before intubation and at the tip of the tube after extubation.. Gargling with povidone-iodine before oral intubation reduces the transport of bacteria into the trachea.

Topics: Anti-Infective Agents, Local; Bacteria; Colony Count, Microbial; Cross Infection; Equipment Contamination; Female; Humans; Intubation, Intratracheal; Male; Methicillin Resistance; Middle Aged; Mouthwashes; Nasal Cavity; Pharynx; Pneumonia; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Trachea

The objective of the present study was to compare the ability of chlorhexidine and povidone-iodine to cause cessation of lactation in Staphylococcus aureus-infected mammary quarters, assess milk production in the treated quarter in the subsequent lactation, and evaluate whether microbiological cure was obtained. Fourteen mid- to late-lactation Holstein-Friesian dairy cattle from the Washington State University dairy herd with single mammary quarter S. aureus intramammary infections were studied. Cows were randomly assigned to one of two treatment groups, povidone-iodine or chlorhexidine. Cows in the povidone-iodine group were infused with 120 ml of 5% povidone-iodine solution (0.5% iodine) after complete milk-out. Chlorhexidine-treated cows were infused with a proprietary chlorhexidine suspension after two milkings 24 h apart. Treated mammary quarters were not milked for the rest of the lactation. Milk production from each mammary quarter (kg of milk/quarter) was measured using in-line volume flow meters for 5 consecutive days before treatment and again at the start of the subsequent lactation. Povidoneiodine caused permanent cessation of lactation in the treated quarter, whereas 71% of the chlorhexidine-treated mammary quarters returned to function in the subsequent lactation. Hence, if the primary objective is to eliminate the mammary quarter from lactation, and thereby presumably lower the risk of herdmates acquiring new S. aureus intramammary infection, then povidone-iodine appears to be the best of the two methods. No difference in total milk production between lactation one and two in either group was found, suggesting that permanent loss of a quarter was not detrimental to overall milk production.

Topics: Animals; Anti-Infective Agents, Local; Cattle; Chlorhexidine; Female; Lactation; Mammary Glands, Animal; Mastitis, Bovine; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Exit site infection is a major risk factor for the development of peritonitis in continuous ambulatory peritoneal dialysis. The frequency of infection can be reduced by scrupulous exit site care with or without topical antiseptics. A randomized trial was performed of 149 catheters in 130 patients to assess any additional benefits conferred by the use of povidine iodine dry powder spray at dressing changes over an existing strict protocol of exit care. Exit infections occurred in 14 (18%) of 77 patients using spray and in 15 (21%) of 72 patients not using spray. The risk of peritonitis was also similar in each group. The proportion of infections caused by Staphylococcus aureus was reduced in the spray group, but those caused by Pseudomonas aeruginosa were increased. Rash occurred in 6% of those using the spray. The use of the spray did not therefore seem justified.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Local; Catheterization; Female; Humans; Infection Control; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Povidone-Iodine; Pseudomonas Infections; Staphylococcal Infections

A randomized prospective study was done to evaluate the two treatments for pressure sores infected with methicillin-resistant Staphylococcus aureus in elderly patients: Gentian violet plus dibutyryl cAMP (GVcAMP, n = 8) and povidone-iodine plus sugar (IS, n = 11). Age, underlying diseases, and nutritional status did not differ between the two groups. Specimens were obtained biweekly from the pressure sores and were cultured. The percentage of culture dishes with no methicillin-resistant S. aureus was 93% for the patients given GVcAMP, but only 74% for those given IS (p < 0.01). By the 14th week after the start of treatment, the mean area of the pressure sores in the GVcAMP group had decreased to 45% of the area at the start of treatment. In the IS group, the decrease was smaller to 56% of the area before treatment. No local or systemic adverse effects occurred in either group. GVcAMP is useful to treat pressure sores infected with methicillin-resistant S. aureus.

Topics: Aged; Aged, 80 and over; Bucladesine; Drug Combinations; Female; Gentian Violet; Humans; Methicillin Resistance; Ointments; Povidone-Iodine; Pressure Ulcer; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

In a first trial involving six commercial dairy herds and 291 cows for a period of eight months, pre-milking udder sanitation by dipping teats in a 0.25% polyvinylpyrrolidone (PVP) iodophor product followed by wiping with paper towels was compared in each herd with traditional teat washing and wiping with individual udder cloths. The incidence of new intramammary infections by Staphylococcus aureus, Streptococcus uberis and Corynebacterium bovis were significantly (P < 0.05) reduced, respectively by 48%, 60% and 47%. There were no significant differences in the two groups of cows for other intramammary infections, total bacterial counts, clostridia spore counts, iodine residues in milk or teat condition scores. In a second trial involving nine commercial dairy herds and 367 cows for a period of seven months, a teat dip containing nisin used before and after milking was compared in each herd with a classical 0.5% iodophor product used in the same way. There was no significant difference in the incidence of new intramammary infections, in spite of a higher rate of new Staphylococcus aureus infections in the group of cows teat-dipped with the nisin product (P = 0.06). It was concluded that pre-dipping with teat dips specifically designed to be safely used before milking can be more efficient than traditional pre-milking udder preparation. These teat dips, when used before and after milking, seem to be as efficient as products which should normally be restricted to post-milking use.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Cattle; Cattle Diseases; Corynebacterium Infections; Female; Incidence; Lactation; Mammary Glands, Animal; Milk; Nisin; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections

Topics: Humans; Povidone-Iodine; Staphylococcal Infections; Wound Healing; Wound Infection

Catheter related sepsis, especially with staphylococci, is one of the most important complications of haemodialysis or peritoneal dialysis. In a prospective, randomized, open study of 129 haemodialysis patients, exit site infection and bacteraemia were significantly greater in the untreated group (18.2% each) than the group treated with povidone-iodine (PVP-I) ointment (4.8% each), P < 0.02. In nasal carriers of S. aureus, PVP-I resulted in 100% risk reduction of bacteraemia and exit site infection (P < 0.05) and 70% risk reduction of catheter tip infections (P < 0.05). Preliminary results of an on-going randomized study in patients on intermittent peritoneal dialysis suggest, in the 69 patients so far studied, a reduced S. aureus infection rate in patients who received PVP-I ointment at the catheter exit site (2.9%) compared with the untreated group (8.8%) despite a higher nasal carriage rate in the PVP-I group. Statistical significance has not been demonstrated for these interim results and the study is continuing.

Topics: Bacteremia; Bacterial Infections; Catheters, Indwelling; Equipment Contamination; Humans; Peritoneal Dialysis; Povidone-Iodine; Prospective Studies; Renal Dialysis; Staphylococcal Infections

Subclavian catheter (SCC) related infections are a major cause of morbidity in hemodialysis patients, the vast majority due to staphylococci species. Povidone-iodine (PI) has proven anti-staphylococcal activity. Therefore, a randomized controlled trial of topical PI ointment was undertaken to evaluate the impact of this prophylactic intervention on the incidence of SCC related infections in hemodialysis patients. The role of S. aureus nasal carrier state in the acquisition of infection was also evaluated. Patients requiring SCC for temporary hemodialysis access were randomized to receive the treatment (T; N = 63) or sterile gauze dressings alone (C; N = 66). Catheter duration ranged from 2 to 210 days in both groups, with a mean of 38.6 days in T and 36.2 days in C (NS). Exit site (ES) infections were significantly less in T (5%) versus C (18%) (P less than 0.02); tip colonization (TC) was 17% in T versus 36% in C (P less than 0.01), while the incidence of septicemia (S) was also significantly less in T (2%) versus C (17%; P less than 0.01). S. aureus nasal carriers were at a threefold higher risk of SCC related septicemia (0.009/day) than noncarriers (0.003/day; P less than 0.05). The beneficial effect of PI ointment was most evident in this high risk group of S. aureus carriers: ES = 0% T versus 24% C, TC = 12% T versus 42% C, S = 0% T versus 29% C, P less than 0.05. There were no adverse effects of the treatment. The routine application of topical PI ointment to temporary hemodialysis catheter exit sites is effective in reducing SCC related infections.

Topics: Acute Kidney Injury; Administration, Topical; Catheterization, Central Venous; Humans; Kidney Failure, Chronic; Middle Aged; Povidone-Iodine; Renal Dialysis; Sepsis; Staphylococcal Infections; Subclavian Vein

A total of 127 patients from 8 hospitals were randomized into 1 of 2 exit-site care regimes to evaluate their effect on rate of exit-site infection (ESI). Group 1 used povidone iodine and nonocclusive dressings changed 2 to 3 times weekly; Group 2 simply cleansed the exit site with nondisinfectant soap and water. Incidence, cause, duration, and treatment of ESI and peritonitis (P) were noted. Groups were analysed for age, sex, end-stage renal disease (ESRD), catheter, and systems. Total cumulative follow up time was 95.6 years. There was a significantly higher rate (p = 0.0183) of ESI in Group 2 (soap and water). The mean rate of ESI was 0.27 episodes/patient year for Group 1 versus 0.71 episodes/patient year for Group 2. Rates of P for the two groups were not significantly different (p greater than 0.50): 0.446 episodes/year for Group 1 versus 0.574 episodes/year for Group 2. S. aureus was responsible for 83% of ESI in Group 1 and 67% of ESI in Group 2. Protective dressing with a disinfectant is associated with significantly less ESI than minimum care. However, further research in exit-site care aimed specifically at reducing S. aureus infection is still required.

Topics: Adult; Aged; Bacterial Infections; Bandages; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Povidone-Iodine; Soaps; Staphylococcal Infections

The prevalence of ischaemic or infective delayed wound healing in amputations for peripheral vascular disease may vary from 18 to 40%. A prospective trial to test the efficacy of 12 h pre-operative preparation with 10% povidone-iodine was performed in a 1-year period, during which time 80 consecutive amputations were performed on 73 patients. Accrual to the treatment arm was incomplete and was principally due to extreme nursing shortages. Failure of randomization resulted in the study being analysed as if it were retrospective. Infection occurred in 14 (23%) of unprepared limbs but was not found in any of the 19 prepared limbs (P less than 0.05). Infection occurred in 11 of 34 unprepared limbs which had distal ulcers or moist gangrenous lesions; however, 15 prepared limbs which had similar distal lesions had no infection (P less than 0.025). The reduction of wound breakdown and infection resulted in a significant reduction in hospitalization prior to commencement of prosthetic fitting (P less than 0.001). Pre-operative antiseptic preparation played an important role in the reduction of infection following amputation for peripheral vascular disease, particularly for those patients whose amputation was required because of contaminated peripheral ischaemic lesions. However, these preliminary results should be confirmed by further study.

Topics: Aged; Amputation Stumps; Clinical Trials as Topic; Humans; Ischemia; Leg; Povidone; Povidone-Iodine; Premedication; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Over a period of 6 months 250 patients were operated on for lumbar disc prolapse, 125 patients each receiving prophylactic antibiotic therapy or only local, intra-operative administration of povidone-iodine. The analysis of variance showed a significant difference between the patient group treated with the antiseptic and the prophylactic antibiotic group. More abscesses and signs of infection occurred in the antibiotic treated group. Animal studies are also described.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Drug Evaluation; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Postoperative Complications; Povidone; Povidone-Iodine; Prospective Studies; Random Allocation; Staphylococcal Infections; Staphylococcus aureus

We studied etiologic factors important in colonization of 179 central venous catheters (CVCs) in patients randomized into group 1 (who received daily topical applications of povidone-iodine) or group 2 (who received only dry dressing changes). Colonization rates of CVC tips were similar between group 1 (18/84 or 21%) and group 2 (22/95 or 23%). Peripheral blood cultures grew Candida in eight hyperalimented patients (evenly divided between groups 1 and 2), S epidermidis in four other patients (also evenly divided), and gram-negative bacteria in three patients. Colonization rates for CVCs in place for 0 to seven days was 15.6% (17/109) and 76.7% (23/30) if used from eight to 30 days. Inflammatory signs at CVC sites were often absent when CVCs became colonized or produced bacteremia. Unimportant determinants of CVC colonization included skin securement of CVCs, antibiotic infusions through CVC lines, and masking and gowning of physicians before CVC placement. Daily applications of povidone-iodine did not reduce colonization of CVCs as compared to dry dressing changes.

Topics: Administration, Topical; Antisepsis; Bacteria; Candida; Candidiasis; Catheterization; Catheters, Indwelling; Central Venous Pressure; Female; Humans; Male; Middle Aged; Parenteral Nutrition, Total; Povidone-Iodine; Premedication; Prospective Studies; Sepsis; Staphylococcal Infections; Staphylococcus epidermidis; Time Factors

Topics: Aerosols; Humans; Povidone; Povidone-Iodine; Staphylococcal Infections; Wound Infection

Topics: Aerosols; Anti-Bacterial Agents; Appendectomy; Clinical Trials as Topic; Drug Tolerance; Evaluation Studies as Topic; Follow-Up Studies; Humans; Postoperative Complications; Povidone; Povidone-Iodine; Staphylococcal Infections; Surgical Wound Infection

Academic hospital nurses were surveyed to assess adherence barriers to a universal povidone-iodine nasal decolonization protocol to prevent

Topics: Anti-Bacterial Agents; Carrier State; Humans; Inpatients; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Breast implant infection and biofilm formation are major concerns in reconstructive and esthetic breast surgery, with significant medical and economic consequences. Staphylococcus is the common pathogen, with rapidly increasing rates of methicillin-resistant Staphylococcus aureus (MRSA). There is no consensus on prevention practices. This study compares the effect of several pocket irrigation and antibiotic prophylaxis regimens on implant colonization and biofilm formation in an established rat model of MRSA-infected silicone breast implants.. Silicone discs were inserted in a sub-pectoral pocket in 57 rats (114 implants). Implant infection was induced by injection of free planktonic MRSA into the surgical pocket. Rats were allocated to study groups treated by different antimicrobial protocols: pocket irrigation with vancomycin, povidone-iodine, or saline. Each group was divided into subgroups treated with or without additional peri-operative systemic vancomycin. Implant colonization or overt infection was assessed at post-operative day 14 both clinically and by cultures.. Pocket irrigation with vancomycin prevented contamination in 87% of implants. Irrigation and systemic vancomycin prevented contamination in 100% of implants with no difference between a single preoperative dose and a 48-h regimen. Systemic vancomycin alone or irrigation with povidone-iodine alone resulted in 100% contamination rates.. In this in vivo model, combination of systemic vancomycin with vancomycin pocket irrigation was the most effective regimen, preventing contamination in 100% of implants. Continuation of post-operative antibiotic treatment showed no added advantage.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Breast Implants; Methicillin-Resistant Staphylococcus aureus; Povidone-Iodine; Rats; Silicones; Staphylococcal Infections; Vancomycin

Topics: Anti-Bacterial Agents; Antimicrobial Stewardship; Humans; Methicillin-Resistant Staphylococcus aureus; Nose; Povidone-Iodine; Staphylococcal Infections

Giant fornix syndrome (GFS) results in chronic, relapsing conjunctivitis in elderly patients with enophthalmos and enlarged fornices, in which infectious material collects and perpetuates inflammation. A 98-year-old woman presented with persistent, bilateral, purulent conjunctivitis; corneal epithelial defects and progressive blepharospasm that did not respond to artificial tears, topical antibiotics and steroids and amniotic membrane grafts. Additional findings of deep-set orbits with enlarged upper fornices were diagnostic of GFS. Over the next 2 months, she responded to a combination of topical and systemic antibiotics, autologous serum eye drops, povidone-iodine forniceal rinses, and hypochlorous acid treatment of the eyelashes. GFS is an important diagnostic consideration in elderly patients with chronic conjunctivitis and deep-set orbits.

Topics: Aged; Aged, 80 and over; Conjunctival Diseases; Conjunctivitis; Conjunctivitis, Bacterial; Female; Humans; Lubricant Eye Drops; Povidone-Iodine; Staphylococcal Infections

Staphylococcal biofilms are major causative factors of non-healing wound infections. Their treatment algorithms recommend the use of locally applied antiseptic agents to counteract the spread of infection. The efficacy of antiseptics against biofilm is assessed in vitro by a set of standard quantitative and semi-quantitative methods. The development of software for image processing additionally allowed for the obtainment of quantitative data from microscopic images of biofilm dyed with propidium iodine and SYTO-9 reagents, differentiating dead cells from live ones. In this work, the method of assessment of the impact of antiseptic agents on staphylococcal biofilm in vitro, based on biofilms' processed images, was proposed and scrutinized with regard to clinically relevant antiseptics, polyhexanide, povidone-iodine and hypochlorite. The standard quantitative culturing method was applied to validate the obtained data from processed images. The results indicated significantly higher activity of polyhexanide and povidone-iodine than hypochlorite against staphylococcal biofilm. Taking into account the fact that in vitro results of the efficacy of antiseptic agents against staphylococcal biofilm are frequently applied to back up their use in hospitals and ambulatory units, our work should be considered an important tool; providing reliable, quantitative data in this regard.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Biofilms; Humans; Hypochlorous Acid; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Reports are available on cross-resistance between antibiotics and biocides. We evaluated the effect of povidone-iodine (PVP-I) and propanol-based mecetronium ethyl sulphate (PBM) on resistance development, antibiotics cross-resistance, and virulence in Staphylococcus aureus.. The minimum inhibitory concentration (MIC) of PVP-I and PBM were determined against S. aureus ATCC 25923 using the agar-dilution method. Staphylococcus aureus ATCC 25923 was subjected to subinhibitory concentrations of the tested biocides in ten consecutive passages followed by five passages in a biocide-free medium; MIC was determined after each passage and after the fifth passage in the biocide-free medium. The developed resistant mutant was tested for cross-resistance to different antibiotics using Kirby-Bauer disk diffusion method. Antibiotic susceptibility profiles as well as biocides' MIC were determined for 97 clinical S. aureus isolates. Isolates were categorized into susceptible and resistant to the tested biocides based on MIC distribution pattern. The virulence of the biocide-resistant mutant and the effect of subinhibitory concentrations of biocides on virulence (biofilm formation, hemolysin activity, and expression of virulence-related genes) were tested.. PVP-I and PBM MIC were 5000 μg/mL and 664 μg/mL. No resistance developed to PVP-I but a 128-fold increase in PBM MIC was recorded, by repeated exposure. The developed PBM-resistant mutant acquired resistance to penicillin, cefoxitin, and ciprofloxacin. No clinical isolates were PVP-I-resistant while 48.5% were PBM-resistant. PBM-resistant isolates were more significantly detected among multidrug-resistant isolates. PVP-I subinhibitory concentrations (¼ and ½ of MIC) completely inhibited biofilm formation and significantly reduced hemolysin activity (7% and 0.28%, respectively). However, subinhibitory concentrations of PBM caused moderate reduction in biofilm activity and non-significant reduction in hemolysin activity. The ½ MIC of PVP-I significantly reduced the expression of hla, ebps, eno, fib, icaA, and icaD genes. The virulence of the biocide-resistant mutant was similar to that of parent strain.. PVP-I is a highly recommended antiseptic for use in healthcare settings to control the evolution of high-risk clones. Exposure to PVP-I causes no resistance-development risk in S. aureus, with virulence inhibition by subinhibitory concentrations. Also, special protocols need to be followed during PBM use in hospitals to avoid the selection of resistant strains.

Topics: 1-Propanol; Anti-Bacterial Agents; Disinfectants; Drug Resistance, Bacterial; Hemolysin Proteins; Humans; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Virulence

Surgical site infection (SSI) remains a major complication after adult spinal surgery. We investigated whether adding preoperative nasal decontamination by antiseptic swab (skin and nasal antiseptic povidone-iodine, SNA-PI) to our antimicrobial protocol reduces the SSI rate among our patients undergoing thoracolumbar spinal surgery.. We retrospectively reviewed all adult thoracolumbar spinal surgeries performed between June 2015 and May 2017 at a single hospital. Patients were divided into those who received nasal decontamination (SNA-PI+) and those who did not (SNA-PI-). SSI rates and responsible pathogens were compared between the cohorts.. A total of 1,555 surgeries with nasal decontamination (SNA-PI+) and 1,423 surgeries without (SNA-PI-) were included. The SSI rate in the SNA-PI+ group was 13 of 1,555 (0.8%) versus 10 of 1,423 (0.7%) for SNA-PI- group (P = 0.68). The infection rate was the highest among posterior instrumented fusions in the SNA-PI+ group (1.4%). Methicillin-sensitive Staphylococcus aureus was responsible for 70% of infections in the SNA-PI- group and 38% in the SNA-PI+ group (P = 0.13).. Routine nasal antiseptic swab before spine surgery did not affect the overall rate of SSI in thoracolumbar spinal surgeries. The incidence of methicillin-sensitive S aureus was lower in patients who received nasal decontamination (5/1,555, 0.3%) compared with those who did not (7/1,423, 0.5%); however, this result was not statistically significant (P = 0.57).

Topics: Adult; Anti-Infective Agents, Local; Humans; Povidone-Iodine; Retrospective Studies; Staphylococcal Infections; Surgical Wound Infection

Povidone-iodine (PVP-I) is well known as an antiseptic and exhibits extensive activity against various pathogens. However, due to its uniquely unpleasant nature, it cannot be used locally to deactivate various sinonasal pathogens. Therefore, we developed a PVP-I composite that blocks the unpleasant odor of PVP-I for use as a local antiseptic in the sinonasal cavity and evaluated its effect on bacterial biofilm's formation and elimination in in vivo and in vitro models.. MTT, lactate dehydrogenase, and live/dead staining assay were performed to examine the cellular toxicity of PVP-I composites on the primary human nasal epithelial and RPMI 2650 cells. Crystal violet assay was performed to quantify bacterial biofilm after treating with various agents, including PVP-I and antibiotics. Hematoxylin-and-eosin staining, live/dead staining assay, and scanning electron microscopy were conducted to evaluate the effect of PVP-I on biofilm formation in a mice biofilm model.. It was observed that the PVP-I composite did not have any significant toxic effect on the nasal epithelial cells. Furthermore, the PVP-I composite effectively inhibited the formation of bacterial biomass within a dose-dependent manner after 48 hours of incubation with Pseudomonas aeruginosa and Staphylococcus aureus. In mice, it effectively eliminated biofilm from the mucosa of the nasal cavity and maxillary sinus at the tested concentrations.. The results of this study indicate that the PVP-I composite is a promising compound that could be used locally to prevent the formation of biofilms and to eliminate them from the sinonasal cavity.

Topics: Animals; Anti-Infective Agents, Local; Biofilms; Mice; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

The usefulness of povidone-iodine as an alternative to antimicrobial agents, for endophthalmitis, has recently been documented. We report a case of endogenous endophthalmitis successfully treated with intravitreal injection of povidone-iodine.. An 88-year-old woman underwent small bowel bypass surgery for postoperative ileus following rectal cancer resection. She developed a fever during total parenteral nutrition and was diagnosed with gram-positive cocci bacteremia of central venous catheter origin. The patient was referred to our department with chief complaints of ocular pain, hyperemia and decreased vision in the right eye, which had manifested during the febrile period. The initial examination revealed the visual acuity in her right eye to be finger counting and that in her left eye 0.2. The right eye showed a severe inflammatory reaction in the anterior chamber, fibrin deposition, and hypopyon. The fundus was difficult to visualize. Endogenous endophthalmitis due to bacteria was diagnosed. Surgical treatment was judged to be difficult based on the patient's poor general condition and mental status, and intravitreal injection of 0.1 ml of 1.25% povidone-iodine was performed on the same day. The inflammation rapidly diminished, and the hypopyon had disappeared 4 days after treatment. The fundus became visible 7 days after treatment and there was no recurrence of endophthalmitis findings. The visual acuity in her right eye recovered to that in the left eye (0.2).. Intravitreal injection of povidone-iodine is potentially useful and effective as an alternative treatment of antibiotics for endogenous endophthalmitis patients, especially in whom surgical therapy is difficult.

Topics: Aged, 80 and over; Anti-Infective Agents, Local; Bacteremia; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Visual Acuity

The objective was to describe French hospital nasal screening and decolonization procedures before clean surgery procedures. Information for participants was sent to the French Society for Infection Control members in June 2018. Seventy hospitals participated in the survey; 40% (N = 28) declared having institutional decolonization procedures: 64% (N = 18) in orthopaedic and 56% (N = 15) in cardiac surgeries. All hospitals used mupirocin for nasal decolonization and body decolonization with chlorhexidine (N = 16) or povidone iodine (N = 10). This study is the first to be performed in France giving information in this field. Screening/decolonization procedures are heterogeneous and the evaluation of their clinical impact remains complex.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Decontamination; France; Humans; Infection Control; Mupirocin; Nose; Orthopedic Procedures; Povidone-Iodine; Qualitative Research; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Surveys and Questionnaires; Thoracic Surgical Procedures

Capsular contracture (CC) has remained an unresolved issue throughout history. Strong evidence focuses on bacterial biofilm as its main source. A literature review revealed that more than 90% of bacteria found in capsules and implants removed from patients with Baker grade III-IV CC belong to the resident skin microbiome (Staphylococcus epidermidis, predominant microorganism). The use of an adequate preoperative skin antiseptic may be a critical step to minimize implant contamination and help prevent biofilm-related CC.. The authors sought to compare the effect of 2 different antiseptic skin preparations: povidone-iodine (PVP-I) vs chlorhexidine gluconate (CHG) on CC proportions after primary breast augmentation through a periareolar approach.. In June of 2014, The Society for Healthcare Epidemiology of America proposed to use CHG for preoperative skin preparation in the absence of alcohol-containing antiseptic agents as strategy to prevent surgical site infection. The clinical safety committee of a surgical center in Colombia decided to change PVP-I to CHG for surgical site preparation thereafter. The medical records of 63 patients who underwent to primary breast augmentation through a periareolar approach during 2014 were reviewed. In the first 6 months PVP-I was used in 32 patients, and later CHG was employed in 31 patients.. Pearson's chi-squared test to compare CC proportions between subgroups showed a statistically significant difference. The CC proportion was higher for patients who had antisepsis with PVP-I. CC was absent when CHG was employed.. CHG as preoperative skin antiseptic for primary breast augmentation surgery was more effective than PVP-I to help prevent biofilm-related CC.

Topics: Administration, Cutaneous; Adolescent; Adult; Anti-Infective Agents, Local; Biofilms; Breast Implantation; Chlorhexidine; Female; Follow-Up Studies; Humans; Implant Capsular Contracture; Microbiota; Middle Aged; Povidone-Iodine; Preoperative Care; Skin; Staphylococcal Infections; Staphylococcus epidermidis; Young Adult

To identify and analyze cases of postoperative infection following strabismus surgery at a large referral center and to report the incidence, risk factors, and outcomes.. An electronic database search identified strabismus procedures at Duke Eye Center from July 1996 to October 2017. Diagnosis codes for periocular infections were used to further identify patients with possible infections following strabismus surgery.. Of 9,111 strabismus surgeries, 13 (0.14%) met criteria for probable infection, all occurring since October 2012 (0/6580 before vs 13/2531 [0.51%] after; P < 0.0001). Mean age of infection cases was 11.4 years; 11 patients (85%) were under 18 years of age. Associated previous diagnoses were genetic abnormalities with associated developmental delay (n = 5 [38%]), previous skin or ear infection (n = 4 [31%]), and acute or chronic rhinitis (n = 3 [23%]). Infection site cultures revealed methicillin-resistant Staphylococcus aureus (n = 3 [23%]), methicillin-sensitive S. aureus (n = 3 [23%]), and Streptococcus pyogenes/group-A Streptococcus (n = 2 [15%]). Only 1 case had bilateral infection. Infection remained extraocular in all cases, but one eye lost light perception secondary to optic atrophy. No common surgeon/procedure/preparation-related risks were identified.. A unifying explanation for the increase in post-strabismus surgery infections at Duke Eye Center was not identified. Potential risk factors include age <18 years, developmental delay, immune compromise, preceding nonocular infection, and bacterial colonization.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Child; Child, Preschool; Female; Humans; Injections, Intraocular; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Oculomotor Muscles; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Povidone-Iodine; Preoperative Care; Prospective Studies; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Strabismus; Streptococcal Infections; Streptococcus pyogenes; Surgical Wound Infection; Treatment Outcome; Young Adult

To develop a new in vitro model of prosthetic vascular graft infection (PVGI) and evaluate antimicrobial and biofilm-disrupting efficacy of 0.1% octenidine dihydrochloride, 10% povidone-iodine and 0.02% chlorhexidine digluconate against biofilm-producing Staphylococcus aureus (S. aureus).. The effect of antiseptics on the microscopic integrity and antimicrobial effect on S. aureus biofilms was tested by growing biofilms on glass coverslips, in the modified Lubbock chronic wound pathogenic biofilm (LCWPB) model and on the surface of vascular grafts using qualitive and quantitative methods as well as by scanning electron microscopy (SEM).. We implemented an innovative in vitro model on S. aureus biofilms grown in different settings, including a clinically challenging situation of PVGI. The strongest antimicrobial activity against S. aureus biofilms, grown on prosthetic vascular grafts, was showed by 0.1% octenidine dihydrochloride. We suggest that combinational therapy of antiseptics between chlorhexidine with either povidone-iodine or octenidine dihydrochloride should be tested in further experiments. Despite the need of further studies, our findings of these in vitro experiments will assist the management of vascular graft infection in clinical cases.

Topics: Anti-Infective Agents, Local; Biofilms; Chlorhexidine; Humans; Imines; Povidone-Iodine; Prostheses and Implants; Prosthesis-Related Infections; Pyridines; Staphylococcal Infections; Staphylococcus aureus

Topics: Analysis of Variance; Animals; Anti-Infective Agents, Local; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Body Weight; Chlorhexidine; Female; Imines; Male; Models, Animal; Povidone-Iodine; Pyridines; Rats; Rats, Wistar; Staphylococcal Infections; Staphylococcus aureus; Statistics, Nonparametric; Surgical Wound; Vascular Grafting

Recent publications have raised concerns of reduced susceptibilities of clinical bacterial isolates towards biocides. This study presents a comparative investigation of the susceptibility of livestock-associated Methicillin-resistant. In total, 28 (18 LA-, 5 HA- and 5 CA) genetically characterized MRSA strains representing a broad spectrum of hosts, clonal complexes and spa-types, as well as the reference methicillin-sensitive. Results from the MIC/MBC and quantitative suspension tests revealed differences between antiseptic substances but not between epidemiological groups of MRSA strains. OCT and PHMB were the most active substances with a minimal MIC of 1 mg/L, followed by CHX (2 mg/L), TCX (32 mg/L) and finally PVP-I (1024 mg/L). The MSSA reference strain showed a tendency to a higher susceptibility compared to the MRSA strains.. This investigation of the susceptibility of a range of LA-, HA- and CA-MRSA strains using standardized conditions gave no indication that LA-MRSA strains are less susceptible to commonly used antiseptics compared to HA- and CA-MRSA strains.

Topics: Animals; Anti-Infective Agents, Local; Biguanides; Chlorhexidine; Community-Acquired Infections; Cross Infection; Humans; Imines; Livestock; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Microbial Viability; Povidone-Iodine; Pyridines; Staphylococcal Infections; Triclosan

Capsular contracture induced by chronic subclinical infection is a major cause of poor outcomes and reoperation in breast implant surgery. The use of pocket irrigation with antiseptic/antibiotic has been shown to reduce the incidence of contracture. A new formulation of hypochlorous acid solution PhaseOne has been proposed as potential agent for irrigation.. This study aimed to test the efficacy of hypochlorous acid solution PhaseOne for use in breast pocket irrigation as an alternative to povidone iodine solution Betadine.. The efficacy of PhaseOne, a hypochlorous acid formulated wound and skin cleanser, was tested in vitro against planktonic and biofilm Staphylococcus aureus with or without biological soil and in an implant attachment assay. Its activity was compared with Betadine containing 10% povidone iodine.. Our findings showed that PhaseOne was unable to eradicate planktonic and/or biofilm S. aureus in the presence of either tryptone soy broth or bovine calf serum (protein soil) in a variety of in vitro assays.. We advise that povidone iodine containing irrigants are superior to hypochlorous acid containing irrigants in the clinical setting and should remain the recommended solution for pocket irrigation to reduce bacterial contamination at breast implants surgery.

Topics: Anti-Infective Agents, Local; Biofilms; Breast Implantation; Breast Implants; Hypochlorous Acid; Implant Capsular Contracture; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Therapeutic Irrigation

Medical implants and surgical site infections (SSIs) can be a burden on both patients and healthcare systems with a significant rise in morbidity, mortality and costs. Preoperatively, our practice of a chlorohexidine gluconate (CHG) washcloth bath or solution shower was supplemented with nasal painting using povidone-iodine skin and nasal antiseptic (PI-SNA). We sought to measure the effectiveness in reducing SSIs in patients undergoing repair of lower extremity fractures.. A retrospective review of trauma patients undergoing orthopedic operations conducted at Conemaugh Memorial Medical Center from 10/1/2012 through 9/30/2016. The intervention period was 10/1/2014 to 9/30/2016 which included the addition of nasal painting with PI-SNA preoperatively. All patients were followed for 1 year prior to January 2013 and 30 or 90 days thereafter for the development of a SSI.. The pre-intervention group consisted of 930 cases with a 1.1% infection rate (10 SSIs). The intervention group consisted of 962 cases with a 0.2% infection rate (2 SSIs). This observed difference was statistically significant (P = 0.020).. This retrospective review of a methicillin-resistant Staphylococcus aureus decolonization protocol using CHG bath/shower and PI-SNA nasal painting revealed a significant decrease in the infection rate of patients undergoing lower extremity fracture repairs. We recommend its use without contraindications, but recognize that additional investigations are necessary.

Topics: Administration, Intranasal; Adult; Aged; Anti-Infective Agents, Local; Baths; Carrier State; Chlorhexidine; Female; Humans; Leg Injuries; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Povidone-Iodine; Retrospective Studies; Staphylococcal Infections; Surgical Wound Infection

With increasing rates of virulent drug resistant organisms, MRSA (methicillin-resistant Staphylococcus aureus) decolonization has been demonstrated to decrease infection rates. Recent research has shown the antiseptic povidone-iodine to be equally effective and potentially cost saving compared to intranasal mupirocin. This study's purpose is to evaluate the incidence of MRSA colonization in a more rural community-based population, rates of infection on a mupirocin decolonization protocol, and develop a cost analysis model to compare costs of utilizing povidone-iodine.. Utilizing over 4 years of data, the incidence of MRSA decolonization of consecutive total knee and hip arthroplasties, as well as the rates of infection of patients uncolonized, colonized with successful decolonization, and unsuccessful decolonization were evaluated. Utilizing these data, cost data, and known infection rate utilizing povidone-iodine decolonization, a cost analysis model was developed.. Of the 5584 cases with MRSA data at a single institution, only 3.5% tested positive for intranasal MRSA. Of those patients, 69% were successfully decolonized. Of the 3864 cases with infection data, 21 sustained a surgical site infection within 90 days (0.54%). Of these patients, all tested negative for intranasal MRSA initially and therefore did not undergo the decolonization protocol. The cost analysis predicts a potential savings of $74.72 per patient at our institution to use a global intranasal povidone-iodine protocol prior to total joint arthroplasty.. Even with a lower incidence of MRSA than typically reported, utilization of intranasal povidone-iodine would potentially save $74.42 per patient.

Topics: Administration, Intranasal; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Arthroplasty, Replacement; Chlorhexidine; Cost-Benefit Analysis; Humans; Incidence; Methicillin; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Povidone-Iodine; Retrospective Studies; Staphylococcal Infections; Surgical Wound Infection

A retrospective study, using prospectively collected data.. The aim of this study was to evaluate the impact of evidence-based care bundles for preventing surgical site infections (SSIs) in spinal instrumentation surgery.. About half of all SSIs are preventable via evidence-based methods. For successful SSI prevention, the bacterial load must be minimized, and methicillin-resistant Staphylococcus aureus (MRSA) protection must be maximized. However, it is difficult to cover all of these requirements by single preventative method.. We screened consecutive patients scheduled for spinal instrumentation surgeries at a single tertiary referral hospital for high surgical, SSI, and MRSA colonization risks. Evidence-based care bundles were implemented for high-risk patients and included 1) additional vancomycin prophylaxis, 2) diluted povidone-iodine irrigation, and 3) nasal and body decontamination. Patient demographics, comorbidities, operative features, and SSIs reported to the Japanese Nosocomial Infections Surveillance system were prospectively obtained in the same method by the same assessor and were used for the analyses. The results were compared before and after the application of the bundle.. There were 1042 spinal instrumentation surgeries (741 before and 301 after care bundles) performed from November 2010 to December 2015. Of 301 surgeries, 57 cases (18.9%) received care bundles. There were no significant differences in patient backgrounds before and after the intervention. The SSI rate decreased significantly from 3.8% to 0.7% (P < 0.01) after the intervention, with an overall 82% relative risk reduction. A significant protective effect was observed in the multivariate analysis (adjusted odds ratio 0.18, 95% confidence interval: 0.04-0.77, P = 0.02). There were no MRSA-related SSIs among those that received care bundles, even though MRSA was the predominant pathogen in the study population.. Evidence-based care bundles, applied in selected high-risk spinal instrumentation cases, minimized bacterial load, maximized MRSA protection, and significantly reduced SSI rates without topical vancomycin powder.. 4.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cross Infection; Evidence-Based Medicine; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Orthopedic Procedures; Patient Care Bundles; Povidone-Iodine; Retrospective Studies; Spinal Diseases; Staphylococcal Infections; Surgical Wound Infection; Vancomycin

To compare the bacterial cultures of the lower eyelid margins and lower fornices between ocular irrigations with and without eyelid margin cleaning before intraocular surgery.. A prospective study was carried out that included 102 eyes from 51 patients undergoing intraocular surgery between December 2016 and April 2017. In each patient, the surgical eye (control group) only received ocular irrigation and the opposite eye (study group) received ocular irrigation with eyelid margin cleaning. Normal saline solution was used in all procedures. In each group, samples from the lower eyelid margins and lower fornices were cultured before and after cleaning. Povidone iodine and antibiotic eye drops were instilled after specimen collection.. The most common bacterial isolate of all groups was Staphylococcus spp. There were no statistically significant differences of positive cultures between the control and study groups in either lower eyelid margins (Odds ratio [OR], 2.19; 95% CI, 0.84-5.72) nor lower fornices (OR, 0.93; 95% CI, 0.43-2.00). In addition, there were no statistically significant differences of positive cultures between before and after eyelid cleanings from both lower eyelid margins (OR, 2.74; 95% CI, 0.53-14.24) and lower fornices (OR, 0.73; 95% CI, 0.21-2.57).. Eyelid margin cleaning with normal saline solution immediately before intraocular surgery did not help to decrease microbial loading on the ocular surfaces. The rate of bacterial contamination, however, was not increased which could be due to not performing eyelid compression.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Colony Count, Microbial; Conjunctiva; Drug Therapy, Combination; Eye Infections, Bacterial; Eyelids; Humans; Instillation, Drug; Middle Aged; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Povidone-Iodine; Preoperative Care; Prospective Studies; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection; Young Adult

Giant fornix syndrome (GFS) was first described as a cause for a relapsing mucopurulent conjunctivitis. Predominantly elderly patients have enlarged superior fornices from superior aponeurosis dehiscence that permits the accumulation of protein coagulum that is colonised by bacteria. Established treatment includes the use of intensive topical antibiotic and corticosteroid. We describe a case of a 98-year-old woman with GFS who did not respond to several weeks of intensive (two hourly) treatment with topical prednisolone 1% drops and chloramphenicol. Subsequent additional regular sweeping of the fornices with cotton buds and topical medication did not improve her symptoms but which resolved with manual coagulum debridement and application of 10% povidone-iodine. This treatment offers an effective treatment option of GFS cases, which do not respond to intensive topical corticosteroids and chloramphenicol.

Topics: Aged, 80 and over; Anti-Infective Agents, Local; Conjunctivitis, Bacterial; Debridement; Diagnosis, Differential; Drug Administration Schedule; Female; Humans; Methicillin-Resistant Staphylococcus aureus; Ophthalmic Solutions; Povidone-Iodine; Staphylococcal Infections

The influence of proteins on the efficacy of antiseptic solutions has been rarely investigated even though exudate can contain high levels of protien. The aim of this study was to analyse the antibacterial efficacy of commonly used solutions in the presence of albumin protein.. Using Staphylococcus aureus in a standardised quantitative suspension assay, the antibacterial effects of poly (1-(2-oxo-1-pyrrolidinyl) ethylene)-iodine (PVP-I) and octenidin-dihydrochloride/phenoxyethanol (OCT/PE) were analysed in the presence of 0-3% bovine serum albumin (BSA). These were compared with previous results obtained with polyhexamethylene biguanide hydrochloride (PHMB).. Presence of albumin caused a significant (p<0.001) decrease in antibacterial effect in the analysed solutions. The concentrations of albumin that provoked highly significant decreases in the bacterial reduction factors of the study agents were: 0.01875 % for PVP-I, followed by 0.75 % for OCT/PE. After addition of 3 % albumin, adequate antimicrobial effects were ensured for titrations to 5 % PVP-I and 8 % OCT/PE. As we could show before, it is not possible to titrate PHMB in order to assure adequate potency.. This study demonstrates that albumin induces a significant decrease of the antibacterial potency of the analysed solutions.

Topics: Anti-Infective Agents, Local; Biguanides; Ethylene Glycols; Exudates and Transudates; Humans; Imines; Microbial Sensitivity Tests; Povidone-Iodine; Pyridines; Serum Albumin, Bovine; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Staphylococcus aureus colonization in the nares of patients undergoing elective orthopedic surgery increases the potential risk of surgical site infections. Methicillin-resistant S. aureus (MRSA) has gained recognition as a pathogen that is no longer only just a hospital-acquired pathogen. Patients positive for MRSA are associated with higher rates of morbidity and mortality following infection. MRSA is commonly found in the nares, and methicillin-sensitive S. aureus (MSSA) is even more prevalent. Recently, studies have determined that screening for this pathogen prior to surgery and diminishing staphylococcal infections at the surgical site will dramatically reduce surgical site infections. A nasal mupirocin treatment is shown to significantly reduce the colonization of the pathogen. However, this treatment is expensive and is currently not available in China. Thus, in this study, we first sought to determine the prevalence of MSSA/MSRA in patients undergoing elective orthopedic surgery in northern China, and then, we treated the positive patients with a nasal povidone-iodine swab. Here, we demonstrate a successful reduction in the colonization of S. aureus. We propose that this treatment could serve as a cost-effective means of eradicating this pathogen in patients undergoing elective orthopedic surgery, which might reduce the rate of surgical site infections.

Topics: Administration, Intranasal; Adult; Anti-Infective Agents, Local; Antibiotic Prophylaxis; China; Cross-Sectional Studies; Elective Surgical Procedures; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nasal Cavity; Orthopedic Procedures; Postoperative Complications; Povidone-Iodine; Prospective Studies; Reproducibility of Results; Staphylococcal Infections; Treatment Outcome

To verify that ocular surface irrigation with 0.025% povidone-iodine (PI) or 0.0025% polyvinyl alcohol-iodine (PAI) during cataract surgery minimizes bacterial contamination of the anterior chamber.. The study was a prospective, interventional case series. First, the bactericidal effect of PI or PAI against Staphylococcus aureus was evaluated in vitro. Next, in 400 eyes undergoing cataract surgery, the ocular surface was irrigated every 20 seconds during surgery with balanced salt solution (BSS; 200 eyes) or BSS containing 0.025% PI (100 eyes) or 0.0025% PAI (100 eyes). At the completion of surgery, anterior chamber fluid was cultured bacteriologically. Visual acuity (VA) and corneal endothelial cell density were measured before and 7 days after surgery.. A marked bactericidal effect was observed when S. aureus was directly exposed for 15 seconds to 0.01% PI or 0.001% PAI diluted in BSS. When the two solutions were stored at room temperature, bactericidal effect did not attenuate after 60 min. The bacterial detection rate at the completion of surgery was significantly reduced in 0.025% PI (0%, 0/100 eyes) or 0.0025% PAI group (0%, 0/100 eyes) compared to BSS group (5%, 10/200 eyes) (p = 0.0340). No differences in postoperative visual acuity and postoperative corneal endothelial cell density were observed between three groups.. In cataract surgery, irrigation every 20 seconds of the operative field with 0.025% PI or 0.0025% PAI, both of which contain 0.0025% available iodine concentration, achieved a very low bacterial contamination rate in the anterior chamber.

Topics: Aged; Aged, 80 and over; Anterior Chamber; Anti-Infective Agents, Local; Cataract Extraction; Eye Infections, Bacterial; Female; Follow-Up Studies; Humans; Intraoperative Period; Male; Middle Aged; Ophthalmic Solutions; Povidone-Iodine; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Therapeutic Irrigation; Treatment Outcome

The purpose of this study was to compare nasal povidone-iodine swab for total joint arthroplasty patients to methicillin-resistant Staphylococcus aureus (MRSA) screening on the incidence of 90-day postoperative surgical site infections in total knee and hip arthroplasties as well as the cost-effectiveness. This is a single-center retrospective review of primary or revision total knee or hip arthroplasty patients. There were 849 patients screened for MRSA and 1004 patients in the nasal swab groups, both with an infection rate of 0.8%. The mean cost for the nasal swab was $27.21 (SD, 0), significantly different (P ≤ .01) than the mean cost for MRSA screens, $121.16 (SD, 26.18). There were significant cost savings with no difference in infection rates; therefore, nasal povidone-iodine swab antiseptic is financially and clinically successful.

Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chlorhexidine; Cohort Studies; Communicable Disease Control; Cost-Benefit Analysis; Health Care Costs; Humans; Incidence; Methicillin-Resistant Staphylococcus aureus; Nasal Mucosa; Povidone-Iodine; Reoperation; Retrospective Studies; Staphylococcal Infections; Surgical Wound Infection

Expanded polytetrafluoroethylene (e-PTFE) is a popular graft material for augmentation rhinoplasty. Gore-Tex and Surgiform are two types of e-PTFE; Surgiform has thicker fibrils and is more compact than Gore-Tex. We conducted an ex vivo study to evaluate the ability of povidone-iodine (PVP-I) vacuum pretreatment to prevent infection with these two types of e-PTFE. Gore-Tex and Surgiform specimens were cut into 2-mm(3) pieces, which were separated into two groups. One group for each e-PTFE was disinfected with vacuum PVP-I impregnation and the other group was not disinfected. Using the pieces of implant material, swabs were obtained from the nasal cavities of 20 healthy adults, and the specimens were incubated on agar plates and viewed by scanning electron microscopy (SEM). We found that PVP-I treatment significantly reduced the bacterial colony counts in both the Gore-Tex and Surgiform groups. In the SEM images, bacterial colonies were observed both inside and outside the untreated Gore-Tex; on the untreated Surgiform, they were found primarily on the surface. Few bacteria were detected in the PVP-I-treated Gore-Tex and Surgiform groups. Our findings suggest that PVP-I pretreatment can reduce the risk of infection associated with e-PTFE.

Topics: Anti-Infective Agents, Local; Colony Count, Microbial; Humans; In Vitro Techniques; Microscopy, Electron, Scanning; Nasal Mucosa; Polytetrafluoroethylene; Povidone-Iodine; Prostheses and Implants; Prosthesis-Related Infections; Rhinoplasty; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Vacuum

To present cases of endophthalmitis following intravitreal injections where povidone-iodine (PI) was not used as part of the surgical preparation.. Retrospective case series.. All cases of presumed injection-related endophthalmitis presenting to the Massachusetts Eye and Ear Infirmary between June 2008 and November 2014 and Dean McGee Eye Institute between January 2010 and January 2015 were identified. Patients who did not receive PI preparation owing to documented self-reported allergy to iodine, iodine-containing contrast material, or shellfish were identified and their injection histories and clinical courses reviewed.. The combined rate of postinjection endophthalmitis at these 2 centers was 0.019%. Among 42 patients with postinjection endophthalmitis, 5 (11.9%) did not receive PI prophylaxis. The mean number of intravitreal injections without PI before the development of endophthalmitis was 10.6 with a 9.4% rate of endophthalmitis (5 cases per 53 injections). All patients underwent tap-and-inject procedures with vancomycin 1 mg and ceftazidime 2 mg. Two patients did not receive PI at the time of tap and inject; 1 of these patients required subsequent pars plana vitrectomy for worsening clinical course. Cultures were positive in 4 of 5 cases; all positive cultures grew coagulase-negative Staphylococcus. All patients who received subsequent intravitreal injections received PI prophylaxis without allergic reactions, thus demonstrating a lack of true PI allergy.. Avoiding PI owing to self-reported iodine "allergy" risks substantial ocular morbidity. Allergy testing can be pursued per patient request or in rare cases of suspected true PI allergy; however, in cases where delayed treatment would adversely affect visual outcome, the clinician should feel confident that minimal allergic risk exists.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Bacterial Agents; Drug Hypersensitivity; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Middle Aged; Povidone-Iodine; Retrospective Studies; Self Report; Staphylococcal Infections; Staphylococcus; Vascular Endothelial Growth Factor A

Treatment of acute postoperative arthroplasty infection with polyethylene exchange and retention of components has a limited success rate, potentially because of residual bacterial burden. We hypothesized that dilute Betadine (povidone-iodine) lavage would decrease bacterial burden in a rabbit knee infection model. We inserted a stainless steel screw with a polyethylene washer into the lateral femoral condyle in 16 bilateral rabbit knees, and the sites were infected with Staphylococcus aureus. After 1 week, all knees were treated with a polyethylene washer exchange and either a saline lavage or a 3.5% Betadine lavage. We assessed bacterial growth after 7 days. Betadine-treated knees showed a statistically significant decrease in the bacterial count on the stainless steel screw and polyethylene washer but no difference in soft-tissue growth. Betadine lavage as a treatment adjunct may improve component retention for acute arthroplasty infection.

Topics: Animals; Anti-Infective Agents, Local; Device Removal; Disease Models, Animal; Povidone-Iodine; Prostheses and Implants; Prosthesis-Related Infections; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Therapeutic Irrigation

To investigate the bactericidal effect of 0.025% povidone-iodine in Balanced Salt Solution PLUS (0.025% PI-BSS PLUS) and its use in vitrectomy for postoperative endophthalmitis.. First, an experimental laboratory model using Staphylococcus aureus was used to evaluate the bactericidal effect of PI-BSS PLUS. Next, in a case series of 4 eyes with postoperative endophthalmitis, vitrectomy using 0.025% PI-BSS PLUS as irrigation solution was conducted, followed by postoperative intravitreal and intravenous antibiotics.. In in vitro study, PI at concentrations of 0.01% and above in BSS PLUS exhibited marked bactericidal effect after 15 seconds of exposure. Bactericidal effect of 0.025% PI-BSS PLUS was maintained at room temperature storage for 15 minutes but was attenuated after 30 minutes. Among 4 eyes that underwent vitrectomy using 0.025% PI-BSS PLUS, coagulase-negative Staphylococcus sp. was isolated in 1 eye at the beginning but not at completion of surgery. In all four eyes, endophthalmitis was resolved with no adverse events. Ocular toxicity was not observed.. The 0.025% PI-BSS PLUS is bactericidal and nontoxic when used as irrigation solution in vitrectomy. In 4 cases of postoperative endophthalmitis, vitrectomy using 0.025% PI-BSS PLUS followed by postoperative antibiotics resolved endophthalmitis.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Bicarbonates; Colony Count, Microbial; Combined Modality Therapy; Drug Combinations; Endophthalmitis; Eye Infections, Bacterial; Female; Glutathione; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Therapeutic Irrigation; Vitrectomy

The purpose of this study was to investigate the pharmacokinetics and safety of intravitreal povidone-iodine (PVI) and its efficacy against experimental Staphylococcus epidermidis endophthalmitis.. In phase I, forty New Zealand white rabbits were divided into groups I and II and received intravitreal 0.1% and 0.3% PVI, respectively. Electroretinography (ERG) and histologic examinations were conducted at baseline, 6, and 12 hours. Half-life was determined using high-performance liquid chromatography. In phase II, after the induction of S. epidermidis endophthalmitis, 0.1% and 0.3% PVI were injected intravitreally once in groups A and B and three times every second day in groups C and D (n = 10 in each group). Electroretinographs, histologic examinations, and vitreous cultures were conducted on day 14.. Electroretinography and histologic examinations did not reveal any notable retinal damage in phase I in either group. Half-lives were 3.27 and 3.58 hours in groups I and II, respectively. In phase II, all groups demonstrated marked improvement, compared to controls. Bacterial growth was found in four eyes in group A (20, 60, 60, and 70 colony forming units [CFU]) and in three eyes in group B (20, 40, and 60 CFU) but not in those belonging to groups C and D at day 14. Retinal damage with lymphocyte infiltration in the inner retinal layers was more common in groups A and B than in groups C and D.. Half-life of PVI was approximately 3 hours in the vitreous. Repeated injection of intraocular PVI, even at low concentrations, is most likely to be effective for the treatment of bacterial endophthalmitis.

Topics: Animals; Anti-Bacterial Agents; Electroretinography; Endophthalmitis; Eye Infections, Bacterial; Half-Life; Intravitreal Injections; Povidone-Iodine; Rabbits; Retina; Staphylococcal Infections; Staphylococcus epidermidis; Vitreous Body

Saphenous vein grafts harvested for use as bypass conduits can be contaminated intraoperatively, e.g. by being inadvertently dropped to the floor of the operating room (OR). This study was performed to investigate microorganisms most likely contaminating vein grafts and to assess the possible efficacy of measures to treat potentially contaminated vein grafts antiseptically for further use.. In a first step we determined the microbiological flora of the OR using surface cultures and cultures from intentionally dropped vein grafts. Several antiseptic agents (PVP-iodine 10%, octenidinhydrochloride 0.1%, polyhexanide 1%) were evaluated for their in vitro efficacy to disinfect artificially contaminated vein segments. The most promising antiseptic regimen was tested on veins contaminated in a real OR setting. Finally, we tested for possible alterations in mechanical properties of the veins caused by antiseptic treatment.. Coagulase-negative staphylococci where the predominant bacteria recovered from the OR with 59.9%. Antiseptic treatment with a combination of octenidine and PVP-iodine resulted in a higher rate of negative cultures than any single agent. Treatment of 50 saphenous vein grafts contaminated in the OR with the combination regimen resulted in only 3 positive cultural results within 7 days. Mechanical tear-stress testing comparing antiseptically treated vein grafts with controls showed no difference in their resistance to tear stress.. Antiseptic treatment of contaminated vein grafts was shown to be effective in a high percentage of cases without altering mechanical properties of grafts and may be an option for the surgeon in case of a contamination.

Topics: Anti-Infective Agents, Local; Antisepsis; Biguanides; Humans; Imines; Operating Rooms; Povidone-Iodine; Prosthesis-Related Infections; Pyridines; Saphenous Vein; Staphylococcal Infections; Staphylococcus; Stress, Mechanical; Tensile Strength; Time Factors; Tissue and Organ Harvesting; Treatment Outcome

To report the incidence, clinical features, microbiologic culture results, management and visual outcome of patients with endophthalmitis after intravitreal injections (IVTs).. This retrospective chart review included all patients receiving IVTs between January 2005 and July 2012. Cases of suspected and confirmed endophthalmitis after IVT were identified and reviewed.. A total of 20,179 IVTs were perfomed during the study period. Six cases of supected endophthalmitis were identified clinically (0.03%), of which 3 were culture positive (0.015%). The risk of culture-positive post-IVT endophthalmitis was 2/8,882 (0.023%) in the 2005 to 2008 period and 1/11,297 (0.009%) in the period 2009 to 2012. Symptoms developed within the first 3 days after IVT in 4 of the 6 patients and visual acuity was reduced to hand motion in 4 of the 6 patients. Microbiologic specimens were positive on 3 of the 6 cases (coagulase-negative Staphylococcus, n = 2; Staphylococcus aureus, n = 1). Mean visual acuity before patients with endophthalmitis was 20/100, whereas mean final visual acuity at last follow-up was 20/200.. The incidence of endophthalmitis after IVT was low with no cases because of Streptococcus species in the present setting using povidone-iodine in the preoperative disinfection of the conjunctival sac. Therefore, adherence to standardized protocols including the use of povidone-iodine when performing IVTs is recommended.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Infective Agents, Local; Endophthalmitis; Eye Infections, Bacterial; Female; Germany; Humans; Incidence; Intravitreal Injections; Male; Middle Aged; Povidone-Iodine; Referral and Consultation; Retinal Diseases; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Tertiary Care Centers; Visual Acuity

With increasing bacterial antibiotic resistance and an increased infection risk due to more complicated surgical procedures and patient populations, prevention of surgical infection is of paramount importance. Intraoperative irrigation with an antiseptic solution could provide an effective way to reduce postoperative infection rates. Although numerous studies have been conducted on the bactericidal or cytotoxic characteristics of antiseptics, the combination of these characteristics for intraoperative application has not been addressed.. Bacteria (Staphylococcus aureus and S. epidermidis) and human cells were exposed to polyhexanide, hydrogen peroxide, octenidine dihydrochloride, povidone-iodine, and chlorhexidine digluconate at various dilutions for two minutes. Bactericidal properties were calculated by means of the quantitative suspension method. The cytotoxic effect on human fibroblasts and mesenchymal stromal cells was determined by a WST-1 metabolic activity assay.. All of the antiseptics except for polyhexanide were bactericidal and cytotoxic at the commercially available concentrations. When diluted, only povidone-iodine was bactericidal at a concentration at which some cell viability remained. The other antiseptics tested showed no cellular survival at the minimal bactericidal concentration.. Povidone-iodine diluted to a concentration of 1.3 g/L could be the optimal antiseptic for intraoperative irrigation. This should be established by future clinical studies.

Topics: Anti-Infective Agents, Local; Biguanides; Cell Survival; Chlorhexidine; Fibroblasts; Humans; Hydrogen Peroxide; Imines; Intraoperative Care; Mesenchymal Stem Cells; Povidone-Iodine; Pyridines; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Therapeutic Irrigation

Topics: Anti-Infective Agents, Local; Humans; Nasal Sprays; Povidone-Iodine; Preoperative Care; Staphylococcal Infections; Surgical Wound Infection

Infection after head and neck oncological surgery is relatively frequent, and is associated with significant morbidity and mortality.. The primary objective of this prospective study was to determine risk factors for Surgical Site Infection (SSI) in major head and neck cancer surgery.. A population of 137 head and neck cancer patients, of the Portuguese Institute of Oncology Francisco Gentil (Lisbon, Portugal), was prospectively studied in order to ascertain the correlation between 31 known risk factors and the presence of SSI.. The rate of SSI was 10.9%, with all of the infections being of the deep incisional type. A discriminant analysis and multiple logistic regression methods identified pre-surgical tracheostomy (p < 0.001), previous surgery (p = 0.001) and length of pre-operative hospital stay (p < 0.001) as the most significant risk factors for surgical site infections.. In order to minimize the risk of post-operative SSI in the context of head and neck cancer patients, particular attention should be paid to patients submitted to tracheostomy before surgery, to those submitted to previous oncological surgery, and to patients who are forced to remain in the hospital for prolonged periods of time before surgery.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Debridement; Disinfection; Drainage; Female; Forecasting; Head and Neck Neoplasms; Humans; Length of Stay; Male; Middle Aged; Neoadjuvant Therapy; Povidone-Iodine; Preoperative Care; Prospective Studies; Reoperation; Risk Factors; Staphylococcal Infections; Surgical Wound Infection; Tracheostomy

Giant fornix syndrome is a chronic copiously purulent conjunctivitis seen in elderly patients with dehiscence of the levator palpebrae superioris aponeurosis. We report a case of giant fornix syndrome secondary to methicillin-resistant Staphylococcus aureus conjunctivitis that was recalcitrant to standard treatment modalities, and we describe 2 novel interventions for this condition, which succeeded in eradicating the infection.. Case report.. After failing an aggressive treatment course of topical antibiotics and corticosteroids and after demonstrating an inability to tolerate oral antibiotics, the patient was treated with supratarsal subconjunctival injections of vancomycin and triamcinolone, followed by repeated sweepings of the conjunctival fornices with 10% povidone-iodine on a cotton swab. The patient's symptoms improved dramatically after the antibiotic and corticosteroid injections and ultimately resolved completely after multiple povidone-iodine sweepings.. In patients with giant fornix syndrome who are recalcitrant to or intolerant of aggressive topical and systemic therapy, supratarsal subconjunctival injections of antibiotics and corticosteroids and sweeping of the conjunctival fornices with povidone-iodine are 2 local treatments which may be useful in eradicating the infection.

Topics: Aged, 80 and over; Anti-Infective Agents, Local; Chronic Disease; Conjunctiva; Conjunctivitis; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Glucocorticoids; Humans; Injections; Methicillin-Resistant Staphylococcus aureus; Povidone-Iodine; Staphylococcal Infections; Syndrome; Therapeutic Irrigation; Triamcinolone Acetonide; Vancomycin

Starting from January 2009, we systematically irrigated the surgical wounds of patients undergoing spine surgery with a solution of povidone-iodine (PVP-I) and hydrogen peroxide (H(2)O(2)).. We prospectively recorded the clinical data of patients who underwent spine surgery during 2009 and we compared the results with retrospectively reviewed clinical records of patients operated during 2008. Patients were analyzed for preoperative risk factors, type of surgical procedure, onset of the infection, clinical presentation, treatment, and outcome. We performed 460 spine surgeries during 2008 and 490 during 2009.. We recorded seven post-operative infections in 2008 compared to none in 2009.. We consider the solution of PVP-I plus H(2)O(2) effective in further reducing the rate of post-operative infection in spine surgery.

Topics: Anti-Infective Agents, Local; Diskectomy; Fracture Fixation; Humans; Hydrogen Peroxide; Pharmaceutical Solutions; Povidone-Iodine; Prospective Studies; Spine; Staphylococcal Infections; Surgical Wound Infection; Therapeutic Irrigation

The fight against healthcare-associated infections is based on preventive measures of multidrug resistant bacteria diffusion. Hand hygiene is the simplest and the most effective preventive measure to reduce cross-transmission of infectious agents. Hydroalcoholic solutions for hand hygiene was recently introduced in the University Hospital of Brest (France). The aims of the study were: to describe the epidemiology of healthcare-associated infections due to methicillin-resistant Staphylococcus aureus (MRSA); to determine the annual consumptions of antistaphylococcal antibiotics; and to discuss the relation between consumption of antiseptic products or antibiotics and the epidemiology of MRSA.. A retrospective epidemiological and pharmaco-epidemiological study was realized from January 2004 to December 2007 in the University Hospital of Brest (France). It allowed to bring to light the cases of healthcare-associated infections due to MRSA and to quantify the consumptions of hang hygiene products and antistaphylococcal antibiotics.. this retrospective study showed a decrease of healthcare-associated infections due to MRSA and an increase of the consumption of hydroalcoholic solutions. Antistaphylococcal resistance rates also decreased in a context of fall of the global antibiotics consumption in the hospital.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Disinfectants; Drug Utilization; Female; Gels; Hand Disinfection; Hospitals, University; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Povidone-Iodine; Retrospective Studies; Soaps; Staphylococcal Infections

In 2009, the American Academy Of Orthopedic Surgeons recommended lifelong prophylaxis after orthopedic total joint replacement (TJR) before these patients undergo dental, aerodigestive, genitourinary (GU), and gastrointestinal (GI) procedures. Because oral and maxillofacial surgeons worldwide are implanting alloplastic total temporomandibular joint replacements (TMJ TJRs), it appeared reasonable to survey these surgeons to obtain data that might shed some light, not only on this issue, but also to obtain some data to begin to develop preliminary guidelines for the peri- and postoperative use of antibiotics for TMJ TJR using these results and the orthopedic data.. A total of 35 surgeons worldwide, members of either the TMJ Concepts or Biomet Microfixation online networks were e-mailed a standard questionnaire surveying their perioperative, postoperative, and prophylactic use of antibiotics for their TMJ TJR cases.. Of the 35 surgeons, 26 (74.2%) from 8 different countries responded. A total of 2,476 cases (3,368 joints) were retrospectively surveyed. Of the responding surgeons, 96.2% used, in order of frequency, cefazolin, clindamycin, cephalosporin, or penicillin-based antibiotics in the perioperative period and continued their use for a mean of 7 days (range 5 to 14) postoperatively. Also, 46.2% soaked the TJR components either in the perioperative antibiotic or in vancomycin, poviodine, gentamycin, or peroxide before implantation. In addition, 61.5% irrigated the wounds after device implantation with bacitracin, vancomycin, poviodine, peroxide, or the perioperative antibiotic. These surgeons reported that 51 joints (1.51%) had become infected within a mean of 6 months (range 2 weeks to 12 years) postoperatively. A total of 32 devices (0.95%) required removal and/or replacement. In cases in which the organisms were isolated, the organisms commonly associated with biofilm infection of TJR devices, Staphylococcus aureus, S epidermidis, Peptostreptococcus, and Pseudamonas aeruginosa, were cultured. In only 1 joint (0.003%) was there a suggestion of an association with an invasive dental/aerodigestive, GU/GI procedure. Regarding prophylaxis after TMJ TJRs and before dental/aerodigestive, GU, or GI procedures, 53.8% of the respondents reported that they provided prophylaxis. Of these, 1 recommended doing this for 6 months and 4 for 2 years, such as has been the American Dental Association/American Academy of Orthopedic Surgeons recommendation since 2003; and 9 reported they believe these TMJ TJR patients should have lifetime antibiotic prophylaxis before invasive dental/aerodigestive, GU, or GI procedures.. The evidence provided from the present small study survey and a review of the orthopedic data could provide the opportunity to develop guidelines for the preoperative, intraoperative, and postoperative antibiotic management for TMJ TJRs and spur additional research into this important area of patient management.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Arthroplasty, Replacement; Bacitracin; Biofilms; Cefazolin; Cephalosporins; Clindamycin; Device Removal; Disinfection; Gentamicins; Gram-Positive Bacterial Infections; Humans; Joint Prosthesis; Penicillins; Peptostreptococcus; Peroxides; Povidone-Iodine; Practice Guidelines as Topic; Practice Patterns, Dentists'; Pseudomonas aeruginosa; Pseudomonas Infections; Retrospective Studies; Staphylococcal Infections; Staphylococcus epidermidis; Surgical Wound Infection; Temporomandibular Joint; Therapeutic Irrigation; Vancomycin

Nosocomial infections which exhibit an increasing trend worldwide, are important contributors to morbidity and mortality. Most bacteria that cause nosocomial infections can retain their viability even after exposure to disinfectants in routine practice. This study was conducted to determine the susceptibilities of nosocomial Staphylococcus aureus and Enterococcus spp. isolates to various disinfectants. A total of 30 S.aureus [16 were methicillin-resistant (MRSA), 14 were methicillin-susceptible (MSSA)] and 21 Enterococcus spp. (13 E.faecalis, 7 E.faecium, 1 non-typable Enterococcus spp.) strains isolated from clinical samples of hospitalized patients as nosocomial infection agents in the Central Microbiology Laboratory of Ibn-i Sina Hospital, Ankara University, Faculty of Medicine, were included in the study. Glutaraldehyde (2% wt/vol), chlorhexidine gluconate (4% wt/vol), 2-propanol (70% vol/vol), povidone iodine (7.5% wt/vol), povidone iodine (10% wt/vol) and hydrogen peroxide (3% wt/vol) susceptibilities of the isolates were investigated by quantitative suspension test at contact times of 3, 5, and 10 minutes. All of the isolates were found susceptible to glutaraldehyde (2%), chlorhexidine gluconate (4%), povidone iodine (7.5%), povidone iodine (10%) and 2-propanol (70%) at all tested contact times. However, 12 S.aureus (5 MSSA, 7 MRSA) and 3 enterococci (2 E.faecium, 1 E.faecalis) isolates were found susceptible to hydrogen peroxide (3%) at 3 minutes contact time; 11 S.aureus (4 MSSA, 7 MRSA) and 7 E.faecalis isolates were found susceptible at 5 minutes contact time, and 6 S.aureus (4 MSSA, 2 MRSA) and 3 enterococci (1 E.faecium, 2 E.faecalis) isolates were found susceptible at 10 minutes contact time. One MSSA and 8 enterococci (4 E.faecium, 3 E.faecalis, 1 Enterococcus spp.) isolates were found resistant to hydrogen peroxide (3%) at 10 minutes contact time. In conclusion, glutaraldehyde (2%), chlorhexidine gluconate (4%), povidone iodine (7.5%), povidone iodine (10%) and 2-propanol (70%) can be safely used against S.aureus and Enterococcus spp. owing to their high effectiveness, however, hydrogen peroxide (3%) should not be preferred against those strains due to the presence of resistant isolates, in Ankara University Ibn-i Sina Hospital.

Topics: 2-Propanol; Chlorhexidine; Cross Infection; Disinfectants; Drug Resistance, Bacterial; Enterococcus; Glutaral; Gram-Positive Bacterial Infections; Humans; Hydrogen Peroxide; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Turkey

Topics: 2-Propanol; Anti-Infective Agents; Carrier State; Chlorhexidine; Cross Infection; Humans; Mupirocin; Nasal Cavity; Povidone-Iodine; Skin; Staphylococcal Infections; Surgical Wound Infection

Biomaterial-related infections continue to hamper the success of reconstructive and arthroplasty procedures in orthopaedic surgery. Staphylococci are the most common etiologic agents, with biofilm formation representing a major virulence factor. Biofilms increase bacterial resistance to antimicrobial agents and host immune responses. In staphylococci, production of polysaccharide intercellular adhesin (PIA) by the enzyme products of the icaADBC operon is the best understood mechanism of biofilm development, making the ica genes a potential target for biofilm inhibitors. In this study we report that the antibacterial agent povidone-iodine (PI) also has anti-biofilm activity against Staphylococcus epidermidis and Staphylococcus aureus at sub-inhibitory concentrations (p < 0.001). Inhibition of biofilm by PI correlated with decreased transcription of the icaADBC operon, which in turn correlated with activation of the icaR transcriptional repressor in Staphylococcus epidermidis. These data reveal an additional therapeutic benefit of PI and suggest that studies to evaluate suitability of PI as biomaterial coating agent to reduce device-related infections are merited.

Topics: Anti-Infective Agents, Local; Biofilms; Genes, Bacterial; Humans; Microbial Sensitivity Tests; Microbial Viability; Orthopedic Procedures; Polysaccharides, Bacterial; Povidone-Iodine; Reverse Transcriptase Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis

Methicillin-resistant Staphylococcus aureus (MRSA) may cause infections during wound dressing. We aimed to compare the antibacterial activities and wound-healing effects of commercially available silver-coated or silver-impregnated wound dressings on MRSA-infected wounds.. Full-thickness skin defects were made on the back of rats (N=108) and were infected with MRSA. The rats were divided into the following 6 groups according to the dressing used for the wounds: nanocrystalline silver (Acticoat), silver carboxymethylcellulose (Aquacel-Ag), silver sulfadiazine (Medifoam silver), nanocrystalline silver (PolyMem silver), silver sulfadiazine (Ilvadon), and 10% povidone iodide (Betadine). We analyzed the wound sizes, histological findings, and bacterial colony counts for the groups. We also inoculated the silver materials on Mueller-Hinton agar plates containing MRSA and compared the inhibition zones in the agar plates.. The order of the rate of wound-size decrease was Acticoat>Aquacel-Ag>PolyMem silver>Medifoam silver>Ilvadon>Betadine. The histological findings revealed that the Acticoat showed more reepithelialization and granulation tissue formation and less inflammatory cell infiltration than the other materials. The order of the time required for wound healing was Acticoat>Aquacel -Ag>PolyMem silver>Ilvadon>Medifoam silver>Betadine. The bacterial colony counts reduced in all the groups, except in the Medifoam silver group. The order of the size of the inhibition zone was Acticoat>Aquacel-Ag>Ilvadon>PolyMem silver>Betadine>Medifoam silver.. Silver-coated or silver-impregnated wound dressings can be used for treating MRSAinfected wounds. Considering its superior efficacy in comparison to the efficacies of other silver-coated or silver-impregnated wound dressings, Acticoat should be preferentially used for the treatment of MRSA-infected skin wounds.

Topics: Animals; Bandages; Carboxymethylcellulose Sodium; Female; Metal Nanoparticles; Methicillin-Resistant Staphylococcus aureus; Povidone-Iodine; Rats; Rats, Sprague-Dawley; Silver; Silver Sulfadiazine; Skin; Staphylococcal Infections; Wound Healing

Infection after strabismus surgery is rare. Here we describe a 5-year-old girl who developed bilateral staphylococcal sub-Tenon's abscess resistant to fourth-generation fluoroquinolones that resolved completely after surgical drainage and irrigation with povidone iodine followed by administration of oral amoxicillin and clavulanic acid. A lost muscle required exploration and reattachment to the sclera.

Topics: Abscess; Anti-Bacterial Agents; Child, Preschool; Combined Modality Therapy; Connective Tissue Diseases; Eye Infections, Bacterial; Female; Functional Laterality; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Postoperative Complications; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Strabismus; Suction; Therapeutic Irrigation

In this study, the minimum bactericidal concentrations (MBCs) of 5 biocides (benzalkonium chloride, glutaraldehyde, sodium hypochlorite, povidone iodine and ethanol) for 56 clinical quaternary ammonium compound (QAC) tolerant S. aureus strains following exposure for 5, 30 or 180 min, collected from a teaching hospital in China, were examined. The distributions of the biocide resistance genes qacA/B, smr, qacH and qacG were investigated by polymerase chain reaction. Following 5 min exposure of benzalkonium chloride and povidone iodine, 7.1% (4/56) and 7.1% (4/56) isolates, respectively, exhibited MBC values higher than their in-use concentrations for mucosa and wound disinfection. The MBC values of all the isolates studied for glutaraldehyde, sodium hypochlorite and ethanol were lower than the in-use concentrations in all contact times. The qacA/B gene was found in 94.6% (53/56) of QAC tolerant S. aureus. The frequencies of smr (3.6%, 2/56) and qacH (7.1%, 4/56) were low and qacG was not detected. The results suggested that clinical QAC tolerant S. aureus isolates of China had the possibility to survive in proper in-use concentrations of some biocides at proper contact time, and qacA/B is the most prevalent disinfectant resistant gene in this type of bacteria.

Topics: Bacterial Proteins; Benzalkonium Compounds; Disinfectants; Drug Resistance, Bacterial; Hospitals, Teaching; Humans; Membrane Transport Proteins; Microbial Sensitivity Tests; Penicillin-Binding Proteins; Polymerase Chain Reaction; Povidone-Iodine; Quaternary Ammonium Compounds; Staphylococcal Infections; Staphylococcus aureus

The aim of the current study is to evaluate the role of povidone iodine (PVI) in the management of experimental bacterial endophthalmitis in young rabbits.. Twenty white rabbits were used. Colony-forming units (CFU) of Staphylococcus epidermidis were injected intravitreally into the right eye of each animal. Injected eyes were evaluated clinically daily (anterior and posterior segment examination), and when clinical signs of endophthalmitis appeared, an injection of 0.1 ml PVI was made intravitreally. In group 1 (n = 10), the injected concentration of PVI was 0.1%, and in group 2 (n = 10) the concentration was 0.2%. At the end of the observation period, vitreous sample culture was made, and vitreous and retina specimens were taken for light histology examination as well. results: Group 1 eyes did not show any signs of clinical improvement. Vitreous culture showed the presence of 10(8) CFU/ml of S. epidermidis. Histological examination indicated acute inflammation. Group 2 animals presented a clear gradual regression of the inflammation. Vitreous culture for S. epidermidis proved to be sterile. Histological examination indicated chronic inflammation.. Intravitreal injection of 0.2% PVI is likely to inhibit bacterial endophthalmitis of rabbit eyes due to S. epidermidis.

Topics: Animals; Anti-Infective Agents, Local; Aqueous Humor; Colony Count, Microbial; Endophthalmitis; Eye; Inflammation; Povidone-Iodine; Rabbits; Staphylococcal Infections; Staphylococcus epidermidis; Treatment Outcome

Topics: Anti-Infective Agents, Local; Chlorhexidine; Escherichia coli; Escherichia coli Infections; Povidone-Iodine; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection; Sutures

To evaluate the efficacy of a standardized regimen for decolonization of methicillin-resistant Staphylococcus aureus (MRSA) carriers and to identify factors influencing decolonization treatment failure.. Prospective cohort study from January 2002 to April 2007, with a mean follow-up period of 36 months.. University hospital with 750 beds and 27,000 admissions/year.. Of 94 consecutive hospitalized patients with MRSA colonization or infection, 32 were excluded because of spontaneous loss of MRSA, contraindications, death, or refusal to participate. In 62 patients, decolonization treatment was completed. At least 6 body sites were screened for MRSA (including by use of rectal swabs) before the start of treatment.. Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed. Successful decolonization was considered to have been achieved if results were negative for 3 consecutive sets of cultures of more than 6 screening sites.. The mean age (+/- standard deviation [SD]) age of the 62 patients was 66.2 +/- 19 years. The most frequent locations of MRSA colonization were the nose (42 patients [68%]), the throat (33 [53%]), perianal area (33 [53%]), rectum (36 [58%]), and inguinal area (30 [49%]). Decolonization was completed in 87% of patients after a mean (+/-SD) of 2.1 +/- 1.8 decolonization cycles (range, 1-10 cycles). Sixty-five percent of patients ultimately required peroral antibiotic treatment (vancomycin, 52%; cotrimoxazole, 27%; rifampin and fusidic acid, 18%). Decolonization was successful in 54 (87%) of the patients in the intent-to-treat analysis and in 51 (98%) of 52 patients in the on-treatment analysis.. This standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course.

Topics: Aged; Aged, 80 and over; Anal Canal; Anti-Bacterial Agents; Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Female; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Pharynx; Povidone-Iodine; Rectum; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Firstly, the aim of this study was to determine the maximally tolerated dose of intravitreally injected povidone-iodine (PVP-I). A second aim was to test the efficacy of PVP-I on rabbit eyes infected intravitreally with Staphylococcus epidermidis.. Phase I of the study used 16 New Zealand albino rabbits, divided into 4 groups (n=4 each). Animals were anesthetized and intravitreally injected with 0.1 mL of 50, 100, 200, or 400 micrograms (microg) of PVP-I in 1 eye, and with saline in the other. The animals were examined at days 1, 7, and 14, using indirect ophthalmoscopy and slit-lamp biomicroscopy; electroretinography (ERG) was performed before treatment and prior to euthanization. Histological preparations were examined to determine retinal damage. Phase II of the study divided 20 New Zealand albino rabbits into 4 groups (n=5 each). Animals were anesthetized and injected with 0.1 mL of S. epidermidis containing 3030 colony forming units (CFU) in 1 eye and saline in the other. Seven (7) h later, animals were treated with 0.1 mL of 20, 50, and 100 microg of PVP-I, or no treatment. Bacterial concentrations from extracted vitreous were determined 2 days following infection. Results were analyzed for statistical significance, using the Student t test and analysis of variance, and histologic preparations assessed the presence of endophthalmitis.. Phase I of the study observed no retinal damage at any of the concentrations studied, as noted by indirect ophthalmoscopy, slit-lamp biomicroscopy, ERG, and histologic exam. Phase II of the study showed no statistical difference in bacterial counts between treatment and control groups. All infected eyes went on to develop endophthalmitis, as observed by indirect ophthalmoscopy and histologic preparations.. These results suggest that 400_g of PVP-I can be tolerated intravitreally in rabbit eyes with no noticeable damage over a 14-day period. Results further showed that 100 microg of intravitreally injected PVP-I has no statistically significant effect on rabbit eyes injected intravitreally with 3030 CFU of S. epidermidis.

Topics: Animals; Anti-Infective Agents, Local; Disease Models, Animal; Electroretinography; Eye Infections, Bacterial; Injections; Maximum Tolerated Dose; Povidone-Iodine; Rabbits; Retina; Staphylococcal Infections; Staphylococcus epidermidis; Treatment Outcome; Vitreous Body

We report a case of mediastinitis successfully treated with autovaccine therapy, once conventional surgical and medical therapies had failed.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Coronary Artery Bypass; Coronary Stenosis; Debridement; Gentamicins; Humans; Male; Mediastinitis; Methicillin Resistance; Povidone-Iodine; Staphylococcal Infections; Staphylococcal Vaccines; Staphylococcus aureus; Surgical Wound Infection; Teicoplanin; Therapeutic Irrigation; Treatment Failure; Treatment Outcome; Vancomycin

Atopic dermatitis (AD) is frequently associated with intestinal and cervical lesions. Staphylococcus aureus produces many kinds of toxins, the bacterial superantigens. The detection rate of toxins was 80.1% from 196 S. aureus strains. Neurological examinations revealed abnormalities in 59 out of 81 AD patients. Cervical magnetic resonance imaging (MRI) was performed in 46 patients randomly and showed abnormal findings in 38 of these patients. In 23 patients who underwent MRI and duodenal biopsy, 3 were found to be normal neurologically and 2 patients showed normal duodenal tissue. However, 18 patients had abnormal findings both on neurological examination and in duodenal tissue. Serial duodenal biopsy tests were performed in 10 AD patients. In 5 patients, the findings of chronic duodenitis disappeared after the therapy with povidone-iodine. These data indicate that the therapy was effective not only for the skin lesions, but improved gastrointestinal tract lesions and cervical myelopathy, by eradicating bacterial superantigens.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Antitoxins; Bacterial Toxins; Cervical Vertebrae; Child; Dermatitis, Atopic; Drug Resistance, Bacterial; Duodenitis; Female; Humans; Immunoglobulin E; Male; Povidone-Iodine; Spinal Cord Diseases; Spinal Diseases; Staphylococcal Infections; Staphylococcus aureus; Superantigens; Treatment Outcome

We investigated the efficacy of disinfection of the upper airway using povidone-iodine against nosocomial pneumonia in geriatric wards. Cases of nosocomial pneumonia were retrospectively analyzed between January 1991 and March 1995 in geriatric wards (190 beds). Moreover, the relationship concerning methicillin-resistant Staphylococcus aureus (MRSA) isolates between patient and environment was investigated using pulsed-field gel electrophoresis (PFGE) with the SmaI restriction enzyme. The incidence of nosocomial pneumonia decreased significantly (p < 0.05). Major causative organisms of nosocomial pneumonia were MRSA and Pseudomonas aeruginosa, which significantly decreased. PFGE studies showed that the patterns of MRSA isolates show a strong association between patient and environment. Our study indicates that disinfection of the upper airways by povidone-iodine is very important in the prevention of nosocomial pneumonia in geriatric wards.

Topics: Aged; Anti-Infective Agents, Local; Bacterial Typing Techniques; Carrier State; Cross Infection; Disease Transmission, Infectious; Electrophoresis, Gel, Pulsed-Field; Environmental Microbiology; Geriatrics; Hospital Units; Humans; Infection Control; Methicillin Resistance; Mouth; Nasal Cavity; Pneumonia, Bacterial; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

Irrigation of breast implants and breast implant pockets with various solutions, including povidone iodine, has been a common practice among plastic surgeons for many years. Recent reports of potential weakening of silicone tubing have led the Food and Drug Administration to pronounce any contact of povidone iodine with breast implants a contraindication. An in vitro experimental study was undertaken to assess the effect of povidone iodine on the physical properties of silicone breast implant shells. Identical specimens were obtained from the shells of silicone breast implants according to published standards. The specimens were randomly assigned to eight groups of five and incubated in various solutions of decreasing concentration of povidone iodine (10% to 0.01%), and a control group (0.9% saline) was used. The containers were stored in a warming cabinet at 37 degrees C for 4 weeks. Testing of the specimens for tensile strength following 4 weeks of incubation showed no significant difference among any of the groups, including the control group. In addition, no correlation was shown between the concentration of the solution used and the tensile strength of the specimens.

Topics: Anti-Infective Agents, Local; Breast Implants; Contracture; Humans; In Vitro Techniques; Povidone-Iodine; Prosthesis-Related Infections; Silicone Gels; Staphylococcal Infections; Staphylococcus epidermidis; Therapeutic Irrigation

To assess the response to the action of different antiseptics and disinfectants usually used in Argentinian hospitals of hospital staphylococci sensitive and resistant to methicillin. To test the effectiveness of the biocides by measuring their effective bactericidal concentrations, and to determine whether there is any correlation between biocide resistance and methicillin resistance in this bacterial population.. The action of seven biocides was tested against 25 strains of nosocomial Staphylococcus spp. sensitive and resistant to methicillin, and in Staphylococcus aureus ATCC 6538. Hospital strains were obtained from April, 2000 to May, 2002, from clinical samples (blood culture, urine culture, catheter tip or abscess) from male and female inpatients and outpatients at two tertiary hospitals. After isolation, antibiotic sensitivity was tested with the agar diffusion method of Kirby and Bauer. The action of hospital biocides on the strains was studied with the Kelsey-Sykes test, which establishes the effective bactericide concentrations of these compounds.. The results showed that the response of strains sensitive and resistant to methicillin varied in comparison to the collection strain. Chlorhexidine digluconate, povidone iodine, weak tincture of iodine and alkaline glutaraldehyde were effective against most strains, regardless of whether they were sensitive or resistant to methicillin.. We found no indication of a relationship between resistance to methicillin and resistance to biocides. Our study shows that further research is needed to evaluate the efficacy of chemical agents against microorganisms that have been exposed to antibiotic therapies.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Argentina; Benzalkonium Compounds; Child; Chlorhexidine; Cross Infection; Disinfectants; Female; Glutaral; Humans; Iodine Compounds; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Povidone-Iodine; Sodium Hypochlorite; Staphylococcal Infections; Staphylococcus; Xylenes

We report a patient who underwent implantation of a DeBakey left-ventricular assist device and developed a methicillin-resistant Staphylococcus aureus drive line infection on postoperative day 304. The patient was forwarded to urgent heart transplantation with a successful outcome.

Topics: Adolescent; Azathioprine; Cardiomyopathy, Dilated; Cyclosporine; Equipment Contamination; Heart Transplantation; Heart-Assist Devices; Humans; Immunosuppressive Agents; Male; Methicillin Resistance; Methylprednisolone; Mupirocin; Patient Isolation; Postoperative Complications; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization occurred from November 2001 in the neonatal intensive care unit (NICU) of our hospital. Since the establishment of our NICU in 1991, some MRSA has been detected in NICU patients. For MRSA infection preventive measures, utilization of the following items was implemented: mupirocin ointment, diluted povidone iodine, methylrosaniline chloride, and disposable rubber gloves. Patients in whom MRSA was detected received intranasal administration of the mupirocin ointment three times daily and were bathed in, or their entire body was wiped with diluted povidone iodine once daily for the first 3 days in each week. In addition, they received an intraoral application of methylrosaniline chloride daily. All therapy was done until MRSA strains were undetectable for 3 continuous weeks. Genotypes of 13 MRSA strains isolated from eight inpatients and one mother were analyzed by pulsed-field gel electrophoresis (PFGE). All PFGE patterns were identical, except for one, which had one distinct migrating fragment. These data suggested that this MRSA outbreak was caused by the same strain, which was derived from the mother of a low-birth-weight infant born on October 30, 2001. Gradually, the number of inpatients carrying MRSA decreased, until finally MRSA was no longer observed, in April 2002. Fortunately, we controlled the MRSA outbreak immediately, and none of the inpatients developed severe MRSA infection. We think that in our NICU, which is isolated from other hospital wards, it is important to prevent the entrance of MRSA-carrying mothers.

Topics: Cross Infection; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Female; Gentian Violet; Gloves, Protective; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Japan; Male; Methicillin Resistance; Mupirocin; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Topics: Ambulatory Surgical Procedures; Cataract Extraction; Disinfection; Endophthalmitis; Humans; Povidone-Iodine; Risk Factors; Staphylococcal Infections; Streptococcal Infections; Surgical Wound Infection

The in vitro activities of povidone iodine, potassium peroxymonosulfate, and dimethyldidecylammonium chloride were investigated against 379 nosocomial isolates of Staphylococcus aureus and Pseudomonas aeruginosa responsible for surgical wound infections in patients operated on between July 1995 and June 2001. Overall, the isolates were inhibited by the antiseptics at concentrations below those used routinely. In spite of increasing resistance to the various antibiotics used to treat surgical wound infections, no significant variation in the susceptibility to antiseptics was demonstrated during this 6-year study.

Topics: Anti-Infective Agents, Local; Bacterial Infections; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Peroxides; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Quaternary Ammonium Compounds; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Time Factors

Bacteria that adhere to damaged tissues encase themselves in a hydrated matrix of polysaccharides, forming a slimy layer known as a biofilm. This is the first report of detection of glycocalyx production by Staphylococcus aureus using confocal laser scanning microscopy (CLSM) on damaged skin tissues.. To analyse glycocalyx production by S. aureus cells on damaged skin tissues and the influence of polymorphonuclear leucocytes (PMNs) and various antimicrobial agents on its production using CLSM in cyclophosphamide (Cy)-treated (neutropenic) or non-Cy-treated (normal) mice.. S. aureus cells were inoculated on damaged skin tissues in neutropenic or normal mice with or without topical application of antimicrobial agents. S. aureus cells were stained with safranine, and positive staining with fluorescein isothiocyanate-conjugated concanavalin A was considered to indicate the presence of glycocalyx.. All S. aureus cells tested on damaged skin tissues formed microcolonies encircled by glycocalyx. The colony counts of S. aureus cells on croton oil dermatitis in normal mice treated with 2% fusidic acid ointment were about 100 times lower than those in neutropenic mice (control).. As S. aureus cells can generally produce a biofilm on damaged skin tissues, antimicrobial agents may not eradicate S. aureus cells without the help of PMNs. S. aureus glycocalyx may play a crucial role in colonization and adherence to damaged skin tissues.

Topics: Animals; Anti-Infective Agents, Local; Biofilms; Colony Count, Microbial; Dermatitis, Contact; Female; Fusidic Acid; Glycocalyx; Mice; Microscopy, Confocal; Neutropenia; Opportunistic Infections; Povidone-Iodine; Skin; Staphylococcal Infections; Staphylococcus aureus

In this study, we elucidated the efficacy of our prophylactic method for wound infection in pull-percutaneous endoscopic gastrostomy (PEG). The total 29 patients received the pull-PEG. The first 8 patients received the oral sterilization with povidone iodine and antibiotics at the time of pull-PEG (Group-I). The frequency of wound infection in this group was 50.0% (4/8). It was revealed that all infections were induced by methicillin resistant staphylococcus aureus (MRSA). 3 patients were MRSA positive in the throat. In Group-II, we eradicated MRSA in the throat before the pull-PEG by combination mupirocin calcium hydrate with the Group-I treatment. In contrast in Group-I, the frequency of wound infection was significantly reduced in Group-II (4.8%: 1/21). The results showed that our eradication method was very useful for prevention of the wound infection in pull-PEG treatment.

Topics: Adolescent; Aged; Aged, 80 and over; Female; Gastroscopy; Gastrostomy; Humans; Male; Methicillin Resistance; Pharynx; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Between October of 1992 and September of 1998, we performed 604 open heart operations. Among them, 12 cases (1.9%) were complicated with postoperative infectious mediastinitis. Five patients (Group A) were treated by conservative therapy which consists of open drainage and intermittent closed irrigation with dilute povidone iodine solution. Seven patients (Group B) were treated surgically in addition to the above-mentioned conservative treatment. Among those patients, one patient developed fatal complication. We have realized that mental care of the patients was also very important when long term hospitalization was necessitated. The hyperbaric oxygen therapy seemed to be also effective for postoperative mediastinitis caused by MRSA.

Topics: Aged; Coronary Artery Bypass; Drainage; Female; Humans; Hyperbaric Oxygenation; Male; Mediastinitis; Middle Aged; Postoperative Complications; Povidone-Iodine; Prognosis; Staphylococcal Infections; Surgical Procedures, Operative; Therapeutic Irrigation

Due to the emergence of mupirocin-resistance in some epidemic strains of methicillin resistant Staphylococcus aureus (EMRSA) and the appearance of EMRSA with intermediate resistance to vancomycin, we evaluated the in-vitro activity of 5% povidone-iodine ('Betadine') cream as a possiblealternative to mupirocin for the elimination of nasal carriage of S. aureus. As judged by enrichment culture, povidone-iodine was bactericidal against three mupirocin-sensitive strains of S. aureus from nasal carriers, and against mupirocin-resistant and -sensitive strains of EMRSA types 3, 15 and 16, after incubation with povidone-iodine for 1.0 min at 32 degrees C. Mupirocin nasal ointment did not prevent growth after 180 min incubation. In a quantitative suspension test, 1:100 dilution of povidone-iodine cream completely eliminated an inoculum of 10(8)cfu/mL of all nine test organisms after incubation at 32 degrees C for 1.0 min, and 1:1000 dilution reduced cfu, by a factor of 10(5). After direct inoculation of the povidone-iodine cream to give 10(5)cfu/g, none of the test strains were recoverable after 30 s, giving a killing rate of approximately 10(4)cfu/s; for mupirocin nasal ointment, the maximum reduction of mupirocin-sensitive strains was ten fold after 3 h. Povidone-iodine activity was not detectable in sensitivity-testing agar, although 0.025% of povidone-iodine was detectable in a 15% nutrient strength tryptone soya agar. Using this minimal medium, the addition of nasal secretions (from any of 11 samples) reduced the activity of povidone-iodine by 80-90%, but mupirocin activity was unaffected. One millilitre of nasal secretions inactivated the equivalent of approximately 22.5 mg of povidone-iodine. These results suggest that povidone-iodine cream may have a role in the prevention of colonization and infection caused by MRSA, including mupirocin-resistant strains.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Biological Availability; Carrier State; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Mupirocin; Nasal Mucosa; Nose; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

To compare the antibacterial effect of povidone-iodine (PI) with that of ofloxacin in an experimental model of bacterial keratitis.. Staphyloccocal keratitis was induced in 21 eyes of Dutch Belted rabbits by intrastromal inoculation of approximately 280 organisms of Staphylococcus aureus. Six hours later, the animals were divided in four groups treated topically with saline 0.9%, Betadine 10%, Betadine 0.5% or Ofloxacin 0.3% (2 gtt every 30 min for 8 h). The central 8-mm cornea was excised, washed and homogenized. Colony counts were performed on serial 10-fold dilutions plated on blood and brain infusion agar and incubated overnight.. Colony-forming units per cornea were 7.4x10(7) for the saline group compared to 8.2x10(7) for PI 10% (P>0.5), 4.3x10(7) for PI 0.5% (P<0.01) and no organisms for ofloxacin 0.3%.. Betadine 0.5% demonstrates a statistically significant bactericidal effect compared with untreated staphyloccocal keratitis in our experimental model. Ofloxacin has superior antibacterial effect under the conditions studied. Further improvements in the povidone-iodine formulation are warranted prior to consideration for human keratitis.

Topics: Animals; Anti-Infective Agents; Colony Count, Microbial; Cornea; Disease Models, Animal; Eye Infections, Bacterial; Iodophors; Keratitis; Male; Ofloxacin; Ophthalmic Solutions; Povidone-Iodine; Rabbits; Staphylococcal Infections; Staphylococcus aureus

Most published studies of the activity of biocides against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) have been based on suspension tests. This study was undertaken to provide information on the effect of chlorhexidine and povidone iodine on bacteria dried on to surfaces, a situation in which biocide activity is known to be reduced. The inactivation of MRSA (10 strains), methicillin-sensitive Staphylococcus aureus (MSSA, 10 strains), VRE (nine strains) and vancomycin-sensitive Enterococcus faecalis (VSE, 10 strains) by 0.5% aqueous chlorhexidine gluconate or 10% povidone iodine was evaluated by applying the European surface test method. Povidone iodine was equally active against resistant and sensitive strains of both species with microbicidal effects (ME), i.e. the log(10)concentration of micro-organisms compared with controls treated with distilled water, after 1.5 min of 3.14 and 3.49 for VRE and VSE respectively, and 3.47 and 3.78 for MRSA and MSSA. Chlorhexidine was equally active against VRE and VSE (ME 3.37 vs. 3. 56 after 7 min, respectively), but was significantly less active against MRSA as opposed to MSSA (ME 3.07 vs. 3.83 after 10 min, P= 0. 017).

Topics: Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Disinfectants; Drug Evaluation, Preclinical; Drug Resistance, Microbial; Enterococcus faecalis; Gram-Positive Bacterial Infections; Humans; Infection Control; Israel; Methicillin Resistance; Microbial Sensitivity Tests; Povidone-Iodine; Serotyping; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Vancomycin Resistance

We present a patient who suffered from composite graft infection and mediastinitis. After replacement of the infected composite graft, in addition to administration of antibiotics, continuous irrigation of the mediastinum with solutions containing povidone-iodine and cefazolin sodium and transposition of the greater omentum were performed. His postoperative course was uneventful. Combined therapies including mediastinal irrigation and omental transposition should be considered after an operation for composite graft infection complicated with mediastinitis.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Blood Vessel Prosthesis Implantation; Cefazolin; Cephalosporins; Heart Valve Prosthesis Implantation; Humans; Male; Mediastinitis; Middle Aged; Omentum; Povidone-Iodine; Prosthesis-Related Infections; Staphylococcal Infections; Therapeutic Irrigation

The iodine content of a tulle gras-type dressing medicated with povidone-iodine (Poviderm) has been measured and its potential efficacy in wound care explored by means of laboratory models. Simple tests demonstrated the ready diffusibility and antibacterial activity of povidone-iodine. Wound models clearly showed that the limiting factor for useful dressing life is extent of exudation. It seems likely that this dressing would provide good topical antibacterial prophylaxis and may reduce the bacterial burden of colonised wounds. The dressing should help contain wound bacteria and thus assist infection control.

Topics: Anti-Bacterial Agents; Bandages; Chronic Disease; Diffusion; Drug Evaluation, Preclinical; Humans; Povidone-Iodine; Pseudomonas Infections; Staphylococcal Infections; Wound Infection

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

In pressure sore wounds after spinal cord injury, methicillin-resistant Staphylococcus aureus can be detected in 2% of the cases. The elimination of the germ is the aim of the treatment. Pressure sore wounds are an often found complication after spinal cord injury. For local treatment five commercially available antiseptics for the skin and mucous membrane were tested in vitro. The method used is a modified qualitative and quantitative suspension test. The antiseptics were tested without and with addition of 5% albumin in order to simulate the conditions of the wound in vivo. The results show a superior efficacy of the povidone-iodine preparations. Betadine, probably due to the higher concentration, is more efficacious than Braunol; chlorhexidine is sufficiently efficacious without the addition of albumin. These results still have to be confirmed by in vivo studies.

Topics: Anti-Infective Agents, Local; Biguanides; Chamomile; Chlorhexidine; Escherichia coli; Escherichia coli Infections; Flavonoids; Humans; Imines; Iodophors; Methicillin Resistance; Oils, Volatile; Plants, Medicinal; Povidone-Iodine; Pressure Ulcer; Pseudomonas aeruginosa; Pseudomonas Infections; Pyridines; Quaternary Ammonium Compounds; Serum Albumin; Skin; Spinal Cord Injuries; Staphylococcal Infections; Staphylococcus aureus

The incidence of catheter-associated urinary tract infections (UTIs) becomes higher with prolongation of the indwelling period of a catheter. As to the entry of bacteria, ascending UTIs have now attracted attention. In the present study. the metal area was examined bacteriologically and the possibility to use antiseptics for blocking the route of developing infections was investigated. The subjects included 72 patients with an indwelling, urethral catheter inserted post-operatively. These patients were divided into three groups treated with once or twice daily application of povidone-iodine or once daily application of povidone-iodine cream. In these groups, the relation between changes in isolation of bacteria from the meatal area and the incidence of UTI was evaluated. It was found that reduction in bacterial count by antisepsis is effective to prevent ascending UTIs. Moreover, once daily application of povidone-iodine was proven to be effective in male patients. The effective antisepsis in females was twice daily application of povidone-iodine.

Topics: Anti-Infective Agents, Local; Antisepsis; Bacteria; Bacteriuria; Burkholderia; Catheters, Indwelling; Chemoprevention; Colony Count, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Enterococcus; Female; Gram-Positive Bacterial Infections; Humans; Incidence; Iodophors; Male; Postoperative Care; Povidone-Iodine; Sex Factors; Staphylococcal Infections; Staphylococcus; Urethra; Urinary Catheterization; Urinary Tract Infections

Infectious complications of spinal or epidural anaesthesia are rare, particularly after spinal anaesthesia. Most of them consist of a meningitis. We report a case of epidural abscess due to Staphylococcus aureus following spinal anaesthesia in a 62-year-old diabetic patient, diagnosed 45 days after the puncture with bacterial samples and magnetic resonance imaging. The pejorative neurological outcome required a laminectomy in spite of an efficient anti-staphylococcal treatment.

Topics: 4-Quinolones; Abscess; Amikacin; Anesthesia, Spinal; Anti-Infective Agents; Diabetes Mellitus, Type 2; Disease Susceptibility; Drainage; Drug Therapy, Combination; Epidural Space; Fluoroquinolones; Humans; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Oxacillin; Pefloxacin; Postoperative Complications; Povidone-Iodine; Punctures; Quinolones; Spinal Diseases; Staphylococcal Infections

The use of quantitative bacteriology in the burns unit has been thought to be efficient in predicting sepsis or graft loss. To examine the relationship between clinical outcome and bacterial densities on and in the burn wound, 69 biopsy/surface swab pairs were collected from 47 patients on 64 occasions, either immediately prior to excision and grafting, or at routine change of dressings. The mean per cent TBSA burn was 16 (range 1-65). There was a significant correlation between log total bacterial count by biopsy with total white cell count and age (P = 0.028), and a significant negative correlation between total bacterial count by swab with per cent TBSA (P = 0.006). There was no significant difference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in counts between patients with perioperative bacteraemia and those without. With burns > 15 per cent TBSA, a relationship between bacterial counts and subsequent sepsis or graft loss still was not demonstrated. It is suggested that quantitative bacteriology by burn wound biopsy or surface swab does not aid the prediction of sepsis or graft loss.

Topics: Age Factors; Alginates; Anti-Infective Agents, Local; Bacteremia; Bacteria; Bandages; Biopsy; Body Surface Area; Burns; Cerium; Chlorhexidine; Colony Count, Microbial; Follow-Up Studies; Forecasting; Graft Survival; Humans; Leukocyte Count; Linear Models; Povidone-Iodine; Pseudomonas Infections; Silver Sulfadiazine; Skin Transplantation; Staphylococcal Infections; Treatment Failure; Treatment Outcome; 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

The authors report the new protocol the apply for prevention of central venous catheter-related infections in haemodialysis. The used preparation is a combination of protamine sulphate and rifampicin and gives better results that povidone iodine in the same conditions.

Topics: Administration, Cutaneous; Antisepsis; Bacterial Infections; Catheterization, Central Venous; Catheters, Indwelling; Drug Combinations; Equipment Contamination; Humans; Povidone-Iodine; Protamines; Renal Dialysis; Retrospective Studies; Rifampin; Skin; Staphylococcal Infections; Staphylococcus

Given the plethora of techniques available for debridement of contaminated bone, no single method can be considered ideal. Ultrasound has been shown to be less traumatic and more effective for debridement of contaminated soft tissue than either abrasive scrubbing or high-pressure jet irrigation. Using the distal femur and condyle of 23 freshly sacrificed adult Sprague-Dawley rats, this study was undertaken to compare ultrasonication to traditional debridement techniques in (1) their effectiveness in decontaminating trabeculated bone, (2) the subsequent effect of each treatment on bone cell function as measured by protein synthesis, and (3) the direct mechanical effects of each technique on the integrity of the bone structure itself. Ultrasonic debridement was found to be as effective as high-pressure jet irrigation or surgical scrubbing in debridement of contaminated trabeculated bone (no significant statistical difference). Overall activated bone cell function 24 hours after each debridement technique also was found to be equivalent (no significant statistical difference). However, electron microscopy reveals radical structural alterations of the bone after high-pressure jet irrigation or abrasive scrubbing that are not seen with ultrasound debridement. Acutely, the devastating effects of abrasive scrubbing and high-pressure jet irrigation leave an exposed bone matrix not only devoid of any cells but also honeycombed with interstices for entrapment of bacteria and other contaminants. All three debridement methods leave the deeper bone cells viable, but only ultrasound maintains the integrity of the directly involved bone trabeculum to reduce contamination, prevent colonization, and decrease possible infection.

Topics: Animals; Bone Diseases; Bone Matrix; Colony Count, Microbial; Debridement; Femur; Microscopy, Electron, Scanning; Povidone-Iodine; Proline; Protein Biosynthesis; Rats; Rats, Sprague-Dawley; Sodium Chloride; Staphylococcal Infections; Stress, Mechanical; Therapeutic Irrigation; Ultrasonic Therapy

Topics: Adult; Drainage; Drug Therapy, Combination; Humans; Liver Abscess; Male; Methicillin Resistance; Minocycline; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Following cardiac transplantation bacterial mediastinitis is a severe early complication. Between March 1986 and September 1993, cardiac transplant operations were performed in 101 patients, of whom six developed purulent mediastinitis. Treatment consisted of surgical débridement, closed local irrigation, drainage and systemic antibiotics. No patient died as a result of bacterial mediastinitis. Low cardiac output and requirements for resternotomy for bleeding and prolonged artificial ventilation were significantly higher in the group with sternal infection. In contrast, since January 1991 the dose of corticosteroid was decreased from 5 mg/kg per day to 1.5 mg/kg per day beginning on the first day after operation. A total of 51 heart transplant operations have been subsequently performed without sign of mediastinal infection.

Topics: Adult; Bacterial Infections; Combined Modality Therapy; Debridement; Dose-Response Relationship, Drug; Enterococcus; Female; Heart Transplantation; Humans; Immunosuppressive Agents; Male; Mediastinitis; Middle Aged; Postoperative Complications; Povidone-Iodine; Reoperation; Rifampin; Serratia Infections; Staphylococcal Infections; Surgical Wound Infection; Therapeutic Irrigation

In early 1983 we experienced a small scale epidemic of Staphylococcus aureus coagulase type IV in the premature infants unit. Children had bacteraemia or impetigo. The microorganism was resistant to methicillin, erythromycin and lincomycin and was susceptible to tetracycline, chloramphenicol and cefmetazole. The results of coagulase typing and antimicrobial sensitivities indicated that these cases represented nosocomial infection with MRSA. The source and route of the infection were investigated, and measures were taken to prevent bacterial spread from carriers and to keep instruments and environments clean. As the source of infection was not identified, we tried wiping the body surface of the premature infants with a diluted IsodineR solution (10% povidone-iodine; 1:100 dilution) in order to prevent colonization of the microorganism on the body surface. As a result, no additional MRSA infection occurred in the premature infant unit. During the subsequent 6 years of frequent surveys of carriers and wiping the appropriate body surface with diluted IsodineR solution we have had no recurrence of MRSA. None of the premature infants wiped with IsodineR solution showed any objective abnormalities, although laboratory testing disclosed an elevated blood iodine level and a transient mild reduction of T4 in some infants.

Topics: Administration, Topical; Carrier State; Cross Infection; Disease Outbreaks; Environmental Microbiology; Follow-Up Studies; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Japan; Methicillin Resistance; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Thyroid Gland

We investigated the staff in our neonatal intensive care unit (NICU) for the presence of methicillin-resistant Staphylococcus aureus (MRSA) in the nasal cavity, and then applied intranasal povidone-iodine cream to the physicians and nurses working on the unit. Prior to the application of povidone-iodine cream, the isolation rate of S. aureus from the nasal cavity was 30% for the physicians and nurses in contact with NICU patients (contact group), not significantly different from the 33.3% rate for other hospital staff (control group). The isolation rate for the contact group decreased to 10.5% after application of the cream. Although MRSA was not isolated from the nasal cavity of those in the control group, it was isolated from 13.3% of those of the contact group before application of the cream. Nasal MRSA disappeared after use of the cream. No adverse reactions or abnormalities in serum levels of thyroid hormone-related substances were observed in any of the subjects. These results indicated that the nasal application of povidone-iodine cream is safe and effective for eradicating MRSA in the nasal cavity.

Topics: Administration, Intranasal; Carrier State; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infectious Disease Transmission, Professional-to-Patient; Intensive Care Units, Neonatal; Medical Staff, Hospital; Methicillin Resistance; Nasal Cavity; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Thyroid Gland

Survival analysis methods are valuable for detecting intervention effects because detailed information from patient records and sensitive outcome measures are used. The burn unit at a large university hospital replaced routine bathing with total body bathing using chlorhexidine gluconate for antimicrobial effect. A Cox proportional hazards model was used to analyse time from admission until either infection with Staphylococcus aureus or discharge for 155 patients, controlling for burn severity and two time-dependent covariates: days until first wound excision and days until first administration of prophylactic antibiotics. The risk of infection was 55 per cent higher in the historical control group, although not statistically significant. There was also some indication that early wound excision may be important as an infection-control measure for burn patients.

Topics: Anti-Bacterial Agents; Baths; Body Surface Area; Burn Units; Burns; Chlorhexidine; Clinical Protocols; Hospitals, University; Humans; Incidence; Infection Control; Length of Stay; Povidone-Iodine; Proportional Hazards Models; Risk Factors; Staphylococcal Infections; Time Factors; Treatment Outcome

This study examines the effects of povidone iodine, normal saline, and cefazolin alone and after scrubbing on bacterial counts in contaminated animal lacerations. Twelve albino guinea pigs each received four lacerations inoculated with a standard inoculum of Staphylococcus aureus. Twelve hours after inoculation, each wound was biopsied to ensure contamination and then either treated or left as an untreated control. One wound on each animal was an untreated control. The remaining three lacerations on six pigs were irrigated with cefazolin (CZ) solution, normal saline, or 1% (wt/vol) povidone iodine solution (PI). Three lacerations on another six pigs were treated with 20% poloxamer 188 scrub (scrub) alone, scrub followed by PI irrigation (SCR/PI), or scrub followed by CZ irrigation (SCR/CZ). Quantitative bacteriology was performed on tissue biopsies 2 hours (time 1), 7 hours (time 2), and 12 hours (time 3) after irrigation. Posttreatment counts for PI, CZ, and normal saline irrigation were not different from control or one another (P > .05). Bacterial counts for SCR/PI were significantly lower than control (P < .05) for all posttreatment biopsies (1.8 to 2.9 mean log(10) decrease). SCR/CZ was significantly lower than control (P < .05) at times 2 and 3 only (1.7 to 2.0 mean log(10) decrease). In this guinea pig model, cleansing 12-hour-old lacerations contaminated with S aureus using SCR/PI or SCR/CZ significantly reduced bacterial counts over 12 hours.

Topics: Animals; Cefazolin; Colony Count, Microbial; Disinfection; Guinea Pigs; Povidone-Iodine; Sodium Chloride; Staphylococcal Infections; Staphylococcus aureus; Therapeutic Irrigation; Wound Infection

Iodine is known as a local disinfectant substance for more than 100 years. Its use however was restricted due to strong local irritation. In the last 25 years Polyvinylpyrrolidon-Iodine solutions (Povidone-Iodine, PVP-Iodine, Betadine) has become more and more popular for treating traumatologic, surgical and orthopaedic infections. However several papers have reported changes in the blood chemistry (T3, T4, TSH, PBJ and Iodine excretion in the urine) after utilizing PVP-Iodine, especially in visceral surgery. We report on a patient in whom a massive iodine resorption with clinical signs of hyperthyroidism occurred, with soft tissue necrosis at the site of irrigation.

Topics: Adult; Amputation, Traumatic; Humans; Hyperthyroidism; Knee Injuries; Male; Postoperative Complications; Povidone-Iodine; Reoperation; Staphylococcal Infections; Streptococcal Infections; Suction; Surgical Wound Infection; Therapeutic Irrigation

Preoperative eyes which had been treated with gentamicin for one-half day were subjected to one of two povidone-iodine (PI) preparations. The control eye was prepared using a previously described 5% PI one-drop technique, while the paired eye was irrigated with a 0.02% PI solution. Aerobic and anaerobic bacterial cultures were taken of each eye before and after PI applications. Statistical analysis of the data indicates that both techniques were equally effective in reducing surface colonization of the anaerobic cocci and bacilli, the viridans streptococci and micrococci. Both methods were also equally ineffective in reducing the numbers of coagulase-negative staphylococci from the surface of the eye. With the apparent emergence of gentamicin-resistant coagulase-negative staphylococci the potential for staphylococcal endophthalmitis is increasing.

Topics: Colony Count, Microbial; Endophthalmitis; Eye Diseases; Humans; Military Personnel; Postoperative Complications; Povidone-Iodine; Preoperative Care; Staphylococcal Infections; Therapeutic Irrigation

Topics: Anti-Infective Agents, Local; Burns; Drug Combinations; Humans; Nitrofurazone; Potassium Iodide; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Antibacterial activity of surgical adhesive films containing various antiseptics in the adhesive layer was studied experimentally. It was shown that the adhesive films containing 0.1 to 1% (in terms of active iodine) of iodopyrone had a stable bactericidal action and were effective against to the main causative agents of surgical infections, i. e. Staphylococcus spp., E. coli, Klebsiella spp., Pseudomonas aeruginosa and others.

Topics: Anti-Infective Agents, Local; Antisepsis; Drug Combinations; Drug Evaluation, Preclinical; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Occlusive Dressings; Potassium Iodide; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Tissue Adhesives

This paper describes an approach to the treatment of exposed pacemaker generator and electrode. Local infection is controlled by the administration of systemic antibiotics and topical antibacterial solutions. Because the generator and lead are enveloped by an inert synthetic coating, it is possible to eradicate an infection without their removal if it is due to a weak opportunist pathogen fully sensitive to antibiotics. Thereafter, subcapsular relocation of the exposed generator or vertical-to-horizontal transposition of the exteriorised lead is carried out. These surgical interventions are designed to overcome the vertical force which tends to cause the extrusion of the pacing hardware.

Topics: Aged; Anti-Bacterial Agents; Female; Humans; Male; Methods; Pacemaker, Artificial; Postoperative Complications; Povidone-Iodine; Reoperation; Staphylococcal Infections; Surgical Wound Infection

The bactericidal action of three formulations of a povidone-iodine (PVI) complex in vitro, in vivo, and in the presence of competing organic matter was evaluated. Bacterial organisms included Staphylococcus aureus ATCC 25923 and 25 clinical isolates of Staph. aureus, designated KU 1-25. For the in vitro studies, 1.0 mL of bacterial inoculum containing 10(7) organisms was introduced into 9.0 mL of chemically stable 10% and 1% PVI formulations in sterile culture tubes, and 1.0-mL samples were withdrawn at set intervals. Samples were plated by using standard techniques and incubated for 24 hours, after which colony-forming units were counted. For in vivo studies, 0.1 mL of 10(6) Staph. aureus ATCC 25923 or KU inoculum was deposited on the dorsum of the hand of healthy human subjects. This area was wiped with a cotton swab saturated with 1%, 2.5%, or 10% PVI formulations. Samples were taken at 15 and 30 seconds after application of the iodophor. To test the bactericidal activity of the three formulations in the presence of a competing substrate, a swab soaked with sterile sheep's blood was applied to the skin and allowed to dry. The percentage of 10(4) Staph. aureus inoculum recovered allowed for comparison of the three products. In vitro, the 1% PVI formulation was bactericidal for 10(7) Staph. aureus within two minutes, as compared with the four minutes required by 10% PVI. On the skin contaminated with 10(6) organisms, the rates of killing within 30 seconds were comparable for both solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Humans; Microbial Sensitivity Tests; Povidone; Povidone-Iodine; Skin; Staphylococcal Infections; Staphylococcus aureus; Temperature

In January 1983, a number of premature infants under management in the premature infants' unit of our hospital were found to have bacteremia due to Staphylococcus aureus. By the end of February of the same year, 4 of these infants, who had been treated in the same unit, developed impetigo. The S. aureus responsible for this condition was classified as type IV by a coagulase typing. In a subsequent antimicrobial susceptibility test using the disk diffusion method, this microorganism was found to be resistant to methicillin, erythromycin and lincomycin, and to be susceptible to tetracycline, chloramphenicol and cefmetazole, indicating that it was a methicillin resistant S. aureus (MRSA). Because the result from the coagulase typing agreed with the antimicrobial susceptibility pattern in all cases, we concluded that these cases represented nosocomial infection with MRSA. The source and route of the infection were investigated, and measures taken to prevent bacterial spread from carriers and to keep instruments and environments clean. Although the source of infection was not identified. Then, we tried wiping the body surface of the premature infants with an Isodine solution (10% PVP-I, 1:100 dilution) in order to prevent colonization of the microorganism on the body surface. With this application+, MRSA was no longer detected from the body surface of the premature infants, and no additional MRSA infection occurred in the premature infants' unit. Data collected for premature infants' managed at our hospital in the subsequent 6 years allows us to conclude that MRSA infection can be almost completely controlled by frequent surveys of carriers and appropriate body surface wiping with Isodine solution.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cross Infection; Disinfection; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Methicillin; Penicillin Resistance; Povidone; Povidone-Iodine; Solutions; Staphylococcal Infections; Staphylococcus aureus; Sterilization

Topics: Animals; Drug Combinations; Potassium Iodide; Povidone; Povidone-Iodine; Pseudomonas Infections; Rabbits; Staphylococcal Infections; Wound Infection

Both tarsocrural joints of 4 horses were inoculated with 1.5 X 10(5) colony-forming units of Staphylococcus aureus. On days 1, 3, and 6, each horse had one tarsocrural joint lavaged with a balanced electrolyte solution and had the contralateral tarsocrural joint lavaged with 0.1% povidone-iodine solution. All horses were orally administered trimethoprim (5 mg/kg)/sufadiazine (25 mg/kg) combination twice daily and phenylbutazone (2 g) once daily for the duration of the study (21 days). On days 0, 1, 3, 6, 9, 14, and 21, synovial fluid specimens were collected and analyzed for color, clarity, total protein concentration, WBC count and differential, and mucin clot-forming ability. Synovial fluid specimens collected on days 1, 3, 6, 9, 14, and 21 were bacteriologically cultured. On day 21, all horses were euthanatized, the tarsocrural joints were opened and examined, synovial membrane specimens were collected, bacteriologically cultured, and histologically evaluated, and articular cartilage specimens were histochemically evaluated. Repeated measures analysis of variance were used to evaluate differences between lavage solutions and among days for objective measurements. A paired t test was used to evaluate differences between solutions for the indices of synovial membrane inflammation and articular cartilage staining intensity with safranin-O-fast green. To be considered significant, the probability of a type-I error was less than 0.05. Significant differences were not found between joints lavaged with electrolyte solution vs povidone-iodine solution for synovial total protein concentration, WBC count, results of synovial fluid and membrane bacteriologic culture, synovial membrane inflammation, or articular cartilage glycosaminoglycan concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Analysis of Variance; Animals; Arthritis, Infectious; Horse Diseases; Horses; Joints; Povidone; Povidone-Iodine; Staphylococcal Infections; Synovial Fluid; Synovial Membrane; Therapeutic Irrigation

Infection is an uncommon but unfortunate complication of prosthetic arterial bypass grafting. Because previously described methods of treatment of such infections which do not involve excision of the graft have not met with uniform success, we undertook a study of the efficacy of silver sulfadiazine cream in the treatment of Staphylococcus aureus infections of polytetrafluoroethylene carotid artery bypass grafts in dogs. At the time of bilateral grafts placement in 14 dogs, wounds were inoculated with at least 2 X 10(7) organisms. Three days later all wounds were opened. The wounds of seven dogs were treated with daily applications of silver sulfadiazine cream and the wounds of the other dogs were treated with daily applications of povidone iodine ointment. The dogs were sacrificed at 30 days or at the earliest evidence of arterial beeding from the wounds, whichever came first. Cultures of the wound were taken, and graft and artery histologic findings were studied at the time of sacrifice. Although survival of the dogs treated with silver sulfadiazine was marginally better than that of the dogs treated with povidone iodine, viable bacteria were present in microabscesses in many apparently healed wounds in the former group. We conclude that daily applications of silver sulfadiazine cream does not reliably eradicate staphylococcal infections involving polytetrafluoroethylene arterial bypass grafts.

Topics: Abscess; Administration, Topical; Animals; Blood Vessel Prosthesis; Dogs; Female; Male; Ointments; Polytetrafluoroethylene; Povidone-Iodine; Silver Sulfadiazine; Staphylococcal Infections; Sulfadiazine; Surgical Wound Infection

A reduction in the incidence and duration of methicillin-resistant Staphylococcus aureus infection and colonization was obtained by the introduction of a rigorous control programme. This included computerization of data, improved nursing practices and an antiseptic routine.

Topics: Anti-Infective Agents, Local; Australia; Baths; Cross Infection; Drug Resistance; Hand Disinfection; Hospitals, District; Humans; Methicillin; Povidone; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Topical; Anti-Bacterial Agents; Burns; Chlorhexidine; Gentamicins; Humans; Kinetics; Mafenide; Polymyxins; Povidone-Iodine; Pseudomonas Infections; Silver Nitrate; Silver Sulfadiazine; Staphylococcal Infections; Streptococcal Infections; Wound Infection

An experimental wound infection model was used to assess the value of four proprietary antiseptics applied topically in preventing the development of wound sepsis. Irrigation of wounds with either saline or noxytiolin 15 min after contamination with Staphylococcus aureus did not reduce either the incidence or degree of infection. Benzalkonium chloride and, to a lesser degree, povidone-iodine significantly reduced the infection rate, but were inferior to chlorhexidine gluconate which eliminated all overt signs of infection. The rate of healing of the chlorhexidine-treated, contaminated wounds was found to be no different from control non-infected wounds. When irrigation was carried out 45 min before wounds were contaminated, chlorhexidine was the only treatment which reduced the rate of infection (P less than 0.001). It is concluded that the superior activity of chlorhexidine in this model is a good indication that it should be a highly effective agent in the prevention of staphylococcal wound infection, and that this is probably due to a combination of bactericidal and persistent action together with low toxicity.

Topics: Animals; Anti-Infective Agents, Local; Benzalkonium Compounds; Chlorhexidine; Female; Guinea Pigs; Mice; Noxythiolin; Povidone-Iodine; Staphylococcal Infections; Surgical Wound Infection; Therapeutic Irrigation; Wound Infection

In a series of 68 operations for insertion or revision of cerebrospinal fluid shunts the incidence of infection was reduced from 20% in controls to 4.2% when systemic and intrathecal or intra-shunt gentamicin prophylaxis was employed. The only infection occurring in the latter group was due to an organism resistant to gentamicin. No reduction in infection rate was noted when povidone iodine was instilled into the wounds.

Topics: Cerebrospinal Fluid Shunts; Child; Drug Resistance, Microbial; Gentamicins; Humans; Povidone; Povidone-Iodine; Premedication; Staphylococcal Infections; Streptococcal Infections; Surgical Wound Infection

A preliminary evaluation of the antiseptic activity of 70% alcohol and 10% povidone-iodine solution was carried out in an animal model. After the inoculation of partial-thickness wounds with Staphylococcus aureus, 0.1 mL of the antiseptic agent (70% alcohol or povidone-iodine solution) was rubbed into the wound for 30 s. The agent was left on the wound for one minute, three minutes, and 24 hours, and then the wounds were cultured for bacteria. After one minute, the treatments did not reduce the number of pathogens. After three minutes, both 70% alcohol and povidone-iodine solution produced a slight reduction, and after 24 hours, povidone-iodine solution slightly reduced the number of pathogenic bacteria that could be cultured. However, after 24 hours, neither agent reduced the number of pathogens below 10(5) colony-forming units per milliliter. These preliminary data suggest that single applications of 70% alcohol or povidone-iodine may have very limited efficacy as antiseptic agents for the treatment of superficial wounds.

Topics: Animals; Anti-Infective Agents, Local; Disease Models, Animal; Ethanol; Povidone; Povidone-Iodine; Rabbits; Solutions; Staphylococcal Infections; Staphylococcus aureus; Swine; Wound Infection

The effect of dilute solutions of hydrogen peroxide, povidone-iodine, and acetic acid on a chronic Staphylococcus epidermidis bacteriuria was studied to determine whether direct bladder instillation of the antimicrobial solutions would reduce or eliminate the bacterial count. In vivo instillation of volumes ranging from 50 to 400ml and retained for 30 seconds to 48 hours was evaluated. The effect of the antimicrobial solution on bacterial survival in urine was also measured in vitro through quantitative analysis of the mixture at various times over 24 hours. Instillation of the antimicrobial solutions into the bladder had no measurable effect on the established bacteriuria. Symptoms of discomfort related to such a manipulation were least evident with hydrogen peroxide. In vitro, hydrogen peroxide had an antimicrobial effect as reflected by the reduction of the number of surviving organisms. Despite inefficacy in a case of already established bacteriuria, hydrogen peroxide appears worthy of study as a prophylactic agent against a variety of organisms because it exhibits in vitro efficacy and minimal in vivo symptoms.

Topics: Acetates; Acetic Acid; Adult; Bacteria; Bacteriuria; Humans; Hydrogen Peroxide; Povidone-Iodine; Staphylococcal Infections; Staphylococcus epidermidis; Urinary Bladder

Nine postmilking teat dips were evaluated by an experimental challenge model against either Staphylococcus aureus, Streptococcus agalactiae, or both. Formulations containing .9 and .6% sodium hypochlorite, 1% sodium dichloro-s-triazene-trione, .55% chlorhexidine gluconate, and .35% povidone iodine reduced incidence of Staphylococcus aureus infections 56.8, 28.3, 75.9, 92.5, and 77.9%. Incidence of infections with Streptococcus agalactiae was reduced 48.1 and 63.2% by 1.7 and 1% sodium dichloro-s-triazene-trione formulations. The 1% chlorhexidine gluconate and .35% povidone iodine products reduced Streptococcus agalactiae infections 71.0 and 67.0%. Three experimental 1% iodophor formulations reduced Streptococcus agalactiae infections 28.9, 44.8, and 50.7%. The experimental challenge model was refined further and provided an efficient method to determine efficacy of postmilking teat dips.

Topics: Administration, Topical; Animals; Cattle; Chlorhexidine; Disinfectants; Drug Evaluation; Female; Iodophors; Mammary Glands, Animal; Mastitis, Bovine; Povidone-Iodine; Sodium Hypochlorite; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus agalactiae; Triazines

Topics: Animals; Anti-Infective Agents; Contracture; In Vitro Techniques; Mammary Glands, Animal; Methods; Mice; Mice, Inbred Strains; Povidone; Povidone-Iodine; Prostheses and Implants; Silicones; Staphylococcal Infections; Surgical Wound Infection; Tensile Strength

Using an experimental animal model, the infection rate of contaminated bone grafts after irrigation with either normal saline, povidone-iodine, or a cefazolin solution was evaluated. Mechanical cleansing appears to be the important factor in preventing infection in these grafts, since all the solutions showed almost equal effectiveness. As the amount of bulk and dead space increases, particularly in Pseudomonas infections, povidone-iodine might be slightly superior, although this difference was not statistically significant.

Topics: Animals; Bone Transplantation; Cefazolin; Disinfection; Povidone-Iodine; Pseudomonas Infections; Rabbits; Ribs; Saline Solution, Hypertonic; Staphylococcal Infections; Sterilization; Surgical Wound Infection; Transplantation, Autologous; Transplantation, Homologous

Topics: Aged; Bacterial Infections; Cardiac Surgical Procedures; Child, Preschool; Enterobacter; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Humans; Infant; Klebsiella Infections; Male; Mediastinal Diseases; Middle Aged; Povidone; Povidone-Iodine; Proteus Infections; Pseudomonas Infections; Serratia; Staphylococcal Infections; Sternum; Streptococcal Infections; Surgical Wound Infection; Therapeutic Irrigation

Topics: Administration, Topical; Adolescent; Adult; Aged; Burns; Candidiasis; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Infection Control; Klebsiella Infections; Male; Middle Aged; Ointments; Povidone; Povidone-Iodine; Proteus Infections; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections

Topics: Aged; Arrhythmias, Cardiac; Bacitracin; Cephalothin; Female; Humans; Kanamycin; Neomycin; Oxacillin; Pacemaker, Artificial; Penicillin V; Penicillins; Povidone-Iodine; Staphylococcal Infections; Wound Infection

Topics: Animals; Anti-Infective Agents, Local; Debridement; Detergents; Guinea Pigs; Hexachlorophene; Povidone; Povidone-Iodine; Staphylococcal Infections; Wound Healing; Wound Infection