povidone-iodine and Urinary-Tract-Infections

We identify which nonantibiotic strategies could reduce the risk of infectious complications following prostate biopsy.. We performed a literature search on MEDLINE®, Embase® and the Cochrane Database for randomized controlled trials (inception to May 2020) assessing nonantibiotic interventions in prostate biopsy. Primary outcome was pooled infectious complications (fever, sepsis and symptomatic urinary tract infection) and secondary outcome was hospitalization. Cochrane risk of bias tool and GRADE approach were used to assess the bias and the certainty of evidence. The study protocol was registered with PROSPERO (CRD42015026354).. Transperineal biopsy significantly reduces infectious complications compared to transrectal biopsy and should therefore be preferred. If transrectal biopsy is performed, rectal preparation with povidone-iodine is highly recommended. The other investigated nonantibiotic strategies did not significantly influence infection and hospitalization after prostate biopsy.

Topics: Anti-Infective Agents, Local; Bacterial Infections; Biopsy; Humans; Male; Postoperative Complications; Povidone-Iodine; Prostate; Randomized Controlled Trials as Topic; Urinary Tract Infections

Prostate biopsy is mostly performed through the transrectal route worldwide and infectious complications may occur in up to 7% of cases. Therefore, alternative strategies to decrease infectious complications are needed. Our aim was to evaluate the effectiveness of intrarectal povidone-iodine cleansing plus formalin disinfection of the needle tip in decreasing infectious complications after transrectal ultrasound guided prostate biopsy.. We conducted a prospective, single-center, phase III trial in patients undergoing transrectal ultrasound guided prostate biopsy randomized 1:1 to rectal mucosa cleansing with gauze soaked in 10% povidone-iodine solution wrapped around the gloved index finger and needle tip disinfection by immersion in a 10% formalin solution before each puncture vs control group. The primary end point was the rate of infectious complications defined as 1 or more of the following events: fever, urinary tract infection, or sepsis.. Overall, 633 patients were randomized to the intervention group and 623 to the control group. The infectious complication rate was 3.9% in the intervention group and 6.4% in the control group (RR 0.61; 95% CI 0.36-0.99;. Intrarectal povidone-iodine cleansing plus formalin disinfection of the biopsy needle tip was associated with a reduction in infectious complications after transrectal prostate biopsy.

Topics: Anti-Infective Agents, Local; Biopsy; Disinfection; Formaldehyde; Humans; Male; Povidone-Iodine; Prospective Studies; Prostate; Sepsis; Urinary Tract Infections

Office cystoscopy may be associated with urinary tract infection (UTI) in up to 10-20% of patients. Current practice of surgical part preparation in males with povidone-iodine excludes distal urethra in males, leaving a possibility for resident intra-urethral flora to cause post-procedural UTI. We designed this randomized study to assess whether additional cleaning of distal urethra with povidone-iodine solution can help reduce post-procedural incidence of UTIs in this setting. Additionally, urethral swab culture was done in the entire cohort to identify the prevalent microflora in the distal male urethra and to evaluate its role in causation of post-procedural UTI. Using a specialized urethral swab culture methodology, 85% males demonstrated some bacteria and 16% showed common uro-pathogens. 28 (14.5%) cases had post-procedure culture positive UTI. The incidence of UTI in control group (22%) was significantly more than the intervention group (7%) (p value <0.007). This result strongly supports inclusion of distal urethral irrigation with povidone-iodine in males before office cystoscopy, even when pre-procedure mid-stream urine culture is sterile.

Topics: Adolescent; Adult; Aged; Bacteria; Cohort Studies; Cystoscopy; Humans; Male; Middle Aged; Povidone-Iodine; Urethra; Urinary Tract Infections; Young Adult

To compare urinary infection rate in children cleaned with sterile water versus a 10% povidone-iodine before bladder catheterization.. Prospective randomized controlled study of children requiring bladder catheterization in the emergency department whose parents consented to the study were randomly assigned to either of 2 groups, in which sterile water (the "sterile water" group) or 10% povidone-iodine (the "10% povidone-iodine" group) was to be used for peri-urethral cleansing prior to catheterization.. The sterile water group had 92 patients and the povidone-iodine group had 94. Most children (87%) were under 12 months of age. Urine cultures were positive in 16% of children in the povidone-iodine group and in 18% in the water group. There was no significant difference in signs and symptoms between the 2 groups. There was no significant association between solution preparation and cultures on univariate regression analysis.. Cleaning the periurethral area of children with sterile water prior to catheterization is not inferior to cleaning with povidone-iodine.

Topics: Anti-Infective Agents, Local; Catheter-Related Infections; Catheters, Indwelling; Colony Count, Microbial; Disinfection; Female; Humans; Infant; Male; Ontario; Povidone-Iodine; Prevalence; Prospective Studies; Urethra; Urinary Catheterization; Urinary Tract Infections; Water

It was shown that prophylactic use of ciprofloxacin (500 mg per os 30 min prior to and 5 days after transrectal multifocal prostatic biopsy) along with topical treatment with 40 ml 1% povidone-iodine and evacuant enema provided negative bacteriological urine analysis in 24 hours for 94.4 per cent of cases. Positive effect was registered for all patients as no urinary tract infections were demonstrated. Transitory fever over 37.5 degrees C was not registered at 67 (97.2 per cent) patients, for the rest cases no changes of the treatment regime were necessary. The results of the trial proves high bacteriological and clinical efficacy of the therapy regimes and allow to recommend its implementation at transrectal biopsy.

Topics: Administration, Topical; Anti-Infective Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacteriuria; Biopsy; Ciprofloxacin; Fever; Humans; Male; Povidone-Iodine; Prostate; Rectum; Urinary Tract Infections; Urine

The automatic release of povidone iodine (PVP-I) into the outlet tube of a urinary collecting bag significantly reduced urinary tract infections (UTIs) and provided a more practical bacterial barrier than manual instillation of PVP-I into the bag as used previously. In 52 patients using a new urinary drainage system with a cartridge that released PVP-I into the outlet tube of the collection bag UTIs developed in 3, compared with 57 patients using a standard closed drainage system and in whom 13 UTIs developed (p less than 0.005). The PVP-I group had 92 percent of the accumulative catheter-days free of bladder infection, compared with 77 percent in the standard group. The main route of bacterial contamination leading to urinary drainage UTIs was through the collection bag.

Topics: Adult; Cross Infection; Drainage; Female; Humans; Male; Middle Aged; Povidone; Povidone-Iodine; Random Allocation; Urinary Catheterization; Urinary Tract Infections

Twenty-three patients who underwent abdominoperineal resection for rectal adenocarcinoma were entered into a prospective study to determine the efficacy of periodic instillation of Betadine into the urinary drainage system as a prophylactic measure for catheter-associated urinary tract infections. We decided to use a control group of 33 consecutive patients done in the period just preceding the starting of this prospective study. In both groups the mean duration of the Foley catheter drainage was similar. Eight of eight female patients in the treatment group and six of seven patients in the control group developed a urinary tract infection. However, only five of 15 male patients (33%) in the treatment group whereas 16 of 26 males in the control group (61%) developed a urinary tract infection. Thus, the addition of Betadine in the drainage system of urinary indwelling catheters was associated with a 50% decrease in the incidence of urinary tract infections in males.

Topics: Abdomen; Adult; Aged; Aged, 80 and over; Catheters, Indwelling; Equipment Contamination; Female; Humans; Male; Middle Aged; Perineum; Povidone; Povidone-Iodine; Rectal Neoplasms; Urinary Catheterization; Urinary Tract Infections

Topics: Female; Humans; Postoperative Complications; Povidone; Povidone-Iodine; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections; Vagina

Bladder irrigation with povidone-iodine in the prevention of urinary-tract infections after single or intermittent urethral catheterisation was investigated in a controlled study. In the control group (36 patients) the catheter was removed after urethral catheterisation and emptying of the bladder, and in the trial group (42 patients) 50 ml povidone-iodine 2% was instilled and allowed to drain immediately before removal of the catheter. The incidence of bacteriuria was 28% in the control group and 4% in the povidone-iodine group. After the introduction of bladder irrigation with povidone-iodine in the orthopaedic department of Leiden University Hospital the incidence of hospital-acquired bacteriuria fell from 6.9% to 3.7%.

Topics: Adolescent; Adult; Aged; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Povidone; Povidone-Iodine; Therapeutic Irrigation; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections

A randomized, controlled study tested the value of a povidone-iodine (PVP-I) lubricant ('Betadine' lubricating gel), in preventing microbial contamination of bladder urine during catheterization. Urine samples, for culture, were obtained by suprapubic aspiration both before passage, and after removal 15 min later, of a no. 16 Foley catheter coated with the test lubricant or with a control preparation ('K-Y' lubricating jelly). Each treatment group included 10 men and five women. Swab cultures of the anterior urethra, taken immediately before catheterization, demonstrated substantial urethral contamination. Thirteen test subjects and 15 controls qualified for the efficacy analysis and all 30 took part in the safety evaluation. Before catheterization, mean colony counts per 5 ml urine numbered 0.3 in the (PVP-I) treated group and 0.4 among controls. After catheter passage, the mean counts were respectively, 3.6 and 69.6 per 5 ml. Thus, catheters coated with PVP-I lubricating gel transported significantly fewer (P less than 0.03) viable contaminants to bladder urine than those covered with 'K-Y' jelly. The organisms most frequently identified in urethral swabs and pre-study midstream clean-catch specimens also predominated in post-catheterization urine, but their incidence was considerably lower among the PVP-I treated subjects than among controls. Lubricity, cohesiveness and adhesiveness were more satisfactory in the test group than in the control series. No adverse reactions occurred and both preparations, as well as the mechanical procedures, were well tolerated. The findings demonstrated the efficacy of the PVP-I lubricant in preventing transfer of viable urethral organisms to the bladder during catheterization.

Topics: Adult; Anti-Infective Agents, Urinary; Bacteria; Catheters, Indwelling; Drug Evaluation; Equipment Contamination; Female; Gels; Humans; Male; Povidone; Povidone-Iodine; Urethra; Urinary Catheterization; Urinary Tract Infections

We randomized 64 patients with a history of recurrent urinary tract infections among 3 regimens of long-term (1 year) prophylactic treatment: 20 were given 100 mg. trimethoprim at night, 25 received 1,000 mg. methenamine hippurate every 12 hours and 19 were asked to cleanse the perineum (especially the periurethral area) twice daily with povidone-iodine solution. The progress of patients in terms of urinary symptoms and/or bacteriuria, changes in periurethral flora, side effects, and hematological and biochemical profiles was followed at regular intervals. All treatments were effective in reducing the incidence of symptomatic attacks when compared to the 12 months immediately before therapy and there was little to choose between the individual regimens on this account. However, trimethoprim was tolerated better than were the other 2 treatment regimens. In the group given trimethoprim most of the breakthrough infections (71.4 per cent) that occurred were caused by trimethoprim-resistant organisms (usually Escherichia coli), while in the other 2 groups the incidence of trimethoprim-resistant organisms causing infection was low (2.7 per cent). Treatment with trimethoprim reduced significantly the periurethral colonization of Escherichia coli.

Topics: Administration, Topical; Adult; Clinical Trials as Topic; Drug Eruptions; Drug Resistance, Microbial; Escherichia coli Infections; Female; Gastrointestinal Diseases; Hippurates; Humans; Methenamine; Perineum; Povidone; Povidone-Iodine; Random Allocation; Time Factors; Trimethoprim; Urinary Tract Infections

After routine cleansing enemas 80 patients were randomized to undergo irrigation of the rectal vault with either povidone-iodine or saline. A transrectal prostatic needle biopsy then was performed. Antimicrobials were not used before biopsy and were only ordered after biopsy if fever developed or a positive urine culture was obtained. Over-all, 41 per cent of the patients had positive urine cultures post-biopsy and 44 per cent had febrile episodes. There was no significant difference between the group receiving the povidone-iodine versus those receiving saline irrigations.

Topics: Anti-Bacterial Agents; Biopsy, Needle; Humans; Male; Povidone-Iodine; Prostate; Rectum; Sodium Chloride; Therapeutic Irrigation; Urinary Tract Infections

To evaluate the efficacy of daily cleansing of the urethral meatus-catheter junction in preventing bacteriuria during closed urinary drainage, randomized, controlled trials of two widely recommended regimens for meatal care were completed. In 32 (16.0 percent) of 200 patients given twice daily applications of a povidone-iodine solution and ointment bacteriuria was acquired, as compared with 24 (12.4 percent) of 194 patients not given this treatment. In 28 (12.2 percent) of 229 patients given once daily meatal cleansing with a nonantiseptic solution of green soap and water bacteriuria was acquired, as compared with 18 (8.1 percent) of 23 patients not given special meatal care. There was no evidence in either trial of a beneficial effect of meatal care. Moreover, each of four different statistical methods indicated that the rates of bacteriuria were higher in the treated groups than in the untreated groups. In subsets of female patients at high risk in both studies significantly higher rates of bacteriuria were noted in the treated groups than in the untreated groups. Current methods of meatal care appear to be hazardous, as well as expensive, and cannot be recommended as measures to control infection.

Topics: Administration, Topical; Adult; Bacteriuria; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Ointments; Povidone-Iodine; Soaps; Urethra; Urinary Catheterization; Urinary Tract Infections

Topics: Humans; Povidone; Povidone-Iodine; Therapeutic Irrigation; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections

Antiseptic vaginal preparation is recommended before gynecologic surgery; however, there is a lack of data regarding the effectiveness of different agents.. To compare rates of postoperative infectious complications and hospital utilization with preoperative vaginal preparation using povidone-iodine or chlorhexidine before hysterectomy.. This was a retrospective analysis of patients who underwent hysterectomy for gynecologic indications at 70 hospitals in a statewide surgical collaborative between January 2017 and December 2019. The primary outcome was postoperative infectious complications (including urinary tract infection, surgical site infections involving superficial, deep, or organ space tissues, or cellulitis) within 30 days of surgery. To adjust for confounding, propensity score matching, 1:1 without replacement and with a caliper of.005 was performed to create cohorts that had vaginal preparation with either povidone-iodine or chlorhexidine and did not differ in observable characteristics. We compared the rates of infectious morbidity and hospital utilization (emergency department visits, readmission, reoperation) in the matched cohorts.. In the statewide collaborative, there were 18,184 patients who received povidone-iodine and 3018 who received chlorhexidine. After propensity score matching of 2935 pairs, the povidone-iodine and chlorhexidine groups did not differ in demographics, comorbidities, choice of preoperative antibiotics, benign vs malignant surgical indication, and surgical approach. Povidone-iodine was associated with a lower rate of infectious morbidity (3.0% vs 4.3%; P=.01), urinary tract infection (1.1% vs 1.7%; P=.03) and emergency department visits (7.9% vs 9.7%; P=.01) than with chlorhexidine. There were nonsignificant trends of lower rates of surgical site infection (2.0% vs 2.7%; P=.07) and reoperation (1.6% vs 2.1%; P=.18).. This propensity score matched analysis provides evidence that povidone-iodine is preferable to chlorhexidine for vaginal preparation before hysterectomy because of lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were approximately 1%, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Emergency Service, Hospital; Female; Humans; Hysterectomy, Vaginal; Matched-Pair Analysis; Middle Aged; Patient Readmission; Povidone-Iodine; Preoperative Care; Propensity Score; Reoperation; Retrospective Studies; Surgical Wound Infection; Urinary Tract Infections

To determine if daily povidone-iodine (PI) bladder irrigation in neurogenic lower urinary tract dysfunction (NLUTD) patients doing clean intermittent catheterization (CIC) can reduce the rate of symptomatic urinary tract infections (UTIs), emergency department (ED) visit for UTIs, and hospitalization for UTIs.. We prospectively reviewed the records of patients with NLUTD on CIC who had recurrent symptomatic UTIs and who were placed on daily intravesical instillations of PI. This trial was conducted from January 2014 to January 2020 on 119 patients.. After using daily PI bladder irrigation, the rate of symptomatic UTIs was reduced by 99.2% (incidence rate ratio [IRR]: 0.008, 95% confidence interval [CI]: 0.001-0.059; p < .001), the rate of ED visits was reduced by 99.2%% (IRR: 0.008, 95% CI: 0.001-0.059; p < .001), and the rate of inpatient hospitalizations for UTI was reduced by 99.9% (IRR: 0.0008, 95% CI: 0.0002-0.0035; p < .001). There was also a significant decrease in multidrug resistance in UTI organisms with the use of PI bladder instillation.. Daily intravesical PI instillation is a well-tolerated approach to prevent UTIs and related ED visits and hospitalizations in NLUTD patients doing CIC.

Topics: Adolescent; Adult; Female; Humans; Incidence; Intermittent Urethral Catheterization; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Therapeutic Irrigation; Urinary Bladder, Neurogenic; Urinary Tract Infections; Young Adult

To assess the effects of three different bowel preparation methods on the incidence of infectious complications in patients who underwent transrectal ultrasonography-guided prostate biopsy.. The standard bowel preparation protocol for prostate biopsy has not been established.. A retrospective study in a single centre.. From January 2013-December 2015, the clinical records of 1,130 patients who underwent prostate biopsy were, respectively, reviewed. All the patients received metronidazole prophylaxis before biopsy. The patients were divided into three groups according to the bowel preparation methods: patients in Group A (n = 402) received only soapy enema; patients in Group B (n = 413) received polyethylene glycol; while patients in Group C (n = 315) received polyethylene glycol plus povidone-iodine enema. Infectious complications were classified as fever (>37.5°C), urinary tract infection and sepsis. The postoperative adverse events were also observed.. The overall postbiopsy infectious complications were observed in 48 (4.25%) patients of all the cases, including 23 (5.72%) cases in Group A, 20 (4.84%) cases in Group B and five patients (1.59%) in Group C. There was significant difference among the groups (p = .018). In detail, these infectious complications included 22 (1.95%) cases of fever and 26 (2.30%) cases of urinary tract infection. No sepsis was observed among the total patients. The incidence of adverse events was 14.43% (58/402) occurred in Group A, 25.91% (107/413) in Group B and 26.67% (84/315) in Group C. The difference was statistically significant.. Our study confirmed that combined preparation regimens of polyethylene glycol with povidone-iodine enema could significantly reduce the postbiopsy infection rate. Conventional soapy enema is associated with less adverse events.. Findings of this study provide useful evidence-based information for healthcare professionals. The application of combined preparation regimens of polyethylene glycol with povidone-iodine enema resulted in better improvement in the prevention of postbiopsy infection.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Biopsy; Cathartics; Enema; Humans; Male; Middle Aged; Polyethylene Glycols; Postoperative Complications; Povidone-Iodine; Prostate; Retrospective Studies; Sepsis; Treatment Outcome; Ultrasound, High-Intensity Focused, Transrectal; Urinary Tract Infections

To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol.. A chart review was conducted on 1007 men who underwent TRUS PNB between 2010 and 2017. Comparison groups include those who received a topical rectal antiseptic (N = 437) compared to those who did not (N = 570). Povidone-iodine (N = 303) or 4% chlorhexidine solution without alcohol (N = 134) were topical agents. Outcomes of interest included post-biopsy infection (urinary tract infection and/or sepsis), hospital admission, and need for ICU monitoring.. Median age and PSA of men included in this study were 64 years and 12 ng/mL. Almost 90% of patients were Caucasian, 13% had diabetes, 3% were on immunosuppression, 32% had at least one prior biopsy, 14% received antibiotics, and 7% were hospitalized in the past 6 months. 22 patients (2.2%) developed a post-biopsy infection with a significant reduction in the group receiving topical rectal antiseptic (0.8 vs. 3.3%, p = 0.01). Post-biopsy UTI rates (p = 0.04) and hospital admission (p = 0.03) were also lower in the topical antiseptic group with trends to reduction in sepsis and need for ICU monitoring.. What started as a resident quality safety project 5 years ago has demonstrated a reduction in infections and hospital admissions following TRUS PNB. Our institutional practice now routinely uses povidone-iodine or chlorhexidine as an adjunct to oral quinolones for TRUS PNB perioperative prophylaxis.

Topics: Administration, Topical; Aged; Anti-Infective Agents, Local; Antisepsis; Chlorhexidine; Critical Care; Hospitalization; Humans; Image-Guided Biopsy; Male; Middle Aged; Patient Safety; Povidone-Iodine; Prostate; Quality Improvement; Sepsis; Urinary Tract Infections

This retrospective study tried to find the potential approach for reducing the urinary tract infection (UTI) in intensive care patients (ICPs) among adult population.In total, 96 eligible ICP cases were included. Of these, 48 cases received 10% povidone-iodine and were assigned to the intervention group, while the other 48 cases underwent sterile water, and were assigned to the control group for the prevention of catheter-associated UTI before indwelling urinary catheter insertion in ICP. The primary outcome was the occurrence of an UTI after the indwelling catheter. The secondary outcome was the identification of pathogenic species. The outcomes were assessed after catheter removed.After catheter removal, the occurrence of an UTI did not differ significantly between the 2 groups (P = .34). In addition, no significant differences regarding the pathogenic species were detected between the 2 groups (Escherichia coli, P = .73; Candida albicans, P = .57; Enterococcus, P = .65; Proteus mirabilis, P = .50; Citrobacter, P = .50; Klebsiella pneumoniae, P = .57).The use of 10% povidone-iodine may not help reducing UTI in ICP.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Local; Catheter-Related Infections; Catheters, Indwelling; Female; Humans; Infection Control; Intensive Care Units; Male; Middle Aged; Povidone-Iodine; Retrospective Studies; Urinary Catheters; Urinary Tract Infections

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB. All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml of a 10% solution of commercially available povidone iodine is mixed with 5 ml of 1% lidocaine jelly to create slurry. A 4 cmx4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2-3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy. This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p=0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies.

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacterial Infections; Biopsy, Needle; Ciprofloxacin; Humans; Male; Povidone-Iodine; Prostate; Prostatic Neoplasms; Reproducibility of Results; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Interventional; Urinary Tract Infections

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

As part of a programme to establish the relative merits of antiseptics that are used as bladder instillations to control urinary tract infections in patients with indwelling catheters, the activity of five such formulations were tested against dense (10(9) cfu/cm2) mixed biofilms composed of Citrobacter diversus, Pseudomonas aeruginosa and Enterococcus faecalis growing on silicone discs. All three species were resistant to chlorhexidine (200 mg/l) and povidone-iodine (1% v/v) in the biofilm mode of growth, whereas these agents rapidly eliminated viable cells from urine suspensions of the mixed community. Lactic acid (1% v/v) produced a 1 log reduction of the biofilm population within 30 min of exposure. The mandelic acid (1% w/v) and mandelic acid (0.5% w/v)/lactic acid (0.5% v/v) mixture proved to be the most effective in eliminating the biofilm organisms. It is suggested that these latter solutions should now be tested for efficacy in bladder washouts against urinary tract infections in catheterized patients.

Topics: Anti-Infective Agents, Local; Catheters, Indwelling; Chlorhexidine; Citrobacter; Drug Resistance, Microbial; Enterococcus faecalis; Humans; Lactates; Lactic Acid; Mandelic Acids; Microbial Sensitivity Tests; Models, Biological; Povidone-Iodine; Pseudomonas aeruginosa; Urinary Catheterization; Urinary Tract Infections

The incidence of urinary infection in catheterized patients is very important in those undergoing T.U.R. for bladder neck and prostatic obstructions because the risk of jatrogenic defilement, and any method of preventing, reducing or delaying the occurrence of infection in catheterized patients, should be tooking considerations. Between March 1984 and September 1985 300 male patients, requiring catheterization after T.U.R. for out-flow obstruction (80% benign, 40% malignant prostatic disease, 16% bladder-neck obstruction), were introduced to the trial. All patients were managed by closed drainage system and treated, immediately after T.U.R., by continuous bladder irrigation with saline solution of iodine and polyvinylpyrrolidone (1:150-1:50 in 3000 ml) until elective removal of the post-operative catheter; use of antibiotics was restricted to preoperatory stage. At the elective removal of the post-T.U.R. catheter (between 3d and 7th day) the urino-culture in 79% showed no bacteriuria, in 15% showed mild infection (less than 500.000 organisms/ml) and in 6% revealed a severe infection (greater than 500.000 organisms/ml). At the same time 300 other patients-the control group-underwent to T.U.R. for the same diseases (out-flow obstruction) and received pre- and post-operative antibiotics only without P.V.P.-I irrigation. This treatment revealed sterile urine only in 40% of cases and persistent bacteriuria in 60% of cases. This original method in preventing and treating catheter infection of patients operated of T.U.R. has revealed itself as effective, simple, not too much expensive and without severe side effects.

Topics: Administration, Intravesical; Anti-Infective Agents, Urinary; Bacteriuria; Humans; Male; Povidone; Povidone-Iodine; Solutions; Therapeutic Irrigation; Urinary Catheterization; Urinary Tract Infections

Twelve postmenopausal women who experienced frequent urinary tract infections were found to have atrophic vaginitis. Four of them who were taking sulfonamide preparations chronically also had an interstitial nephritis manifest by decreasing glomerular filtration rate and eosinophiluria. Treatment consisted of a Betadine douche daily for 1 week, administration of an appropriate nonsulfonamide antibiotic, and institution of estrogen therapy to restore glycogen deposition in the vaginal epithelium and promote return of a normal vaginal pH and bacterial flora. Prior to estrogen therapy, the frequency of infection was four per patient per year. During a follow-up observation period ranging from 2 to 8 years, there have been only four infections in the entire group. When sulfonamides were discontinued in the 4 patients with manifestations of interstitial nephritis, the eosinophiluria cleared, and the glomerular filtration rate increased significantly.

Topics: Estrogens; Female; Glomerular Filtration Rate; Humans; Menopause; Middle Aged; Nephritis, Interstitial; Povidone-Iodine; Recurrence; Sulfonamides; Therapeutic Irrigation; Urinary Tract Infections; Vaginitis

Despite technical advances, Foley catheter associated urinary tract infections continue to be the leading cause of nosocomial infections. PVP-I2 has been shown to be nonirritating to abraded tissue and we have shown that dilute solutions are bactericidal for organisms causing Foley catheter associated urinary tract infections. The purpose of this study was to ascertain the toxicity of PVP-I2 on the catheterized rat bladder and to measure the systemic absorption of I2. Bladder catheters were surgically placed into each of 3 groups of rats: group 1, catheters only; group 2, irrigation with PBS q.8h; and group 3, irrigation with a 1:3 dilution of a 10 per cent PVP-1 per cent I2 solution q-8h. One-half of each group was sacrificed at 1 and 2 weeks respectively. Photographs of mounted bladders and histologic sections were then graded by 3 independent observers. Blood for protein bound iodine (PBI), T3 and T4 levels was obtained before the study and at sacrifice. No difference in ulcerations, erythema or inflammation was noted. PBI was higher in group 3 rats at conclusion than group 1 and 2 (6.88 mg./dl. versus 3.42 mg./dl.) (p less than 0.05). There was no difference in T3 or T4 levels. In this study, PVP-I2 was no more toxic to the bladder than catheterization alone or irrigation with PBS.

Topics: Absorption; Animals; Female; Iodine; Povidone; Povidone-Iodine; Rats; Rats, Inbred Strains; Therapeutic Irrigation; Urinary Bladder; Urinary Catheterization; Urinary Tract Infections

This is a preliminary study evaluating diluted solutions of povidone-iodine (PVP-I) as urinary bladder irrigants for the treatment and prevention of urinary tract infection. Diluted povidone-iodine solutions were used as indwelling catheter irrigants and as instillations into the urinary bladder following intermittent catheterization. The diluted PVP-I solutions had no efficacy in either the treatment or prevention of urinary tract infections when used as indwelling urethral or suprapubic catheter irrigants. There was a suggestion of a slight decrease in the incidence of urinary tract infections during the use of PVP-I in the intermittent catheterization group in this uncontrolled study, but the percentage of positive urine cultures was greater than desired. The absence of any unfavorable data has led us to conclude that the diluted PVP-I caused no undesirable side effects in any of the patients treated with this agent, PVP-I bladder irrigation warrants further investigation in special cases such as lower urinary tract fungal infections.

Topics: Catheterization; Evaluation Studies as Topic; Humans; Povidone; Povidone-Iodine; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections

Topics: Bacteriuria; Humans; Male; Postoperative Complications; Povidone; Povidone-Iodine; Premedication; Prostatectomy; Therapeutic Irrigation; Urinary Bladder; Urinary Tract Infections

Topics: Female; Humans; Povidone; Povidone-Iodine; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Female; Humans; Iodine; Male; Ointments; Povidone; Povidone-Iodine; Urethra; Urinary Tract Infections