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PURPOSE: To compare the cleanliness of the conjunctival sac following the use of iodine compounds (PAI) and levofloxacin as postoperative eye drops. STUDY DESIGN: A prospective open-label study. PATIENTS AND METHODS: Either topical levofloxacin or fourfold-diluted PAI was administered for 1 week postoperatively in 128 eyes of 128 patients who underwent routine cataract surgery. Conjunctival samples were obtained at three time points: pre-surgery, 1 week postoperatively, and 1 month postoperatively. RESULTS: The respective positive bacterial culture rates for postoperative iodine and levofloxacin were 88.1% and 85.2% pre-surgery, 71.6% and 50.8% 1 week postoperatively, and 92.5% and 86.5% 1 month postoperatively. Positive bacterial culture rates in both groups significantly declined at 1 week, and the rates returned to the baseline level 1 month postoperatively. The magnitude of reduction of DNA copy number detected by polymerase chain reaction at 1 week was larger in the levofloxacin group, although no significant differences were seen at pre-surgery or 1 month postoperatively. In the levofloxacin group, only one strain was culture positive at 1 week, however, its minimum inhibitory concentration (MIC) against S. epidermidis was high (128 µg/ml). The MIC value increased from 2.31 ± 2.19 µg/ml pre-surgery to 57.14 ± 22.34 µg/ml 1 month postoperatively, while no significant change was found in the iodine group. CONCLUSION: Postoperative iodine and levofloxacin eye drops both reduced bacterial contamination in the conjunctival sac, with a superior level of disinfection in the levofloxacin group. However, postoperative levofloxacin eye drops enhanced the emergence of highly resistant bacteria, whereas no such development was seen in the iodine group.
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Purpose: Commercially available chlorhexidine gluconate (CHG) has a beyond-use date of 24 h. This study evaluated the stability and sterility of 0.05% CHG for 30 days after opening and compared its cost to povidone iodine (PI) for intravitreal injection antisepsis. Methods: 0.05% CHG was aliquoted into 1-mL syringes and stored at room temperature or refrigerated. Turbidity, pH, high-performance liquid chromatography (HPLC), and sterility testing were performed. A cost analysis was conducted. Results: 0.05% CHG remained stable for at least 30 days. All samples had measured turbidity <0.5 nephelometric turbidity units. The pH of all samples remained between 5.0 and 7.0. HPLC demonstrated CHG concentration at day 30 relative to day 0 of 98.52% ± 4.16% at room temperature and 99.99% ± 3.38% at 2°C -6°C. The cost per week to perform 150 injections using 0.05% CHG was $463.25 when opening a new bottle daily compared with $16.73 for 5% PI. This cost decreased to $23.16 when utilizing a bottle of CHG for 30 days. Conclusion: 0.05% CHG remains stable and sterile for at least 30 days after opening. The ability to use CHG for at least 30 days after its opening significantly decreases its utilization expense.
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We present a case of iodine-induced allergic contact dermatitis in a 10-year-old child. The child had a superficial wound on the left knee from an injury and was treated with daily applications of povidone-iodine (PVP-I) ointment for three to four days. The child subsequently developed a worsening skin lesion that increased from an initial 2 cm to 10 cm, spreading over the upper part of the leg, accompanied by pain and scanty discharge. Referred to the dermatology department, the dermatologist diagnosed iodine-induced allergic contact dermatitis based on the clinical presentation and the absence of other oral or topical medications, as well as no history of allergy to any substances or medications. Discontinuation of the suspected PVP-I ointment led to complete healing within 10 days with the use of only an emollient. This case underscores the importance of recognizing iodine allergy as a potential complication when used in wound care, particularly in pediatric patients.
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OBJECTIVE: Acute laceration wound (ALW) is one of the most common injuries in Indonesia with potential significant morbidities. In rural areas, povidone-iodine and honey are commonly used as wound dressings. This study aimed to identify the effectiveness of honey compared to paraffin gauze and the commonly used povidone-iodine in improving ALW healing time. METHOD: This study was a single-blind, pilot randomised controlled trial (RCT) with three intervention groups (honey, povidone-iodine, and paraffin). The outcomes were wound healing time, slow healing, secondary healing, signs of infection, wound dehiscence, oedema, maceration, necrosis, exudate and cost. RESULTS: A total of 35 patients (male to female ratio: 4:1), with a mean age of 22.5 (range: 6-47) years, were included and randomised to treatment groups using predetermined randomisation according to wound location and wound dressing selection: honey group, n=12; povidone-iodine group, n=11; paraffin group, n=12 with one patient lost to follow-up. All groups achieved timely healing, with a mean healing time of 9.45±5.31 days and 11.09±5.14 days for the povidone-iodine and paraffin groups, respectively, and a median healing time of 10 (3-19) days for the honey group (p>0.05). More wounds in the honey group achieved healing in ≤10 days compared with the other groups. Both povidone-iodine and honey groups had fewer adverse events, with the latter having the lowest cost. CONCLUSION: In this study, honey was clinically effective in accelerating healing time with a lower cost compared to paraffin, and was comparable to povidone-iodine. Future RCTs with a larger sample size should be pursued to determine honey's role in ALW treatment.
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Antiinfecciosos Locales , Miel , Laceraciones , Povidona Yodada , Cicatrización de Heridas , Humanos , Povidona Yodada/uso terapéutico , Cicatrización de Heridas/efectos de los fármacos , Masculino , Femenino , Adulto , Proyectos Piloto , Persona de Mediana Edad , Adolescente , Método Simple Ciego , Antiinfecciosos Locales/uso terapéutico , Laceraciones/terapia , Adulto Joven , Niño , Indonesia , Vendajes , Parafina/uso terapéutico , Resultado del TratamientoRESUMEN
Worldwide, synthetic compounds are used for both in-office and at-home dental care. They are a valuable resource for both prophylactic and curative treatments for various dental problems, such as tooth decay, periodontal diseases, and many more. They are typically preferred due to their broad range of actions and ability to produce targeted, rapid, and long-lasting effects. Using a 0.12% chlorhexidine mouthwash is capable of reducing the plaque index from 47.69% to 2.37% and the bleeding index from 32.93% to 6.28% after just 2 weeks. Mouthwash with 0.1% OCT is also highly effective, as it significantly lowered the median plaque index and salivary bacterial counts in 152 patients in 5 days compared to a control group (p < 0.0001), while also reducing the gingival index (p < 0.001). When povidone-iodine was used as an irrigant during the surgical removal of mandibular third molars in 105 patients, it resulted in notably lower pain scores after 2 days compared to a control group (4.57 ± 0.60 vs. 5.71 ± 0.45). Sodium hypochlorite is excellent for root canal disinfection, as irrigating with 1% NaOCl completely eliminated the bacteria from canals in 65% patients. A 0.05% CPC mouthwash proved effective for perioperative patient care, significantly decreasing gingival bleeding (p < 0.001) and suppressing Streptococcus levels even one week post-surgery. Lastly, a 6% H2O2 paint-on varnish and 6% H2O2 tray formulations successfully bleached the teeth of 40 patients, maintaining a noticeably whiter appearance up to the 6-month follow-up, with significant color differences from the baseline (p < 0.005). Synthetic compounds have a large research base, which also provides a greater awareness of their mechanism of action and potential adverse effects. For a better understanding of how they work, several methods and assays are performed. These are protocolary techniques through which a compound's efficacy and toxicity are established.
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Antisépticos Bucales , Humanos , Antisépticos Bucales/farmacología , Odontología , Clorhexidina/farmacología , Clorhexidina/uso terapéuticoRESUMEN
Cryopreservation is a method adopted for storage of autologous skulls. Herein, this current research sought to explore the effects of different cryoprotectants on the biological characteristics of rat calvarial osteoblasts after cryopreservation. Neonatal Sprague-Dawley rats were selected and their skull tissues were isolated. The skull tissues were allocated into the refrigerating-3M, refrigerating-6M, M199-3M, M199-6M, povidone iodine-3M, and povidone iodine-6M groups according to the usage of cryoprotectants and treatment time (month) and the fresh group. Osteoblasts were isolated from skull tissues in each group through digestion. The histomorphology of the skull was evaluated by H&E staining and cell morphology was observed by microscopy. The viability, proliferation, apoptosis, and osteogenic activity of osteoblasts were assessed by trypan blue staining, MTT, flow cytometry, and alkaline phosphatase (ALP) staining. The skull histomorphology and osteoblast morphology were similar between the fresh and refrigerating groups. Osteoblast viability was weakened after cryopreservation. The longer the refrigeration time, the lower the number of living cells and the higher the apoptosis rate. However, cryopreservation using different cryoprotectants did not evidently affect osteoblast proliferation and ALP activity. Different cryoprotectants show no apparent effect on the osteogenic activity of rat calvarial osteoblasts after cryopreservation.
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Apoptosis , Proliferación Celular , Supervivencia Celular , Criopreservación , Crioprotectores , Osteoblastos , Ratas Sprague-Dawley , Cráneo , Animales , Criopreservación/métodos , Osteoblastos/citología , Osteoblastos/efectos de los fármacos , Cráneo/citología , Cráneo/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Crioprotectores/farmacología , Proliferación Celular/efectos de los fármacos , Apoptosis/efectos de los fármacos , Ratas , Osteogénesis/efectos de los fármacos , Células CultivadasRESUMEN
Background: The selection of an appropriate chemical solution in wound care reduces the severity of wounds and accelerates the healing process. Povidone-iodine (PV-I), a chemical solution popularly known as an antiseptic, is frequently used in studies of wound care to prevent wound infection and accelerate woud the process of wound healing. Objective: To identify the latest evidence on the benefits of PV-I in wound infection prevention and healing in all areas. Methods: This review is a scoping review by Arskey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) is used for reporting. The literature search used databases including PubMed, CINAHL, and search engines such as Scopus. This study was conducted using thematic analysis. Results: This review yielded 19 out of 2109 studies that were identified in the initial search. Four outcomes comprised 20 sub-outcomes have been identified. Although strong evidence is lacking, PV-I in the form of foam is effective in improving wound healing, shortening healing time, and producing fewer adverse events than hydrocelluers. Moreover, saline and PV-I are effective as skin disinfectants when compared to saline alone in reducing surgical site infection (SSI), and they are also more effective than hypochlorous acid in improving wound healing. Nevertheless, there was no difference between PV-I and hypochlorous acid in the prevention of SSI and bacterial growth. In terms of healing time, silver foam and hyaluronic acid were more favorable than PV-I. Moreover, the use of chlorhexidine to improve SSI and silver dressing to improve hospital stay is more favorable than that of PV-I. Conclusion: There is limited evidence regarding the effectiveness of wound care outcomes, and the efficacy of PV-I as a surface disinfectant for wound infection prevention remains controversial. Consequently, PV-I is not highly recommended for wound care, and further investigation into the effectiveness of PV-I as a surface disinfectant is required for various types of surgeries.
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OBJECTIVE: To determine the effectiveness of povidone-iodine application after skin closure to prevent surgical site infection after an emergency cesarean section and to assess risk factors associated with surgical site infection. METHODS: A randomized controlled trial enrolled 352 pregnant women who required emergency cesarean delivery at King Chulalongkorn Memorial Hospital, from August 2018 to March 2019. Participants were randomly assigned to receive the povidone-iodine application at the incision after skin closure (n = 176) or without application (n = 176). Thirty-day surveillance of complications and adverse effects was performed. The primary outcome was the incidence of surgical site infection, which was compared between groups using the chi-squared test. The adjusted odds ratios (ORs) of the factors associated with surgical site infection were determined by logistic regression analysis. RESULTS: There were no significant differences in the incidence of surgical site infection and adverse effects between the povidone-iodine and control groups (9.5% vs 7.1%, P = 0.430). The significant factor associated with surgical site infection was a long interval (≥60 min) from the administration of prophylactic antibiotics to the incision (adjusted OR 4.06, 95% CI 1.49-11.03). CONCLUSION: The application of povidone-iodine after skin closure in an emergency cesarean section did not have the advantage of reducing the incidence of surgical site infection. CLINICAL TRIAL REGISTRATION: This study was registered in TCTR registry on March 10, 2018 with trial identification number: TCTR20180310002 (https://www.thaiclinicaltrials.org/show/TCTR20180310002). The first participant was recruited on August 2, 2018.
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BACKGROUND: Chlorhexidine gluconate (CHG) and povidone-iodine (PI) are commonly used to prevent prosthetic joint infection (PJI) during total joint replacement; however, their effective concentrations and impact on biofilms are not well defined. AIM: To determine: (1) the in-vitro minimum inhibitory concentration of CHG and PI against model PJI-causing organisms and clinical isolates; (2) their impact on biofilm formation; (3) whether there is a synergistic benefit to combining the two solutions; and (4) whether adding the antibiotic vancomycin impacts antiseptic activity. METHODS: We measured in-vitro growth and biofilm formation of Staphylococcus epidermidis, meticillin-sensitive and meticillin-resistant Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Candida albicans, as well as recent clinical isolates, in the presence of increasing concentrations of CHG and/or PI. Checkerboard assays were used to measure potential synergy of the solutions together and with vancomycin. FINDINGS: CHG and PI inhibited growth and biofilm formation of all model organisms tested at concentrations of 0.0004% and 0.33% or lower, respectively; highly dilute concentrations paradoxically increased biofilm formation. The solutions did not synergize with one another and acted independently of vancomycin. CONCLUSION: CHG and PI are effective at lower concentrations than typically used, establishing baselines to support further clinical trials aimed at optimizing wound disinfection. There is no synergistic advantage to using both in combination. Vancomycin is effective at inhibiting the growth of S. epidermidis and S. aureus; however, it stimulates P. aeruginosa biofilm production, suggesting in the rare case of P. aeruginosa PJI, it could exacerbate infection.
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Biopelículas , Clorhexidina , Pruebas de Sensibilidad Microbiana , Povidona Yodada , Infecciones Relacionadas con Prótesis , Vancomicina , Biopelículas/efectos de los fármacos , Biopelículas/crecimiento & desarrollo , Clorhexidina/farmacología , Clorhexidina/análogos & derivados , Povidona Yodada/farmacología , Vancomicina/farmacología , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/prevención & control , Humanos , Sinergismo Farmacológico , Antiinfecciosos Locales/farmacología , Antibacterianos/farmacología , Candida albicans/efectos de los fármacos , Bacterias/efectos de los fármacosRESUMEN
PURPOSE: Although 5% povidone-iodine (PVP-I) is frequently used as an ocular antiseptic agent, there is a lack of consensus regarding the effects of PVP-I concentration, storage after opening, and compounded preparation on PVP-I antisepsis. We performed a series ofâ¯in-vitro experiments to determine the impact of these factors on PVP-I's inhibition of common causes of post-procedural eye infection. METHODS: Inhibition of microorganism growth was measured in-vitroâ¯as a function of active PVP-I exposure time. In control experiments, PVP-I was inactivated before microorganism exposure. Tested PVP-I solutions varied in concentration (0.6%, 5%, or 10%), length of storage after opening (0, 7, or 30 days), and preparation (commercial vs.compounded from stock PI solution). Tested pathogens includedâ¯S. epidermidis, S. viridans, P. aeruginosa, methicillin-resistant S. aureus, methicillin-sensitive S. aureus, andâ¯C. albicans. RESULTS: PVP-I solutions inhibited all bacterial growth by 3 min and fungal growth by 15 s. Compared to 5% PVP-I, the 0.6% PVP-I was less effective in inhibiting S. viridans growth (200 ± 0 colonies vs. 7 ± 8 at 30 s, P = 0.0004; 183 ± 21 vs. 0 ± 0 at 1 min, P = 0.018), but more effective in inhibiting P. aeruginosa (30 ± 20 vs. 200 ± 0 at 15 s, P = 0.019). Compared to commercial and newly-opened PVP-I solutions, compounded preparations and solutions stored for 7 or 30 days after bottle opening either preserved or improved antiseptic efficacy against tested microorganisms. CONCLUSIONS: Concentration of PVP-I solution affects antiseptic efficacy within 1 min of exposure, but all solutions performed equivalently at 3 min. In contrast to results of prior studies investigating dilute PVP-I, the 0.6% PVP-I did not demonstrate a uniformly equivalent or superior anti-septic effect. Compounded preparation and storage length after bottle opening did not decrease PVP-I antiseptic activity.
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INTRODUCTION: Brushing older adults or intubated patients who are unable to rinse can transmit bacteria from dental plaque into the oral cavity and increase the risk of aspiration pneumonia. Therefore, this study examined brushing methods to prevent the spread of bacteria in the oral cavity. Methods: Three types of brushing methods were performed on five volunteers by dental hygienists (water group: brushing with toothbrush bristles soaked in water; gel group: brushing with a moisturizing gel placed on the toothbrush; PV-I group: brushing with toothbrush bristles dipped in povidone-iodine). Neither group spat out the saliva or gargled during brushing but brushed while wiping the water/gel/PV-I solution with a sponge brush. The same five volunteers served as subjects for the three methods. Saliva was collected before and after brushing, and the number of colonies was determined using bacterial culture. Results: The water group demonstrated a significantly increased number of bacteria in the saliva owing to the spread of bacteria from the dental plaque. The gel group prevented the spread of the bacteria. The PV-I group showed a significant decrease in the number of bacteria in the saliva after brushing. CONCLUSIONS: Brushing with toothbrush bristles dipped in a povidone-iodine solution is recommended for intubated or older adult patients who cannot gargle.
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The novel personal protection equipment based on a face mask equipped with a nanofiber filter functionalized with povidone iodine has been developed and tested in a clinical trial. This nanofiber filter was characterized with a low flow resistance and, thus, allowed comfortable breathing. The performed study proved that the novel nanofiber filter with incorporated povidone-iodine was characterized with a slow release of iodine which minimized side effects but kept disinfection efficiency. Our clinical study performed on 207 positively tested SARS-CoV-2 patients wearing the PPE for 4-8 hours daily for 1 to 4 days has shown that even the iodine amount as low as 0.00028 ppm was sufficient to significantly decrease the reproduction number and, very importantly, to protect against severe course of disease.
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COVID-19 , Nanofibras , Povidona Yodada , SARS-CoV-2 , Povidona Yodada/uso terapéutico , Povidona Yodada/administración & dosificación , COVID-19/prevención & control , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Infecciones por Coronavirus/prevención & control , Betacoronavirus , Antiinfecciosos Locales/administración & dosificación , Masculino , Femenino , Adulto , Máscaras , Equipo de Protección Personal , Persona de Mediana EdadRESUMEN
Aim: To determine whether rinsing with preprocedural mouthrinses against coronavirus disease before acid etching affects resin-based sealant microleakage. Materials and Methods: A presented in vitro experimental study was performed on 15 extracted permanent third molars. Samples were randomly allocated into five groups: Group 1-distilled water (control); Group 2-1% hydrogen peroxide; Group 3-1.5% hydrogen peroxide; Group 4-0.5% povidone-iodine; and Group 5-1% povidone-iodine. After the teeth were immersed in the assigned mouth rinses for 60 s, they were sealed with Concise™ white sealant. Subsequently, the teeth were thermocycled for 500 cycles, immersed in 2% methylene blue solution for 24 h, and sectioned with two parallel cuts in the buccolingual direction. Sixty surfaces (12 surfaces in each group) were examined for microleakage under a 40× light microscope and scored as described by Zyskind et al. Welch's one-way analysis of variance test and the Games-Howell test were used to analyze the results at a significance level of P < 0.05 for all tests. Results: The intergroup comparisons indicated that the 0.5% povidone-iodine group and the 1% povidone-iodine group had significantly higher microleakage compared with the control group. The 1% and 1.5% hydrogen peroxide groups demonstrated no significant difference in mean microleakage scores compared with the control group. There was no significant difference between the povidone groups and the hydrogen peroxide groups. Conclusions: Preprocedural rinsing with 0.5% and 1% povidone-iodine before acid etching caused higher microleakage of resin-based sealant, while hydrogen peroxide rinsing gave comparable microleakage compared with the control group.
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To evaluate the efficacy of topical vancomycin and povidone iodine (PI) application on methicillin-resistant Staphylococcus aureus (MRSA) keratitis model in rabbits.MRSA keratitis was induced by injecting 0.1 mL MRSA containing 1000 colony-forming units (CFU) into central cornea of right eyes of 24 New Zealand White rabbits. Animals were divided into four groups (n = 6): control (treated with balanced salt solution), 50 mg/mL topical vancomycin, 5% topical PI, and combination; examined before and after treatment, and corneal tissues were harvested for analysis at 9th hour of treatment.Bacterial load was determined as: 7.63 ± 0.82 log10 CFU/g in control group, 6.95 ± 1.66 log10 CFU/g in PI group, 4.67 ± 0.77 log10 CFU/g in combination group, and 4.33 ± 0.71 log10 CFU/g in vancomycin group (p = 0.001). Median of total clinical score increased significantly from 7 [range: 5-8] to 11.5 [range: 11-15] (p = 0.001) in control group, did not change (6 [range: 5-8] to 7 [range: 5-7]; p = 0.695) in vancomycin group, increased significantly from 7 [range: 5-8] to 12.5 [range: 10-14] (p < 0.001) in PI group, increased significantly from 6.5 [range: 5-7] to 8 [range: 7-9] in combination group (p = 0.002). Post-treatment clinical scores for chemosis, conjunctival injection, iritis, hypopyon, epithelial erosion, and corneal infiltrate were significantly lower in vancomycin-treated groups compared to others (p < 0.05). In PI-treated groups, especially scores for chemosis, conjunctival injection, epithelial erosion and corneal infiltrate were significantly higher than vancomycin (p < 0.05).Topical vancomycin significantly inhibited bacterial growth in MRSA keratitis. However, PI was ineffective in controlling this growth; additionally, exerted toxic effect on ocular surface. When vancomycin was combined with PI, no additional increase in efficacy of treatment was detected compared to only vancomycin.
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Antibacterianos , Antiinfecciosos Locales , Modelos Animales de Enfermedad , Infecciones Bacterianas del Ojo , Staphylococcus aureus Resistente a Meticilina , Povidona Yodada , Infecciones Estafilocócicas , Vancomicina , Animales , Conejos , Vancomicina/administración & dosificación , Povidona Yodada/administración & dosificación , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Antiinfecciosos Locales/administración & dosificación , Úlcera de la Córnea/microbiología , Úlcera de la Córnea/tratamiento farmacológico , Córnea/microbiología , Córnea/patología , Soluciones Oftálmicas , Administración Tópica , Carga Bacteriana , Recuento de Colonia Microbiana , Queratitis/microbiología , Queratitis/tratamiento farmacológicoRESUMEN
Chylothorax in infants after surgery for congenital heart disease is associated with significant morbidity and mortality. Numerous management modalities applied alone or in various combinations have been utilized but definitive guidelines have not yet been established. We present two infants who developed refractory chylothorax after congenital heart surgery. We also reviewed evidence for the use of available treatment modalities. In our experience, the use of lymphangiography followed by pleurodesis by povidone-iodine was safe and our impression was that it may have played a decisive role in controlling the lymph leak.
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BACKGROUND: The use of povidone-iodine for ocular surface asepsis is widespread for intravitreal injections. They became frequent procedures, leading to serial exposure of patients' eyes to iodinated solutions. In this study, we investigate the changes in the ocular surface in patients submitted to repeated use of povidine for intravitreal injection of anti-VEGF asepsis, analyzing Ocular Surface Disease Index, non-invasive break up time, blinking quality, lipid layer, meniscus height and osmolarity. METHODS: This case-control study included 34 individuals (68 eyes), 14 males, 20 females aged 48 to 94. Inclusion criteria were individuals who received application of 2% povidone-iodine eyedrops for intravitreal injections treatment with the non-treated contralateral eye used as control. Ocular surface examinations were performed at a single occasion. A pre-intravitreal injection asepsis protocol with povidone-iodine was applied. All statistical analysis was performed using the STATA® 18.0 Software and a p-value = 0.05 was considered as the statistical significance value in all tests. RESULTS: The median number of IVIs in treated eyes was 12 (range 6-20). The results in treated eyes compared with untreated eyes were respectively : median OSDI 16 (IQR 6-39) and 12.5 (IQR 8-39) (p = 0.380); mean NIBUT 10.30 (SD ± 2.62) and 10.78 (SD ± 2.92) ( s, p = 0.476); median blinking quality 100 (IQR 100) and 100 (IQR 100 ) (%, p = 0.188); median lipid layer 87 (IQR 77-90) and 86 (IQR 74-100) (nm, p = 0.451); median meniscus height 0.22 (IQR 0.19-0,31) and 0.24 (IQR 0.20-0.27) (mm, p = 0.862), median Meibomian gland atrophy 33 (IQR 24-45) and 31.5 (IQR 25-39) (%, p = 0.524); and mean osmolarity 306.6 (SD ± 21.13) and 313.8 (SD ± 29) (mOsm, p = 0.297). There was no statistically significant relationship between the repetitive use of 2% iodinated solution and signs or symptoms compatible with dry eye syndrome in this group of patients. CONCLUSIONS: The findings suggest that 2% povidone iodine is a safe and efficacious agent for ocular surface antisepsis during intravitreal injections, not leading to substantial ocular surface modifications. This conclusion supports the continued use of povidone iodine in routine ophthalmic procedures without increased risk of inducing dry eye syndrome.
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Nosocomial Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in a significant increase in morbidity and mortality in hospitalized patients. We aimed to analyze the impact of applying 10% povidone iodine (PI) twice daily to both nares in addition to chlorhexidine (CHG) bathing on nosocomial (MRSA) bacteremia in critically ill patients. A quality improvement study was completed with pre and post-design. The study period was from January 2018 until February 2020 and February 2021 and June 2021. The control period (from January 2018 to May 2019) consisted of CHG bathing alone, and in the intervention period, we added 10% PI to the nares of critically ill patients. Our primary outcome is rates of nosocomial MRSA bacteremia, and our secondary outcome is central line associated blood stream infection (CLABSI) and potential cost savings. There were no significant differences in rates of MRSA bacteremia in critically ill patients. Nosocomial MRSA bacteremia was significantly lower during the intervention period on medical/surgical areas (MSA). CLABSIs were significantly lower during the intervention period in critically ill patients. There were no Staphylococcus aureus CLABSIs in critical care area (CCA)during the intervention period. The intervention showed potential significant cost savings. The application of 10% povidone iodine twice a day in addition to CHG bathing resulted in a significant decrease in CLABSIs in critically ill patients and a reduction in nosocomial MRSA in the non-intervention areas. Further trials are needed to tease out individual patients who will benefit from the intervention.
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BACKGROUND: Exit-site infection (ESI) is a common recurring complication in patients undergoing peritoneal dialysis (PD). Sucrose and povidone-iodine (SPI) mixtures, antimicrobial ointments that promote wound healing, have been used for the treatment of ulcers and burns, but their efficacy in exit-site care is still unclear. METHODS: This single-center retrospective observational study included patients who underwent PD between May 2010 and June 2022 and presented with episodes of ESI. Patients were divided into SPI and non-SPI groups and followed up from initial ESI onset until PD cessation, death, transfer to another facility, or June 2023. RESULTS: Among the 82 patients (mean age 62, [54-72] years), 23 were treated with SPI. The median follow-up duration was 39 months (range, 14-64), with an overall ESI incidence of 0.70 episodes per patient-year. Additionally, 43.1% of second and 25.6% of third ESI were caused by the same pathogen as the first. The log-rank test demonstrated significantly better second and third ESI-free survival in the SPI group than that in the non-SPI group (p < 0.01 and p < 0.01, respectively). In a Cox regression analysis, adjusting for potential confounders, SPI use was a significant predictor of decreased second and third ESI episodes (hazard ratio [HR], 0.22; 95% confidence interval [CI], 0.10-0.52 and HR, 0.22; 95%CI, 0.07-0.73, respectively). CONCLUSIONS: Our results showed that the use of SPI may be a promising option for preventing the incidence of ESI in patients with PD. TRIAL REGISTRATION: This study was approved by the Keio University School of Medicine Ethics Committee (approval number 20231078) on August 28, 2023. Retrospectively registered.
Asunto(s)
Antiinfecciosos Locales , Infecciones Relacionadas con Catéteres , Diálisis Peritoneal , Povidona Yodada , Sacarosa , Humanos , Povidona Yodada/uso terapéutico , Persona de Mediana Edad , Estudios Retrospectivos , Masculino , Femenino , Anciano , Antiinfecciosos Locales/uso terapéutico , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Relacionadas con Catéteres/etiología , Catéteres de Permanencia/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: The effect of the periurethral cleansing range on catheter-associated urinary tract infection (CAUTI) occurrence remains unknown. The purpose of this study was to evaluate the efficacy of expanded periurethral cleansing for reducing CAUTI in comatose patients. METHODS: In this randomized controlled trial, eligible patients in our hospital were enrolled and allocated randomly to the experimental group (expanded periurethral cleansing protocol; n = 225) or the control group (usual periurethral cleansing protocol; n = 221). The incidence of CAUTI on days 3, 7, and 10 after catheter insertion were compared, and the pathogen results and influencing factors were analyzed. RESULTS: The incidences of CAUTI in the experimental and control groups on days 3, 7, and 10 were (5/225, 2.22% vs. 7/221, 3.17%, P = 0.54), (12/225, 5.33% vs. 18/221, 8.14%, P = 0.24), and (23/225, 10.22% vs. 47/221, 21.27%, P = 0.001), respectively; Escherichia coli and Candida albicans were the most common species in the two groups. The incidences of bacterial CAUTI and fungal CAUTI in the two groups were 11/225, 4.89% vs. 24/221, 10.86%, P = 0.02) and (10/225, 4.44% vs. 14/221, 6.33%, P = 0.38), respectively. The incidences of polymicrobial CAUTI in the two groups were 2/225 (0.89%) and 9/221 (4.07%), respectively (P = 0.03). The percentages of CAUTI-positive females in the two groups were 9.85% (13/132) and 29.52% (31/105), respectively (P < 0.05). The proportion of CAUTI-positive patients with diabetes in the experimental and control groups was 17.72% (14/79), which was lower than the 40.85% (29/71) in the control group (P < 0.05). CONCLUSION: Expanded periurethral cleansing could reduce the incidence of CAUTI, especially those caused by bacteria and multiple pathogens, in comatose patients with short-term catheterization (≤ 10 days). Female patients and patients with diabetes benefit more from the expanded periurethral cleansing protocol for reducing CAUTI.