Lavado con povidona yodada diluida en el reemplazo articular de cadera y rodilla para prevenir infecciones: estudio retrospectivo comparativo / Diluted povidone-iodine lavage in total hip and knee replacement: A retrospective comparative study

Introducción: Una de las medidas profilácticas para disminuir la incidencia de infecciones periprotésicas es el lavado con povidona yodada diluida, un agente con acción bactericida contra distintos microorganismos. El propósito de este estudio fue evaluar la incidencia de infecciones periprotésicas dentro de los primeros 90 días, en pacientes a quienes se les realizó un lavado con povidona yodada luego de implantar los componentes protésicos y antes del cierre de la herida. materiales y métodos: Se llevó a cabo un análisis retrospectivo comparativo de pacientes sometidos a artroplastias primarias de cadera y rodilla por artrosis y se comparó la incidencia de infecciones periprotésicas dentro de los primeros 90 días posoperatorios, entre pacientes que fueron operados antes de la introducción del lavado con povidona yodada y luego con su uso rutinario. Resultados: Se realizaron 643 (47,60%) reemplazos de rodilla y 708 (52,40%) reemplazos de cadera. Al comparar la incidencia de infecciones periprotésicas entre ambos grupos, no se observaron diferencias estadísticamente significativas (0,92% vs. 0,21%; p = 0,11). Sin embargo, se incrementó el riesgo de infección en los primeros 90 días posteriores a la cirugía (OR = 4,5; IC95% 0,56-36,19) cuando no se utilizó la solución. Conclusiones: El riesgo de desarrollar infecciones periprotésicas se incrementó 4,5 veces al realizar una artroplastia sin irrigación con povidona yodada diluida. Sin embargo, no se pudo demostrar que esto fuese estadísticamente significativo. Nivel de Evidencia: III

Introduction: One of the prophylactic techniques to reduce the incidence of periprosthetic infections is dilute povidone-iodine lavage, an agent with bactericidal action against different microorganisms. The purpose of this study was to evaluate the incidence of periprosthetic infections within the first 90 days in patients who had undergone povidone-iodine lavage after implantation of prosthetic components and before wound closure. Materials and methods: A comparative retrospective study was performed on patients who had undergone primary total hip or knee replacement due to advanced joint osteoarthritis between October 1999 and April 2020. We assessed the PJI rate between two cohorts: Group A, which consisted of patients who received povidone-iodine lavage routinely, and Group B, where this solution was not applied. Results: 643 (47.60%) knee replacements and 708 (52.40%) hip replacements were performed. When comparing the incidence of periprosthetic infections between both groups, no statistically significant differences were observed (0.92% vs. 0.21%; p = 0.11). However, the risk of infection was increased in the first 90 days after surgery (OR = 4.5; 95% CI 0.56-36.19) when the solution was not used. Conclusions: The risk of developing periprosthetic infections increased 4.5 times when performing an arthroplasty without irrigation with diluted povidone-iodine. However, this could not be shown to be statistically significant. Level of Evidence: III

Uso de agentes antimicrobianos como solução refrigerante no ultrassom para tratamento das doenças periodontais: uma revisão de literatura / The use of antimicrobial agents as a cooling solution in ultrasound devices for periodontal diseases treatment: a literature review

Objetivo: revisar a literatura quanto ao uso de soluções no reservatório líquido do ultrassom (US) para o tratamento das doenças periodontais, avaliando as contribuições dessa associação e as soluções mais eficazes para essa terapêutica. Métodos: foi realizada pesquisa bibliográfica nas bases de dados Public Medline (PubMed), Lilacs, Science Direct e ISI web of knowledge. As palavras-chave utilizadas foram: "periodontal disease", "ultrasonic", "cooling solution", "antimicrobial" e "irrigation". Como critérios de inclusão, foram selecionados estudos prospectivos, retrospectivos, caso controle, transversal e relatos de casos, publicados em inglês. Resultados: após pesquisa e minuciosa revisão por título e resumo de cada estudo, 15 estudos foram selecionados para avaliação dos desfechos investigados. As principais soluções associadas ao US foram povidono-iodo (PVPI), clorexidina, óleos essenciais, bicarbonato de sódio. O irrigante mais utilizado foi o PVPI, seguido por clorexidina e óleos essenciais. Os agentes podem conferir discretas melhoras no nível clínico de inserção e profundidade de sondagem, porém os resultados são controversos, já que nem todos os ensaios demonstraram efeitos positivos. Uma importante evidência observada foi em relação à redução dos níveis de microrganismos derivados do aerossol do US quando essas substâncias foram utilizadas no reservatório de água, sendo esse um aspecto positivo de seu uso como solução refrigerante ao US. Considerações finais: de modo geral, não puderam ser confirmados benefícios adicionais dos irrigantes antimicrobianos nos principais parâmetros periodontais avaliados, porém não se pode descartar o potencial uso desses agentes para a redução da dispersão de microrganismos advindos do aerossol, promovendo assim maior proteção ao paciente e ao profissional.(AU)

Objective: to review the literature regarding the use of solutions in the liquid ultrasonic (US) reservoir devices for the treatment of periodontal diseases, evaluating the benefits of this association, and the most effective solution for this therapy. Methods: bibliographic research was carried out in the Public Medline (PubMed), Lilacs, Science Direct, and ISI web of knowledge databases. The keywords used were: "periodontal disease", "ultrasonic", "cooling solution", "antimicrobial", and "irrigation". Inclusion criteria were prospective, retrospective, case-control, cross-sectional studies, and case reports published in English. Results: after a meticulous analysis of each paper by title and summary, 15 studies were selected for further investigation of clinical outcomes. The main solutions associated with US devices as coolant were PVPI, Chlorhexidine, Essential Oils and Sodium Bicarbonate. The most used coolant agent was PVPI, followed by chlorhexidine and essential oils. It has been shown that irrigating solutions can provide improvements in the clinical attachment level and probing depth, but the results are controversial since not all trials showed positive effects. Important evidence observed was the reduction of the levels of microorganisms derived from the US aerosol when these substances were used as a cooling solution. Conclusions: in general, additional benefits of coolant solutions could not be confirmed in the main periodontal parameters evaluated, however, the potential use of these agents to reduce the dispersion of microorganisms derived from the aerosol cannot be ruled out, thus promoting additional protection to the patient and professional.(AU)

Effectiveness of preoperative decolonization with nasal povidone iodine in Chinese patients undergoing elective orthopedic surgery: a prospective cross-sectional study

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.

Efficacy of 2.5% and 1.25% povidone-iodine solution for prophylaxis of ophthalmia neonatorum

Objective: To determine the efficacy of 2.5% and 1.25% Povidone-Iodine solution for Ophthalmia neonatorum prophylaxis

Study Design: Interventional study

Place and Duration of Study: Eye Department, Combined Military Hospital, Sargodha, from May to November 2014

Methodology: A total of 200 eyes of 100 newborn babies were enrolled and divided into two groups of 100 right eyes and 100 left eyes. A conjunctival swab for bacterial culture was taken within 30 minutes after delivery. A single drop of 2.5% Povidone-Iodine was then placed in the right eye while in the left eye a single drop of 1.25% Povidone-Iodine was placed. Thirty minutes after placing Povidone-Iodine, a conjunctival swab was again taken. A bacterial suspension was prepared from each swab in determining bacterial counts. The bacterial suspension was inoculated on yeast extract agar and the number of colony forming units were counted. At each culture, the number of colony forming units before and after instillation of 2.5% Povidone-Iodine and 1.25% Povidone-Iodine were compared. Wilcoxon's signed rank test was used for statistical analysis

Results: The 2.5% Povidone-Iodine solution caused a statistically significant decrease in the number of colony forming units [p=0.001]. Similarly, the 1.25% Povidone-Iodine solution also reduced the number of colony forming units to a statistically significant level [p=0.001]

Conclusion: The 1.25% concentration of Povidone-Iodine is as effective as the 2.5% concentration of Povidone-Iodine in reducing the number of colony forming units in healthy conjunctivae of newborns

Effect of chlorhexidine, povidone iodine, and ozone on microorganisms in dental aerosols: Randomized double-blind clinical trial.

Objective: Dental handpieces, ultrasonic scalers, air polishers, air abrasion units produce the most visible aerosols. The objective of this study was to assess the effect of chlorhexidine (CHX), povidone iodine (PI), and ozone (OZ) on the microorganisms in dental aerosols. Materials and Methods: A total of 60 patients were included in this study, they were randomly assigned into three groups and were subjected to scaling before and after rinsing with 0.2% CHX, 1% PI or irrigation with OZ. Blood agar plates were used to collect the gravitometric settling of aerosols and were sent for aerobic and anaerobic culture. Results: The results demonstrated high percentage reduction of aerobic and anaerobic colony forming units (CFUs) in all three groups. In aerobic CFUs, CHX showed the highest reduction (57%) at mask position whereas at chest position and at 9 ft, PI showed higher CFU reductions (37% and 47%, respectively). In anaerobic CFUs, CHX showed the highest percentage of reduction at chest level (43%) and at 9 ft (44%). Conclusion: CHX, PI and OZ showed similar effects in reducing aerobic and anaerobic CFU's at the chest mask and at 9 ft. OZ can be used as a preprocedural agent, considering its beneficial effects.

Clinical Trial Comparing Efficacy and Safety of Ornidazole 1% and Povidone Iodine 5% Fixed Dose Combination Ointment with Povidone Iodine 5% Formulation and Ornidazole 1% Formulation for Prevention or Treatment of Surgical Wounds.

Aim: This trial is undertaken to evaluate the efficacy and safety of this FDC ointment for post-surgical patient management. This multi-centre, prospective, randomized, comparative, open-labeled, three-arm parallel group study involving 180 patients was conducted in patients with surgical wound. The trial was conducted at 2 centres and had 90 patients completed at each center. Methods: Patients were in randomized in three groups, to receive either the study formulation of Ornidazole 1% - Povidone iodine 5% FDC ointment (Group I ) or Povidone iodine 5% Ointment (Group II) or Ornidazole 1% Ointment (Group III). These ointments were applied for post surgical wound care. Dressing was done twice daily till the discharge of patients (Day 5-7). Patients were asked to use respective ointment for wound dressings after discharge. The patients were assessed for clinical wound improvement by using the Bates Jensen Wound Assessment Tool (BWATS). General and systemic examination was done at every visit of the patient. Results: Reduction in wound size was significant in all three groups from day 1 onwards. In group I exudates amount improved significantly from day 5 as compared to day 3, in Group II and Group III the improvement was from Day 8 onwards as compared to day 5. Peripheral tissue edema and Peripheral Tissue Induration improved in Group I and as compared to baseline. Epithelialization was statistically better in Group I and Group II from day 1 compared to baseline and in Group III it improved from day 5. No adverse event were seen in any of the groups. Conclusion: We concluded that the combination was better as compared to each individual drug in prevention of wound infection and promoting wound healing.

Eficácia in vitro de desinfetantes comerciais utilizados no pré e pós-dipping frente a Staphylococcus spp. isolados em rebanhos leiteiros / In vitro efficacy of commercial disinfectants used in pre-and post-dipping against Staphylococcus spp. isolated from dairy cattle

The objective of this study was to evaluate the in vitro efficacy of commercial disinfectants used in pre- and post-dipping, against Staphylococcus spp. isolated from milk originating from dairy cattle farms in the Wasteland and Forest Zone of Alagoas, Brazil. We used iodine (0.57%), chlorhexidine (2.0%), chlorine (2.5%) and quaternary ammonium compound (4.0%) at concentrations indicated, conventionally used as commercial disinfectants before and after dipping. We analyzed a total of 97 isolates of Staphylococcus spp. identified as S. aureus (16), coagulase positive Staphylococcus (7) and coagulase-negative Staphylococcus (74). The disinfectants were evaluated at three different times (15", 30" and 60"). We found that 56.3% of Staphylococcus aureus was sensitive to iodine, 68.8% to chlorine, 87.5% to chlorhexidine, and 37.5% to the compound of ammonia, in time 60". As for coagulase positive staphylococci (CPS), 100% of the isolates was resistant to chlorhexidine, 85.7% to the ammonia compound, 57.1% to chlorine, and 42.9% iodine, in time 60". Regarding coagulase negative staphylococci (CNS), 91.9% was sensitive to chlorhexidine, 70.3% to chlorine, 66.2% to iodine, and 24.3% the ammonium compound, at time 60". It is concluded from this study that the greatest disinfectant activity in vitro was with chlorhexidine and chlorine for S. aureus, with iodine and chlorine for SCP, and with chloride and chlorhexidine for SCN. Due to variations in the sensitivity and resistance profile found, it is necessary for regular assessments of the effectiveness of disinfectants used on the farms, to observe the effectiveness of the product and thus ensure the control of mastitis in the herd.

Objetivou-se com esse estudo avaliar a eficácia in vitro de desinfetantes comerciais utilizados no pré e pós- -dipping, frente a Staphylococcus spp. isolados do leite de vacas procedentes de propriedades leiteiras do Agreste e Zona da Mata do Estado de Alagoas. Foram utilizados iodo (0,57%), clorexidine (2,0%), cloro (2,5%) e composto de amônio quaternário (4,0%), nas concentrações indicadas, como desinfetantes comerciais usados convencionalmente no pré e pós-dipping. Analisou-se um total de 97 isolados de Staphylococcus spp. identificados como S. aureus (16), Staphylococcus coagulase positiva (7) e Staphylococcus coagulase negativa (74). Os desinfetantes foram avaliados em três tempos distintos (15", 30" e 60"). Observou-se que 56,3% de Staphylococcus aureus foram sensíveis ao iodo, 68,8% sensíveis ao cloro, 87,5% à clorexidine e 37,5% ao composto de amônia no tempo de 60". Quanto aos Staphylococcus coagulase positiva (SCP), 100% dos isolados foram resistentes ao clorexidine, 85,7% ao composto de amônio, 57,1% ao cloro, e 42,9 resistentes ao iodo no tempo de 60". Em relação aos Staphylococcus coagulase negativa (SCN) foi observado 91,9% de sensibilidade ao clorexidine, 70,3% sensíveis ao cloro, 66,2% ao iodo e 24,3% sensíveis ao composto de amônio no tempo de 60". Conclui-se com esse estudo que a maior atividade desinfetante in vitro foi verificada para clorexidine e cloro frente aos S. aureus, iodo e cloro para os SCP e clorexidine e cloro para os SCN. Devido às variações no perfil de sensibilidade e resistência encontradas, é necessária a avaliação regular da eficiência dos desinfetantes usados nas propriedades, com o intuito de observar a eficácia do produto e assim garantir o controle da mastite no rebanho.

Efectos tóxicos y manejo de las lesiones provocadas por el pez león (Pteroisvolitans, P. miles) / Toxic effects and management and injuries caused by the lion fish(Pteroisvolitan, P. miles)

El Pez León (Pterois volitans y Pteroismiles), especie registrada como invasora en el Atlántico occidental; se ha constituido en un poderoso depredador gracias a que no tiene un antagonista natural en la segunda barrera coralina más grande del mundo, poniendo en riesgo a las especies marinas endémicas de la zona, así com o a nadadores, buzos recreativos, comerciales y pescadores que entran en contacto con el pez. El pinchazo del pez león es venenoso, tiene aproximadamente 17 espinas dorsales,pélvicas y anal, cada uno contiene un tubo que se conecta al extremo de una glándula venenosa que segrega 3 a 10mg de veneno por espina. El mecanismo de intoxicación se produce cuando la persona pisa o toca al pez, ejerciendo presión sobre las espinas y al penetrar la piel las glándulas venenosas liberan el veneno. La toxina inoculada puede causar dolor intenso, fiebre, parálisis respiratoria humana e insuficiencia circulatoria. La toxicidad del veneno es debida a antigénicos de proteínas de alto peso molecular. El tratamiento se basa en la termolabilidad de dichas proteínas, bloquear la respuesta inflamatoria sistémica y las posibles complicaciones. Con esta revisión bibliográfica se pretende ampliar sobre los efectos tóxicos y el manejo de las lesiones provocadas por el pez león, a fin de informar a la comunidad médica hondureña de los problemas de salud causada...

Efficacy of various spray disinfectants on irreversible hydrocolloid impression materials: An in vitro study.

Background: Most of the materials (casts, impressions, etc.) that are sent to the dental laboratories show the presence of numerous pathogenic microorganisms. All the spray disinfectants are not equally effective against these microorganisms. Aims and Objectives: The aim was to compare the effectiveness of different spray disinfectants on irreversible hydrocolloid impressions and to find out the most effective dilution, contact time, and effect against each microorganism studied. Materials and Methods: The effects of four spray disinfectants, 5.25% sodium hypochlorite, 0.525% sodium hypochlorite, 1:213 (1 part in 213 parts of water) povidone iodine, and 2% glutaraldehyde along with control (distilled water) on irreversible hydrocolloid impressions contaminated with Staphylococcus aureus, Bacillus subtilis and Streptococcus viridans were studied. Results: Sodium hypochlorite, 5.25%, showed 1-min exposure time which was able to effect a 4log10 reduction in bacterial counts against S. aureus and S. viridans followed by 0.525% sodium hypochlorite and 2% glutaraldehyde for 10 min. None were able to effect a 4 log10 reduction against B. subtilis. Conclusion: Sodium hypochlorite with a concentration of 5.25% was the most effective disinfectant and required the shortest contact time (1 min). Not all ADA-approved concentrations of surface disinfectants work equally well on irreversible hydrocolloid impression materials.

Conjuntivite neonatal com ênfase na sua prevenção / Neonatal conjunctivitis with emphasis on its prevention

Nos últimos tempos, a necessidade da utilização de medicamentos para prevenção da conjuntivite neonatal (CN) passou a ser questionada em alguns países desenvolvidos, devido ao elevado nível de assistência pré-natal. Ao contrário, no Brasil, embora não haja dados oficiais sobre sua ocorrência, vários trabalhos recentes comprovam elevada prevalência da infecção genital em mulheres em idade fértil e em gestantes. Isso, aliado ao fato de que o índice de transmissão da infecção genital por clamídia e gonococo, da mãe infectada para o recém-nascido é de 30 a 50 por cento, leva à conclusão de que a profilaxia medicamentosa está mais que justificada. A CN implica em importante potencial de complicações locais e sistêmicas, além da necessidade de exames laboratoriais para seu diagnóstico etiológico. Por isso, constitui importante problema de saúde pública, negligenciado no Brasil, onde não há padronização do método de prevenção. Embora o uso do nitrato de prata pareça ainda ser o método oficial, seu uso tem sido questionado devido à incompleta proteção contra clamídia, principal agente da conjuntivite neonatal nos dias atuais, e pela frequente ocorrência de conjuntivite química. Por isso, tem sido substituído por outros agentes, como a eritromicina, a tetraciclina, além de outros antibióticos. A superioridade da Iodopovidona em relação a esses antibióticos, nos vários quesitos analisados, tem sugerido que esse é o mais adequado entre os produtos, testados até o momento, para prevenção da CN.

Nowadays the use of drugs for prevention of neonatal conjunctivitis (NC) has been questioned in some developed countries, due to the high level of prenatal care. In Brazil, although no official data on the occurrence of NC is available, several recent studies has shown high prevalence of genital infection in childbearing age and pregnant women. This, coupled with the 30 percent to 50 percent transmission rate of genital chlamydia and gonococcus from mother to newborn, leads to the conclusion that chemoprophylaxis is justified. The potential for local and systemic complications and the need for laboratory tests for its diagnosis have made NC an important public health problem, overlooked in Brazil, where there is no standardization of the method of prevention. Although the use of silver nitrate still appears to be the official method, it has been questioned due to incomplete protection against chlamydia, nowadays the leading agent of NC, and by the frequent occurrence of chemical conjunctivitis. So, it has been replaced by other agents such as erythromycin, tetracycline and other antibiotics. The advantages of povidone-iodine compared to these agents in the various items analyzed, has suggested that it is the best, among the products tested so far, for the prevention of NC.

Non-surgical instrumentation associated with povidone-iodine in the treatment of interproximal furcation involvements

OBJECTIVE: The aim of this controlled clinical trial was to evaluate the effect of topically applied povidone-iodine (PVP-I) used as an adjunct to non-surgical treatment of interproximal class II furcation involvements. MATERIAL AND METHODS: Thirty-two patients presenting at least one interproximal class II furcation involvement that bled on probing with probing pocket depth (PPD) >5 mm were recruited. Patients were randomly chosen to receive either subgingival instrumentation with an ultrasonic device using PVP-I (10 percent) as the cooling liquid (test group) or identical treatment using distilled water as the cooling liquid (control group). The following clinical outcomes were evaluated: visible plaque index, bleeding on probing (BOP), position of the gingival margin, relative attachment level (RAL), PPD and relative horizontal attachment level (RHAL). BAPNA (N-benzoyl-L-arginine-p-nitroanilide) testing was used to analyze trypsin-like activity in dental biofilm. All parameters were evaluated at baseline and 1, 3 and 6 months after non-surgical subgingival instrumentation. RESULTS: Six months after treatment, both groups had similar means of PPD reduction, RAL and RHAL gain (p>0.05). These variables were, respectively, 2.20±1.10 mm, 1.27±1.02 mm and 1.33±0.85 mm in the control group and 2.67±1.21 mm, 1.50±1.09 mm and 1.56±0.93 mm in the test group. No difference was observed between groups at none of the posttreatment periods, regarding the number of sites showing clinical attachment gain >2 mm. However, at 6 months posttreatment, the test group presented fewer sites with PPD >5 mm than the control group. Also at 6 months the test group had lower BAPNA values than control group. CONCLUSION: The use of PVP-I as an adjunct in the non-surgical treatment of interproximal class II furcation involvements provided limited additional clinical benefits.

Effects of the povidone-iodine (PVPI) in treatment of bacterial peritonitis induced in rats / Eficácia do polivinilpirrolidona-iodo (PVPI) no tratamento da peritonite bacteriana em ratos

PURPOSE: To evaluate the effectiveness of the use of the povidone-iodine (PVI) added to the liquid of wash of the peritoneal cavity in the reduction of bacterial absorption and in the remainder non-phagocyted bacteria in the circulating blood of rat. METHODS: Thirty four Wistar females rats were used, distributed in the following groups: A (n=10), non-treated; B (n=9), wash of the peritoneal cavity with solution of PVI to 1 percent in saline solution; C (n=15), wash of the cavity with saline solution. After anesthesia, it was made intraperitoneal infusion of solution of Escherichia coli labeled with 99mTc containing 10(8) CFU/ml. After 40 minutes, it was made the treatment, in the group A, manipulation of the viscera; in the group B, irrigation of the peritoneal cavity with warm solution of 1 percent PVPI to 37,5ºC, and in the group C irrigation with warm saline (37,5ºC). After 15 minutes of the treatment, blood samples and fragments of liver, spleen and lung was obtained for count of the radioactivity, and animals killed by abdominal aorta section. There were determined the bacterial absorption index and the remainder index in the bloodstream. RESULTS: Of the total of bacteria infused in the peritoneum, there was absorption of 0,92 percent (0,14 percent to 2,13 percent) in the animals of the group A (controls), 0,49 percent (0,18 percent to 0,71 percent) after use of topical PVPI (group B) and 0,80 percent (0,04 percent to 3,8 percent) after wash with saline solution (group C). There was significant reduction of the absorption when compared the treated animals with PVPI and the controls (p=0,003). Of the total of bacteria absorbed for the circulatory current, the percentile amount of bacteria non-phagocyted in the outlying blood was of 2,9 percent (1,1 percent to 17,7 percent) in the control group, 15,2 percent (8,3 percent to 21,4 percent) in those treated with PVPI (group B) and 6,9 percent (0,8 percent to 29,7 percent) after wash...

OBJETIVO: Avaliar a eficácia do uso do polivinilpirrolidona-iodo (PVPI) acrescido ao líquido de lavagem da cavidade peritoneal na redução da absorção bacteriana e no remanescente bacteriano não fagocitado no sangue periférico de ratos. MÉTODOS: Estudou-se 34 ratos Wistar fêmeas, distribuídos aleatoriamente nos seguintes grupos: controle (n=10), nenhum tratamento; PVPI (n=9), lavagem da cavidade peritoneal com solução de PVPI a 10 por cento em solução salina; salina (n=15), lavagem da cavidade com solução salina. Após anestesia, fez-se inoculação intraperitoneal de solução de Escherichia coli marcadas com 99mTc contendo 10(8) UFC/ml. Após 40 minutos, realizou-se o tratamento que foi, no grupo controle, manipulação das vísceras; no grupo PVPI, irrigação da cavidade peritoneal com solução de PVPI aquecido a 37,5ºC na concentração de 1 por cento, e no grupo salina irrigação com solução salina aquecida a 37,5ºC. Após 15 minutos do tratamento, os animais foram mortos por secção da aorta abdominal e colhidas amostras do sangue, do fígado, do baço e do pulmão para contagem da radioatividade. Foram determinados o índice de absorção bacteriano e o índice de remanescente no sangue periférico. RESULTADOS: Do total de bactérias inoculadas no peritôneo, houve absorção de 0,92 por cento (0,14 por cento a 2,13 por cento) nos animais do grupo controle, 0,49 por cento (0,18 por cento a 0,71 por cento) após uso do PVPI tópico e 0,80 por cento (0,04 por cento a 3,8 por cento) após lavagem com solução salina. Houve redução significativa da absorção quando comparados os animais tratados com o PVPI e os controles não tratados (p=0,03). Do total de bactérias absorvidas para a corrente circulatória, o percentual de bactérias não fagocitadas presentes no sangue periférico foi de 2,9 por cento (1,1 por cento a 17,7 por cento) nos animais controle 15,2 por cento (8,3 por cento a 21,4 por cento) naqueles tratados com PVPI e 6,9 por cento (0,8 por cento a 29,7 por...

Comparison of the Efficacies of Silver-Containing Dressing Materials for Treating a Full-Thickness Rodent Wound Infected by Methicillin-resistant Staphylococcus aureus / 대한진단검사의학회지

BACKGROUND: 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. METHODS: 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(R)), silver carboxymethylcellulose (Aquacel(R)-Ag), silver sulfadiazine (Medifoam silver(R)), nanocrystalline silver (PolyMem silver(R)), silver sulfadiazine (Ilvadon(R)), and 10% povidone iodide (Betadine(R)). 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. RESULTS: The order of the rate of wound-size decrease was Acticoat(R)>Aquacel(R)-Ag>PolyMem silver(R)>Medifoam silver(R)>Ilvadon(R)>Betadine(R). The histological findings revealed that the Acticoat(R) 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(R)>Aquacel (R)-Ag>PolyMem silver(R)>Ilvadon(R)>Medifoam silver(R)>Betadine(R). The bacterial colony counts reduced in all the groups, except in the Medifoam silver(R) group. The order of the size of the inhibition zone was Acticoat(R)>Aquacel(R)-Ag>Ilvadon(R)>PolyMem silver(R)>Betadine(R)>Medifoam silver(R). CONCLUSIONS: 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(R) should be preferentially used for the treatment of MRSA-infected skin wounds.

Antiseptiques et desinfectants bien connaitre les produits d'usage courant

Les antiseptiques qui ont une autorisation de mise sur le marche sont de veritables medicaments. Moins utilises apres l'apparition des antibiotiques; les antiseptiques et desinfectants ont repris une place preponderante dans la prevention et la lutte contre les infections nosocomiales. Face aux problemes de la prevention des infections; la rigueur est recommandee; et il faut insister sur la formation des personnels utilisateurs d'antiseptiques et de desinfectants. L'utilisation appropries de ces produits est d'autant plus necessaire que les techniques medicales de plus en plus invasives induisent des risques infectieux importants

Flora bacteriana conjuntival após uso tópico de ciprofloxacino e gatifloxacino em cirurgia de catarata / Conjunctival bacterial flora after topical use of ciprofloxacin and gatifloxacin in cataract surgery

OBJETIVO: Avaliar alterações da flora conjuntival após uso dos colírios de ciprofloxacino e gatifloxacino 0,3 por cento na profilaxia dos pacientes submetidos à facectomia. MÉTODOS: Quarenta pacientes submetidos a facectomia foram alocados em dois grupos, conforme o colírio antibiótico utilizado: Grupo A: ciprofloxacino 0,3 por cento e Grupo B: gatifloxacino 0,3 por cento. Os pacientes usaram os colírios 1 hora antes da cirurgia e nos primeiros 14 dias pós-operatórios. Foi coletado material da conjuntiva em cinco momentos: 1 hora antes da cirurgia, sem medicações tópicas (t0); imediatamente antes da aplicação de iodopovidona (PVPI) (t1), antes do início da cirurgia, após iodopovidona (t2), 14 dias após a cirurgia (t3) e 28 dias após a cirurgia (t4). RESULTADOS: O uso de antibióticos no pré-operatório diminuiu a positividade das culturas anteriores ao uso do iodopovidona em ambos os grupos; no Grupo A esta redução não alcançou significância estatística (Grupo A - p=0,07 e Grupo B - p=0,04). A positividade das culturas foi reduzida nos dois grupos após aplicação de iodopovidona e 14 dias após a cirurgia (p<0,05). Em t4 a freqüência do Staphylococcus coagulase-negativo foi menor no grupo A quando comparado ao grupo B (p<0,05) e a sensibilidade ao ciprofloxacino em relação a t0 foi menor em todos grupos. CONCLUSÃO: O colírio de gatifloxacino aplicado 1 hora antes da cirurgia reduziu significantemente a positividade das culturas. Ambos antibióticos promoveram redução da flora quando administrados no pós-operatório.

PURPOSE: To evaluate alterations of the conjunctival flora after the use of 0.3 percent ciprofloxacin and gatifloxacin in the prophylaxis of patients undergoing cataract surgery. METHODS: 40 patients undergoing cataract surgery were distributed into two groups according to the use of antibiotic eye drops: Group A: 0.3 percent ciprofloxacin and Group B: 0.3 percent gatifloxacin. Both groups used antibiotic eye drops 1 hour before surgery and 14 days after surgery. Conjunctival material was collected at 5 time points: 1 hour before surgery, without any topical medication (t0); immediately before the application of povidone-iodine (PVPI) (t1), before the beginning of surgery, after povidone-iodine (t2), 14 days (t3) and 28 days after surgery (t4). RESULTS: Preoperative antibiotics reduced the positivity of the cultures before the use of PVPI in both groups, although in Group A this reduction was not significant (Group A - p=0.07 and Group B - p=0.04). The number of positive cultures was reduced in all groups after the use of povidone-iodine and on the 14th postoperative day (p<0.05). In t4 there was a reduction in the frequency of coagulase-negative Staphylococcus in Group A compared with Group B (p<0.05); the susceptibility to ciprofloxacin was also reduced in all groups, when compared with t0. CONCLUSIONS: Gatifloxacin eye drops applied one hour before surgery significantly reduced the number of positive conjunctival cultures. Both antibiotics reduced the conjunctival flora when administered in the postoperative period.

Cost-effectiveness analysis of chlorhexidine gluconate compared with povidone-iodine solution for catheter-site care in Siriraj Hospital, Thailand.

BACKGROUND: Catheter-related bloodstream infections (CRBSI) are an important cause of patient morbidity, mortality, and increased health care costs. Use of an antiseptic solution for skin disinfection at the catheter insertion site helps prevent catheter-related infections. In Thailand, povidone-iodine solution is the most commonly used agent for this purpose. However, the results of several studies including a meta-analysis indicated that the use of chlorhexidine gluconate is more effective than the use of povidone-iodine as an antiseptic for preventing CRBSI. This study evaluated the cost-effectiveness of chlorhexidine gluconate versus povidone-iodine for catheter-site care using the Siriraj Hospital perspective. MATERIAL AND METHOD: We used a decision analytic modeling for estimating the cost-effectiveness of antiseptic solutions. The CRBSI rate was obtained from the Center for Nosocomial Infection Control at Siriraj Hospital, while the efficacy of cholorhexidine compared to povidone-idone was based on a meta-analysis. The cost of managing infections was derived from the Thai Drug Related Group (DRG). A series of sensitivity analyses were performed. Since the time horizon of the analysis was less than 1 year, there was no need for discounting. RESULTS: We found that the use of chlorhexidine, rather than povidone iodine, for central catheter site care resulted in a 1.61% decrease in the incidence of CRBSI, a 0.32 % decrease in the incidence of death, and savings of 304 baht per catheter used. For peripheral catheter site care, the results were similar although the differences were smaller. CONCLUSION: Use of chlorhexidine gluconate in place of the current standard solution for vascular catheter site care is a cost-effective method of improving patient safety in Siriraj Hospital.

Morphological analysis of three wound-cleaning processes on potentially contamined wounds in rats / Análise morfológica de três tipos de limpeza em feridas cutâneas potencialmente infectadas em ratos

PURPOSE: To evaluate the inflammatory response of potentially infected wounds treated with isotonic saline solution, chlorhexidine and PVP-I, seven days after surgery. METHODS: Thirty-two male rats were used, divided into 4 groups. All animals had their surgical wounds infected with a standard bacterial inoculum. Control group (A): animals had their surgical wounds sutured without any kind of cleaning. Saline solution group (B): animals had their wounds cleaned with saline solution. Chlorhexidine group (C): animals had their wounds cleaned with chlorhexidine. PVP-I group (D): animals had their wounds cleaned with PVP-I. Seven days after surgery, all the animals had their skin submitted to microscopic and macroscopic evaluation. RESULTS: Edema was found on all histological slices analyzed, as well as vascular proliferation and congestion. Groups A and D showed presence of mild neutrophilic infiltrate, and moderate lymphocytic and macrophage infiltrate. Group B showed severe neutrophilic, macrophage, and lymphocytic infiltrate. Group C showed moderate neutrophilic, macrophage, and lymphocytic infiltrate. CONCLUSION: Group D was the group which showed inflammatory infiltrate most similar to the group that was not submitted to treatment.

OBJETIVO: Avaliar a resposta inflamatória da limpeza de feridas potencialmente infectadas tratadas com PVP-I, clorexidina e solução salina isotônica, no sétimo dia de pós-operatório, em ratos Wistar. MÉTODOS: Utilizou-se 32 ratos distribuídos em quatro grupos. Os animais tiveram suas feridas operatórias infectadas com um inóculo bacteriano padrão. Grupo controle (A): os animais tiveram suas feridas operatórias suturadas sem a limpeza com qualquer substância. Grupo solução salina (B): os animais tiveram suas feridas operatórias lavadas com solução salina. Grupo Clorexidina (C): os animais tiveram suas feridas operatórias lavadas com clorexidina. Grupo PVP-I (D): os animais tiveram suas feridas operatórias lavadas com PVP-I. Após sete dias foi realizada a avaliação morfológica da pele. RESULTADOS: Em todos cortes histológicos observou-se a presença de edema, proliferação e congestão vascular. O grupo A e D mostraram a presença de um infiltrado neutrofílico discreto, macrofágico e linfocítico moderados. O grupo B, um infiltrado neutrofílico, macrofágico e linfocítico severos. O grupo C, um infiltrado de neutrófilos, macrófagos e linfócitos em moderada quantidade. CONCLUSÃO: O grupo D foi o grupo que apresentou o infiltrado inflamatório mais semelhante com o grupo que não recebeu nenhum tratamento.

Bacterial flora--A potential source of endophthalmitis after cataract surgery.

OBJECTIVES: To study bacteria from eye lids and conjunctival sac of patients undergoing cataract surgery before and after the application of antiseptics. MATERIAL AND METHOD: Patients undergoing elective cataract extraction in one university hospital were randomly enrolled. Cultures for bacteria and candida were done by swabbing the eye lids before and after cleaning with 4% chlorhexidine gluconate. Subsequently 10% povidone iodine was applied on eye lids and conjunctival sacs. Cultures of specimens from eye lids and conjunctival sac were taken after the application of 10% povidone iodine and at the end of the operation. RESULTS: Fifty-one patients were enrolled. Positive cultures were found in 90.2% and 82.4% before and after cleaning the face with 4% chlorhexidine. After topical application of 10% povidone iodine, only 19.6% had positive cultures from eye lids and conjunctival sac; a significant reduction (p=0.001). At the end of the operation, positive cultures were found from eye lids in 10 patients and from the conjunctival sac in 4 patients. Isolates were skin flora and candida species in 2 patients. None of the patients had endophthalmitis. CONCLUSION: Cleaning eye lids with 4% chlorhexidine followed by applying 10% povidone iodine was effective in decreasing skin flora in cataract surgery. The organisms were not completely eliminated. Postoperative follow-up to detect infectious complications is warranted.

Evaluation of effectiveness of 10 percent polyvinylpyrrolidone-iodine solution against infections in wire and pin holes for Ilizarov external fixators

CONTEXTO E OBJETIVO: A incidência de infecção superficial no trajeto dos fios e pinos junto à pele é uma complicação freqüente em pacientes em tratamento pelo método de Ilizarov. Este estudo objetivou avaliar a eficácia da aplicação diária da solução tópica de polivinilpirrolidona-iodo a 10% na interferência de infecção nos orifícios dos fios de Kirschner e pinos de Schanz de pacientes em uso de fixador externo de Ilizarov comparada à limpeza desses orifícios somente com soro fisiológico a 0,9%. TIPO DE ESTUDO E LOCAL: Ensaio clínico randomizado controlado, no Ambulatório de Ortopedia e Traumatologia do Hospital São Paulo e Centro de Ortopedia e Traumatologia de Jundiaí. MÉTODOS: 30 pacientes foram tratados pelo método de Ilizarov: 15 orientados a realizarem o curativo dos orifícios dos fios e pinos com soro fisiológico a 0,9% e 15 com soro fisiológico a 0,9% mais polivinilpirrolidona-iodo tópico a 10%. Os pacientes foram avaliados nos retornos ambulatoriais, para identificação dos sinais e sintomas de infecção superficial nos orifícios dos fios e pinos. Amostras foram obtidas para cultura e antibiograma na presença de exsudato com pus à expressão. RESULTADOS: Aplicado os testes exato de Fisher e qui-quadrado não foi possível encontrar associação estatisticamente significante da intervenção da solução tópica de polivinilpirrolidona-iodo na prevenção de infecções nos trajetos dos fios e pinos.CONCLUSÕES: A solução de polivinilpirrolidona-iodo tópica a 10% quando aplicada diariamente no orifício dos fios de Kirschner e pinos de Schanz à pele não reduz a incidência de infecção superficial nesses trajetos quando comparada com pacientes que realizam a remoção mecânica de sujidades com soro fisiológico a 0,9%.

Barrido ultrasónico bactericida en el tratamiento de la enfermedad periodontal: descripción de un caso clínico / Bactericidal ultrasonic scaling in the treatment of periodontal disease: report of a case

En el presente caso clínico se prueba una alternativa de tratamiento para un caso de periodontitis moderada mediante el uso de un agente antibacteriano colocado en una jeringa tipo Luer. Al final del tratamiento la reabsorción ósea se había detenido. No se necesitó tratamiento endodóntico