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Annals of Surgery Dec 2021There is uncertainty around preoperative skin antisepsis in clean surgery. Network meta-analysis provides more precise estimates than standard pairwise meta-analysis and... (Comparative Study)
Comparative Study Meta-Analysis
The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic Review and Network Meta-analysis.
OBJECTIVE
There is uncertainty around preoperative skin antisepsis in clean surgery. Network meta-analysis provides more precise estimates than standard pairwise meta-analysis and can rank interventions by efficacy, to better inform clinical decisions.
BACKGROUND
Infection is the most common and costly complication of surgery. The relative efficacy of CHG and PVI based skin antiseptics in clean surgery remains unclear.
METHODS
We searched for randomized or nonrandomized studies comparing the effect of different preparations of CHG and PVI on the dichotomous outcome of surgical site infection. We included studies of adults undergoing clean surgery. We excluded studies concerning indwelling vascular catheters, blood sampling, combination antiseptics or sequential applications of different antiseptics. We performed a network meta-analysis to estimate the relative efficacy of interventions using relative risks (RR).
RESULTS
We included 17 studies comparing 5 antiseptics in 14,593 individuals. The overall rate of surgical site infection was 3%. Alcoholic CHG 4%-5% was ranked as the most effective antiseptic as it halved the risk of surgical site infection when compared to aqueous PVI [RR 0.49 (95% confidence interval 0.24, 1.02)] and also to alcoholic PVI, although uncertainty was larger [RR 0.51 (95% confidence interval 0.21, 1.27)]. Adverse events related to antiseptic application were only observed with patients exposed to PVI.
CONCLUSIONS
Alcoholic formulations of 4%-5% CHG seem to be safe and twice as effective as PVI (alcoholic or aqueous solutions) in preventing infection after clean surgery in adults. Our findings concur with the literature on contaminated and clean-contaminated surgery, and endorse guidelines worldwide which advocate the use of alcoholic CHG for preoperative skin antisepsis.
REGISTRATION
PROSPERO ID CRD42018113001.
Topics: Adult; Anti-Infective Agents, Local; Chlorhexidine; Humans; Network Meta-Analysis; Povidone-Iodine; Preoperative Care; Surgical Wound Infection
PubMed: 32773627
DOI: 10.1097/SLA.0000000000004076 -
BMJ Open Apr 2019Short peripheral intravenous catheters (PVCs) are the most frequently used invasive medical devices in hospitals. Unfortunately, PVCs often fail before the end of... (Randomized Controlled Trial)
Randomized Controlled Trial
Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, combined or not with use of a bundle of new devices, for prevention of short-term peripheral venous catheter-related infectious complications and catheter failure: an open-label, single-centre, randomised, four-parallel...
INTRODUCTION
Short peripheral intravenous catheters (PVCs) are the most frequently used invasive medical devices in hospitals. Unfortunately, PVCs often fail before the end of treatment due to the occurrence of mechanical, vascular or infectious complications, which prolongs hospitalisation and increases healthcare costs and mortality.Prevention of these complications is mainly based on the respect of hygiene rules and the use of biocompatible catheters. In critically ill patients, 2% chlorhexidine-alcohol is superior to 5% povidone iodine-alcohol for skin preparation before central venous and arterial catheters; whether this finding can be extended to PVC inserted in the wards remains speculative. Similarly, the use of new technologies such as catheters designed to minimise blood exposure, zero-reflux needleless connectors, disinfecting caps and flushing PVCs before and after each medication administration to maintain catheter patency are of theoretical interest to prevent PVC failure, but little scientific data support their routine use.
METHODS AND ANALYSIS
The CLEAN 3 study is an open-label, single-centre, randomised, two-by-two factorial trial. One thousand patients visiting our emergency department and requiring hospital admission in the wards will be randomised to one of four strategies according to skin preparation and devices used. The two primary endpoints will be (1) the incidence of infectious complications related to the catheters (colonisation, local infection or bloodstream infection) and (2) the time between catheter insertion and catheter failure defined as any premature removal of PVC before end of treatment, other than for routine replacement.
ETHICS AND DISSEMINATION
This protocol has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.
TRIAL REGISTRATION NUMBER
EudraCT 2018-A02535-50; NCT03757143.
Topics: Adult; Aged; Anti-Infective Agents, Local; Antisepsis; Catheter-Related Infections; Catheterization, Peripheral; Catheters, Indwelling; Central Venous Catheters; Chlorhexidine; Equipment Failure; Ethanol; Female; Humans; Incidence; Length of Stay; Male; Middle Aged; Multivariate Analysis; Povidone-Iodine
PubMed: 30944142
DOI: 10.1136/bmjopen-2018-028549 -
Acta Ophthalmologica Aug 2018There is increasing evidence that topical antibiotics, given before and/or after intravitreal injections, are ineffective in preventing endophthalmitis and are possibly... (Review)
Review
There is increasing evidence that topical antibiotics, given before and/or after intravitreal injections, are ineffective in preventing endophthalmitis and are possibly harmful. In addition to the lack of efficacy and increased development of resistant organisms, the use of topical antibiotics adds significantly to the cost of delivering intravitreal therapy. Despite this, in many countries, it is still common practice to use pre- and/or postinjection topical antibiotics. This review outlines the general principles of effective antibiotic prophylaxis, and the evidence regarding topical antibiotic use as a prophylactic measure for endophthalmitis following intravitreal injections. A key distinguishing feature of intravitreal injections from most other invasive procedures is the fact that they are often repeated on multiple occasions to the same eye. Given the lack of evidence to support topical antibiotics as an effective method of prophylaxis for postinjection endophthalmitis, it appears that more widespread education of ophthalmologists is required to avoid continued inappropriate use. Revision of drug labels in some jurisdictions, and amendment of local/professional society guidelines, may be required to assist in achieving this goal. Emphasis should be placed on antisepsis and aseptic technique, which are the major proven methods of endophthalmitis prevention, rather than antibiotics.
Topics: Administration, Topical; Anti-Bacterial Agents; Antibiotic Prophylaxis; Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections
PubMed: 28440583
DOI: 10.1111/aos.13417 -
European Review For Medical and... Apr 2015Chlorhexidine (CHX) is one of the most widely used antiseptic, especially in dentistry. At low concentrations CHX is bacteriostatic and at high concentrations acts... (Review)
Review
OBJECTIVES
Chlorhexidine (CHX) is one of the most widely used antiseptic, especially in dentistry. At low concentrations CHX is bacteriostatic and at high concentrations acts bactericidal causing cell death by cytolysis. In this study, we performed a systematic review of pharmaco-biological activity and application of CHX.
MATERIALS AND METHODS
Articles for inclusion in this review were retrieved from online databases PubMed/Medline. The selected papers were included in the present manuscript according to their relevance for the topic.
RESULTS
Totally 75 papers were enrolled in this research. CHX has strong biocidal activity against Gram-positive bacteria and weaker activity against Gram-negative bacteria. It is also active against yeasts, some dermatophytes and some lipophilic viruses. The most widely application CHX has found in dentistry and antisepsis. Numerous studies have confirmed the beneficial effects of CHX in reducing of plaque accumulation, in tooth caries, gingivitis, periodontitis and in alveolar osteitis. Unfortunately, CHX exhibits cytotoxic activity on human cells, can cause colorization of teeth and fillings, and its activity depends on the pH of the environment and the presence of organic substances.
CONCLUSIONS
CHX play a valuable role in the dentistry and antisepsis. However, it can also cause side effects, limiting its application time.
Topics: Anti-Infective Agents, Local; Antisepsis; Biological Availability; Chlorhexidine; Dental Plaque; Humans
PubMed: 25912596
DOI: No ID Found -
International Journal of Retina and... 2015Endophthalmitis is an uncommon but often visually devastating complication of intravitreal injections. This commentary reviews the key aspects and technical components...
Endophthalmitis is an uncommon but often visually devastating complication of intravitreal injections. This commentary reviews the key aspects and technical components of intravitreal injections and how they may relate to the development of endophthalmitis. Because endophthalmitis is a rare event, data are often lacking on specific aspects of injection technique that may or may not be helpful in preventing infection. What is not in doubt, however, is the utmost importance of using povidone-iodine antisepsis to the ocular surface prior to injection, and maintaining a lash and lid margin-free injection site.
PubMed: 27847605
DOI: 10.1186/s40942-015-0012-9 -
Frontiers in Immunology 2020Sepsis continues to produce widespread inflammation, illness, and death, prompting intensive research aimed at uncovering causes and therapies. In this article, we focus... (Review)
Review
Sepsis continues to produce widespread inflammation, illness, and death, prompting intensive research aimed at uncovering causes and therapies. In this article, we focus on ghrelin, an endogenous peptide with promise as a potent anti-inflammatory agent. Ghrelin was discovered, tracked, and isolated from stomach cells based on its ability to stimulate release of growth hormone. It also stimulates appetite and is shown to be anti-inflammatory in a wide range of tissues. The anti-inflammatory effects mediated by ghrelin are a result of both the stimulation of anti-inflammatory processes and an inhibition of pro-inflammatory forces. Anti-inflammatory processes are promoted in a broad range of tissues including the hypothalamus and vagus nerve as well as in a broad range of immune cells. Aged rodents have reduced levels of growth hormone (GH) and diminished immune responses; ghrelin administration boosts GH levels and immune response. The anti-inflammatory functions of ghrelin, well displayed in preclinical animal models of sepsis, are just being charted in patients, with expectations that ghrelin and growth hormone might improve outcomes in patients with sepsis.
Topics: Animals; Anti-Inflammatory Agents; Cytokine Release Syndrome; Cytokines; Ghrelin; Humans; Inflammation; Inflammation Mediators; Receptors, Ghrelin; Sepsis; Signal Transduction
PubMed: 33584688
DOI: 10.3389/fimmu.2020.610363 -
Archives of Disease in Childhood. Fetal... Mar 2018
Topics: Anti-Infective Agents, Local; Antisepsis; Catheter-Related Infections; Central Venous Catheters; Drug Resistance, Microbial; Humans; Infant, Newborn; Infection Control; Sepsis
PubMed: 29371239
DOI: 10.1136/archdischild-2017-313150 -
The American Journal of Medicine Mar 2021
Topics: Antisepsis; Asymptomatic Infections; COVID-19; Communicable Disease Control; Humans; Mouthwashes; Nasopharynx; Pneumonia, Viral; SARS-CoV-2
PubMed: 33338507
DOI: 10.1016/j.amjmed.2020.12.001