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Clinical Ophthalmology (Auckland, N.Z.) 2021To determine the best method of antimicrobial prophylaxis against implanted material-associated infections in the setting of scleral buckle surgery.
OBJECTIVE
To determine the best method of antimicrobial prophylaxis against implanted material-associated infections in the setting of scleral buckle surgery.
DESIGN
Experimental study.
PARTICIPANTS
Scleral buckle elements were soaked in either gram-positive or polymicrobial broth, while control buckle elements were soaked in PBS only.
METHODS
Solid silicone and sponge scleral buckle elements were inoculated with common pathogens of the ocular surface, and then soaked in either 1% or 5% povidone-iodine, 1 mg/mL gentamicin solution, or sterile saline for 1, 5, 10, or 15 minutes. Bacteria were then isolated from the buckle elements and cultured for 24 hours.
RESULTS
In all gram-positive bacterial conditions, gentamicin solution decreased the bacterial load from 451,666.67 colony-forming units (CFU)/mL to 171,611.11 CFU/mL (p=0.0004). The fractional bacterial survival after soaking in gentamicin was higher for the silicone sponge than band (0.357 vs 0.079, p=0.038). Both 1% and 5% povidone-iodine were able to completely eradicate all gram-positive bacteria of both buckle elements. Only 5% povidone-iodine was able to completely sterilize all microbes on the buckle after soaking in a polymicrobial solution consisting of gram-positive, gram-negative bacteria, and fungi.
CONCLUSION
Povidone-iodine solution was significantly more effective at bacterial eradication compared to gentamicin solution. For all scleral buckle procedures, we recommend soaking the buckle element in 2-3% povidone-iodine solution before placement and rinsing the ocular surface with the same solution after placement.
PubMed: 34079217
DOI: 10.2147/OPTH.S305637 -
The Journal of Hospital Infection Jan 2023Inadequate infection control, wound care, and oral hygiene protocols in nursing homes pose challenges to residents' quality of life. Based on the outcomes from a focus... (Review)
Review
Inadequate infection control, wound care, and oral hygiene protocols in nursing homes pose challenges to residents' quality of life. Based on the outcomes from a focus group meeting and a literature search, this narrative review evaluates the current and potential roles of antiseptics within nursing home infection management procedures. We examine contemporary strategies and concerns within the management of meticillin-resistant Staphylococcus aureus (MRSA; including decolonization regimes), chronic wound care, and oral hygiene, and review the available data for the use of antiseptics, with a focus on povidone-iodine. Compared with chlorhexidine, polyhexanide, and silver, povidone-iodine has a broader spectrum of antimicrobial activity, with rapid and potent activity against MRSA and other microbes found in chronic wounds, including biofilms. As no reports of bacterial resistance or cross-resistance following exposure to povidone-iodine exist, it may be preferable for MRSA decolonization compared with mupirocin and chlorhexidine, which can lead to resistant MRSA strains. Povidone-iodine oral products have greater efficacy against oral pathogens compared with other antiseptics such as chlorhexidine mouthwash, highlighting the clinical benefit of povidone-iodine in oral care. Additionally, povidone-iodine-based products, including mouthwash, have demonstrated rapid in-vitro virucidal activity against SARS-CoV-2 and may help reduce its transmission if incorporated into nursing home coronavirus 2019 control protocols. Importantly, povidone-iodine activity is not adversely affected by organic material, such as that found in chronic wounds and the oral cavity. Povidone-iodine is a promising antiseptic agent for the management of infections in the nursing home setting, including MRSA decolonization procedures, chronic wound management, and oral care.
Topics: Humans; Anti-Infective Agents, Local; Povidone-Iodine; Chlorhexidine; Methicillin-Resistant Staphylococcus aureus; Mouthwashes; Quality of Life; COVID-19; SARS-CoV-2; Nursing Homes
PubMed: 36216172
DOI: 10.1016/j.jhin.2022.09.021 -
Ophthalmology May 2023To investigate the effects of serial intravitreal injections (IVIs) on the ocular surface and meibomian glands (MGs) in patients treated with anti-vascular endothelial... (Observational Study)
Observational Study
PURPOSE
To investigate the effects of serial intravitreal injections (IVIs) on the ocular surface and meibomian glands (MGs) in patients treated with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD).
DESIGN
Retrospective, controlled, observational study.
PARTICIPANTS
Patients with nAMD receiving unilateral IVIs with anti-VEGF agents. The fellow eye was used as control.
METHODS
Tear film and ocular surface examinations were performed on a single occasion at a minimum of 4 weeks after IVI. A pre-IVI asepsis protocol with povidone-iodine (PVP-I) was applied.
MAIN OUTCOME MEASURES
Upper and lower MG loss, tear meniscus height (TMH), bulbar redness (BR) score, noninvasive tear break-up time (NIBUT), tear film osmolarity (TOsm), Schirmer test, corneal staining, fluorescein tear film break-up time (TBUT), meibomian gland expressibility (ME), and meibum quality.
RESULTS
Ninety patients with a mean age of 77.5 years (standard deviation [SD], 8.4; range 54-95) were included. The median number of IVIs in treated eyes was 19.5 (range, 2-132). Mean MG loss in the upper eyelid was 19.1% (SD, 11.3) in treated eyes and 25.5% (SD, 14.6) in untreated fellow eyes (P = 0.001). For the lower eyelid, median MG loss was 17.4% (interquartile range [IQR], 9.4-29.9) in treated eyes and 24.5% (IQR, 14.2-35.2) in fellow eyes (P < 0.001). Mean BR was 1.32 (SD, 0.46) in treated eyes versus 1.44 (SD, 0.45) in fellow eyes (P = 0.017). Median TMH was 0.36 mm (IQR, 0.28-0.52) in treated eyes and 0.32 mm (IQR, 0.24-0.49) in fellow eyes (P = 0.02). There were no differences between treated and fellow eyes regarding NIBUT, TOsm, Schirmer test, corneal staining, fluorescein TBUT, ME, or meibum quality.
CONCLUSIONS
Repeated IVIs with anti-VEGF with preoperative PVP-I application was associated with reduced MG loss, increased tear volume, and reduced signs of inflammation compared with fellow nontreated eyes in patients with nAMD. This regimen may thus have a beneficial effect on the ocular surface.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found after the references.
Topics: Humans; Aged; Povidone-Iodine; Retrospective Studies; Intravitreal Injections; Dry Eye Syndromes; Meibomian Glands; Fluoresceins; Tears
PubMed: 36693594
DOI: 10.1016/j.ophtha.2023.01.009 -
Antimicrobial Resistance and Infection... Nov 2022Reports are available on cross-resistance between antibiotics and biocides. We evaluated the effect of povidone-iodine (PVP-I) and propanol-based mecetronium ethyl...
BACKGROUND
Reports are available on cross-resistance between antibiotics and biocides. We evaluated the effect of povidone-iodine (PVP-I) and propanol-based mecetronium ethyl sulphate (PBM) on resistance development, antibiotics cross-resistance, and virulence in Staphylococcus aureus.
METHODS
The minimum inhibitory concentration (MIC) of PVP-I and PBM were determined against S. aureus ATCC 25923 using the agar-dilution method. Staphylococcus aureus ATCC 25923 was subjected to subinhibitory concentrations of the tested biocides in ten consecutive passages followed by five passages in a biocide-free medium; MIC was determined after each passage and after the fifth passage in the biocide-free medium. The developed resistant mutant was tested for cross-resistance to different antibiotics using Kirby-Bauer disk diffusion method. Antibiotic susceptibility profiles as well as biocides' MIC were determined for 97 clinical S. aureus isolates. Isolates were categorized into susceptible and resistant to the tested biocides based on MIC distribution pattern. The virulence of the biocide-resistant mutant and the effect of subinhibitory concentrations of biocides on virulence (biofilm formation, hemolysin activity, and expression of virulence-related genes) were tested.
RESULTS
PVP-I and PBM MIC were 5000 μg/mL and 664 μg/mL. No resistance developed to PVP-I but a 128-fold increase in PBM MIC was recorded, by repeated exposure. The developed PBM-resistant mutant acquired resistance to penicillin, cefoxitin, and ciprofloxacin. No clinical isolates were PVP-I-resistant while 48.5% were PBM-resistant. PBM-resistant isolates were more significantly detected among multidrug-resistant isolates. PVP-I subinhibitory concentrations (¼ and ½ of MIC) completely inhibited biofilm formation and significantly reduced hemolysin activity (7% and 0.28%, respectively). However, subinhibitory concentrations of PBM caused moderate reduction in biofilm activity and non-significant reduction in hemolysin activity. The ½ MIC of PVP-I significantly reduced the expression of hla, ebps, eno, fib, icaA, and icaD genes. The virulence of the biocide-resistant mutant was similar to that of parent strain.
CONCLUSION
PVP-I is a highly recommended antiseptic for use in healthcare settings to control the evolution of high-risk clones. Exposure to PVP-I causes no resistance-development risk in S. aureus, with virulence inhibition by subinhibitory concentrations. Also, special protocols need to be followed during PBM use in hospitals to avoid the selection of resistant strains.
Topics: Humans; Staphylococcus aureus; Povidone-Iodine; Anti-Bacterial Agents; Virulence; 1-Propanol; Hemolysin Proteins; Drug Resistance, Bacterial; Staphylococcal Infections; Disinfectants
PubMed: 36369050
DOI: 10.1186/s13756-022-01178-9 -
Endocrine Journal Jan 2022In this study, we aimed to determine the association of neonatal/post-neonatal hypothyroidism with mother's iodine exposure, especially povidone iodine disinfection, and...
In this study, we aimed to determine the association of neonatal/post-neonatal hypothyroidism with mother's iodine exposure, especially povidone iodine disinfection, and hysterosalpingography. Participants were mother-child pairs in a Japanese birth cohort (n = 100,286). Risk factors of hypothyroidism were supplement intake, seaweed intake, other daily iodine intake, povidone iodine disinfection at delivery, and maternal history of hysterosalpingography, thyroid disease (Graves' disease and Hashimoto's thyroiditis), and medication (thiamazole and levothyroxine). Congenital hypothyroidism (CH) at age 1 year was assessed using a questionnaire. Transient hypothyroidism was defined as elevated thyroid stimulating hormone level at birth and absence of CH at age 1 year. The incidence of CH at age 1 year per 100 children was 1.1 for those born at 22-30 weeks' gestation, 0.17 following povidone iodine disinfection, and 0.07, 0.95, 0.81, 1.17, and 1.15 with a maternal history of hysterosalpingography, Graves' disease, Hashimoto's thyroiditis, thiamazole use, and levothyroxine use, respectively. Odds ratios (95% confidence intervals) of CH at age 1 year for povidone iodine disinfection, hysterosalpingography history, maternal Graves' disease, and maternal Hashimoto's thyroiditis were 1.13 (0.71-1.79), 0.47 (0.07-3.36), 7.06 (3.70-13.5), and 5.93 (2.90-12.1), respectively. For transient hypothyroidism for povidone iodine disinfection and hysterosalpingography history, these values were 1.99 (1.51-2.62) and 0.63 (0.20-1.96), respectively. Maternal thyroid disease greatly increased neonatal/post-neonatal hypothyroidism risk. Povidone iodine disinfection may increase transient hypothyroidism risk but not the risk at 1 year of age. Hysterosalpingography does not increase hypothyroidism risk from birth to age 1 year.
Topics: Congenital Hypothyroidism; Female; Humans; Infant; Infant, Newborn; Iodine; Japan; Mothers; Thyroxine
PubMed: 34433732
DOI: 10.1507/endocrj.EJ21-0168 -
European Review For Medical and... Apr 2023Intravitreal injections (IVI) of therapeutic substances are one of the most common procedures in ophthalmology and, for sure, the most feared complication of them is...
OBJECTIVE
Intravitreal injections (IVI) of therapeutic substances are one of the most common procedures in ophthalmology and, for sure, the most feared complication of them is endophthalmitis. Nowadays, a precise prophylactic protocol does not exist to avoid these infections, and the role of new antiseptic drops is an interesting field of research in this regard. In this article we are going to discuss the tolerability and the efficacy of a new antiseptic drop based on a solution of hexamidine diisethionate 0.05% (Keratosept®; Bruschettini Srl, Genoa, Italy).
PATIENTS AND METHODS
This was a single-center, case-control study, comparing the in vivo effect of hexamidine diisethionate 0.05% with povidone iodine 0.6% solution during IVI program. Ocular bacterial flora composition was analyzed with a conjunctival swab on day 0. After injection patients underwent antibacterial prophylaxis with Keratosept for 3 days or povidone iodine 0.6%. A second conjunctival swab was collected on day 4 and patients were asked to fulfill a questionnaire based on the OSDi model, to investigate the ocular tolerability of the drug administered.
RESULTS
Efficacy was tested on 50 patients, 25 of whom received hexamidine diisethionate 0.05% drops and the other 25 received povidone iodine 0.6% solution drops, 100 total conjunctival swabs, 18 positive swabs before and 9 after treatment for the first group and 13 before and 5 after for the second one. Tolerability was tested on 104 patients, 55 underwent Keratosept therapy and 49 povidone iodine one.
CONCLUSIONS
Keratosept demonstrated a good efficacy profile with better tolerability against povidone iodine in the analyzed sample.
Topics: Humans; Povidone-Iodine; Intravitreal Injections; Case-Control Studies; Anti-Infective Agents, Local; Conjunctiva
PubMed: 37140316
DOI: 10.26355/eurrev_202304_32153 -
Enfermedades Infecciosas Y... Mar 2023Povidone-iodine and hydrogen peroxide could be effective in against SARS-CoV-2. (Clinical Trial)
Clinical Trial
INTRODUCTION
Povidone-iodine and hydrogen peroxide could be effective in against SARS-CoV-2.
METHODS
A "non-interventional trial" in 88 patients (43±17 yrs., 55% men) with SARS-CoV-2 in nasopharyngeal swabs (RT-PCR). 31 received mouth rinses/gargling with povidone-iodine (every 8h, two consecutive days), 17 with mouth rinses/gargling of hydrogen peroxide, and 40 controls. Were repeated PCR in 3, 11 and 17 days.
RESULTS
After intervention the viral load (Log10 copies/ml) remained similar in povidone-iodine (4.3±2.7 copies/ml), hydrogen peroxide (4.6±2.9 copies/ml; p=0.40) and controls (4.4±3.0 copies/ml). The percentage of patients with a negative result in the second PCR was 27% in povidone-iodine group, 23% in hydrogen peroxide and 32% in controls; in the third PCR, 62%, 54% y 58% respectively; and in the fourth PCR, 81%, 75% y 81%.
CONCLUSION
Our results do not support the clinical usefulness of mouth rinses/gargling with povidone-iodine or hydrogen peroxide in patients with COVID-19.
Topics: Female; Humans; Male; Anti-Infective Agents, Local; COVID-19; Hydrogen Peroxide; Mouthwashes; Povidone-Iodine; SARS-CoV-2
PubMed: 36058840
DOI: 10.1016/j.eimce.2022.08.003 -
The Journal of Hospital Infection Apr 2022Ten percent povidone-iodine (PVP-I) was initially promoted as 'tamed iodine' as the chemical activity of the active biocide, uncomplexed or free molecular iodine (I), is...
BACKGROUND
Ten percent povidone-iodine (PVP-I) was initially promoted as 'tamed iodine' as the chemical activity of the active biocide, uncomplexed or free molecular iodine (I), is reduced 30- to 50-fold compared with Lugol's solution. The idea that I is responsible for topical iodine staining and irritation remains widely held. However, there are no controlled studies that characterize the cytotoxicity and staining of the hydrophobic I species compared with the other hydrophilic iodine species that comprise over 99.9% of the total iodine in topical iodine disinfectants.
AIMS
To compare the staining properties of the I species with other topical iodine disinfectants; to evaluate if the concentrations of I in diluted PVP-I used to reduce severe acute respiratory syndrome coronavirus-2 in the nasal cavity are potentially cytotoxic; and to determine if high concentrations of I can be delivered beyond the stratum corneum into the hypodermis, which could provide a mechanistic rationale for I out-gassing.
METHODS
Five liquid compositions that contained complexed and uncomplexed (free) I in aqueous and non-aqueous carriers were used to evaluate the interaction of I with mammalian cells in culture as well as human and pig skin.
FINDINGS
Concentrations of I (7800 ppm) that are 1500 times higher than that found in PVP-I can be applied to skin without irritation and staining. I is not cytotoxic at concentrations >100 times higher than that found in PVP-I, and does not contribute materially to staining of skin at concentrations found in Lugol's solution (approximately 170 ppm). I can partition into hypodermis tissue, remain there for hours and out-gas from skin. PVP-I and Lugol's solution are highly effective topical disinfectants, but do not facilitate diffusion of I through the stratum corneum.
CONCLUSION
The maximum concentration of I found in diluted PVP, approximately 25 ppm, is not cytotoxic or irritating. The potential clinical utility of I has been limited by incorporating this broad-spectrum biocide into acidic aqueous formulations that contain numerous chemical species that contribute toxicity but not biocidal activity. I can be delivered topically into hypodermis tissue without irritation.
Topics: Animals; COVID-19; Disinfectants; Humans; Iodine; Iodophors; Mammals; Povidone-Iodine; Swine
PubMed: 35124143
DOI: 10.1016/j.jhin.2022.01.015 -
Otology & Neurotology : Official... Dec 2022Commercially available povidone-iodine solution can eliminate biofilms and persister cells rapidly in in vivo achievable concentrations without inducing ototoxicity.
HYPOTHESIS
Commercially available povidone-iodine solution can eliminate biofilms and persister cells rapidly in in vivo achievable concentrations without inducing ototoxicity.
BACKGROUND
Chronic suppurative otitis media (CSOM) is a substantial global problem. Current treatment options often induce a temporary remission without leading to a permanent cessation of symptoms secondary to the treatments' inability to eliminate persister cells. Povidone-iodine has been shown to be able to clear biofilm and planktonic cells in in vitro assays, but there are reports of ototoxic effects limiting its clinical utility.
METHODS
Bacterial and biofilm growth with quantification by spectrophotomer, murine auditory brainstem response (ABR), and distortion product otoacoustic emissions, immunohistochemistry, in vivo povidone-iodine treatment of murine CSOM, persister cell assay.
RESULTS
Commercially available 10% povidone-iodine solution is able to completely eradicate multiple clinical strains of Pseudomonas aeruginosa and Staphylococcus aureus in vitro with 10 minutes of exposure. Mice that have received a transtympanic injection of 1% povidone-iodine solution did not have significantly different auditory brainstem response or distortion product otoacoustic emission results compared with the control. Mice that received a povidone-iodine scrub or 10% povidone-iodine solution had significantly worsened hearing (25- and 13-dB increase in threshold, respectively; p < 0.05). In vivo CSOM infection recurred in all mice after the completion of treatment with 10% povidone-iodine solution, and there was no improvement in the bacterial load after treatment, indicating in vivo failure of therapy.
CONCLUSION
Povidone-iodine solution is effective at eliminating biofilm and persister cells in vitro at in vivo achievable concentrations but fails in vivo most likely because of kinetics of distribution in vivo. Even if drug distribution could be improved, the therapeutic window is likely to be too small given that the diluted solution does not have ototoxic potential, whereas while the scrub variant, which contains detergents, and the undiluted solution are ototoxic after a single treatment.
Topics: Mice; Animals; Povidone-Iodine; Otitis Media, Suppurative; Anti-Infective Agents, Local; Ototoxicity; Neoplasm Recurrence, Local
PubMed: 36240734
DOI: 10.1097/MAO.0000000000003726 -
Clinical & Experimental Optometry Apr 2021Adenoviral conjunctivitis is the most common cause of ocular viral infection in the world, but currently has no approved therapeutic treatments. The antiseptic... (Review)
Review
Adenoviral conjunctivitis is the most common cause of ocular viral infection in the world, but currently has no approved therapeutic treatments. The antiseptic povidone-iodine (PVP-I) has been used as an off-label treatment for the condition, but high-quality evidence for its use is limited. This paper aims to review the literature surrounding the use of PVP-I in the management of adenoviral conjunctivitis. Unfortunately, treatment regimens, inclusion criteria, outcome measures, and review periods vary widely between studies, making direct comparisons between outcomes difficult. The majority of studies investigate daily instillation of 0.4 to 2.0% PVP-I rather than one-time instillation of PVP-I as has been used anecdotally in practice. In addition, only one treatment arm investigates daily PVP-I alone, with no significant difference in the duration of disease or clinical outcome compared to placebo. All other treatment arms investigate PVP-I in combination with dexamethasone which generally improve outcomes. Tolerability of PVP-I is generally good for low concentrations <1.0%, but efficacy of treatment is generally reported to be concentration dependent. Future research should investigate the optimal concentration, dosing regimen and role of each agent in combination treatment and aim to use laboratory techniques to improve diagnosis and provide quantifiable outcomes.
Topics: Anti-Infective Agents, Local; Conjunctivitis; Glucocorticoids; Humans; Povidone-Iodine; Treatment Outcome
PubMed: 33689609
DOI: 10.1080/08164622.2021.1877532