Prophylactic therapy for prevention of surgical site infection after extraction of third molar: An overview of reviews

Background: To compare the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars with different degree of impaction. Material and Methods: Systematic reviews and meta-analyses evaluating the effect of different prophylactic therapies on prevention of surgical site infection after extraction of third molars were included. An electronic search was performed in PubMed, EMBASE, and the Cochrane Database of Systematic reviews. AMSTAR 2 tool was used to evaluate the confidence in results from the included reviews. Descriptive analyses were performed. Results: Six reviews were included. A significant benefit of different antibiotics to the prevention of site infection after extraction of third molars was reported. Amoxicillin/amoxicillin clavulanic acid could significantly reduce the rate of surgical site infection versus placebo. Chlorhexidine gel could significantly reduce the frequency of alveolar osteitis versus placebo. Conclusions: Based on the limited evidence, there is a significant benefit of prophylactic therapy while the comparative effect of different types of prophylactic regimes are controversial. (AU)

Eficacia del apósito de gluconato de clorhexidina sobre las infecciones relacionadas con el catéter de hemodiálisis / Efficacy of Chlorhexidine Gluconate Dressing on Catheter-Related Infections in Hemodialysis

Introducción: El uso de catéteres venosos centrales para hemodiálisis se relaciona con un mayor desarrollo de complicaciones infecciosas, por lo que las Guías de Práctica Clínica recomiendan diferentes estrategias para disminuir dichas complicaciones, sin indicación clara sobre el apósito a utilizar en la cura del orificio de salida. Objetivo: Comparar la tasa de infecciones relacionadas con el catéter de dos pautas de cura del orificio de salida del catéter venoso central de hemodiálisis: apósito con gluconato de clorhexidina al 2% frente a clorhexidina en solución al 2%, cubierta con apósito de poliuretano semipermeable autoadhesivo. Material y Método: Estudio experimental, controlado, aleatorizado en pacientes en hemodiálisis a través de catéter venoso central para comparar dos pautas de cura, grupo control: clorhexidina en solución al 2% cubierta con apósito de poliuretano semipermeable autoadhesivo y grupo intervención: apósito con gluconato de clorhexidina al 2%. Se recogieron datos socioclínicos y relacionados con las complicaciones infecciosas. Se realizó un análisis descriptivo e inferencial.. Resultados: Se estudiaron 50 pacientes, 25 en cada grupo. El grupo intervención presentó dos infecciones del orificio de salida y el grupo control, presentó doce casos (OR: 0,176, IC 95%: 0,039-0,790; p=0,013). El grupo intervención presentó un caso de bacteriemia frente a dos episodios del grupo control (OR: 0,533, IC 95%: 0,048-5,892; p=ns). Conclusión: La cura con apósito con gluconato de clorhexidina al 2% es una medida protectora frente a la infección del orificio de salida en comparación con la cura con clorhexidina en solución al 2% y apósito de poliuretano. (AU)

Introduction: The use of central venous catheters for hemodialysis is associated with a higher incidence of infectious complications, leading Clinical Practice Guidelines to recommend various strategies to reduce such complications, with no clear indication of the dressing to use for catheter exit site care. Objectives: To compare the infection rate related to the catheter exit site using two different protocols: dressing with 2% chlorhexidine gluconate versus 2% chlorhexidine solution, both covered with self-adhesive semi-permeable polyurethane dressing for central venous catheters used in hemodialysis. Material and Method: An experimental, controlled, randomized study was conducted in hemodialysis patients with central venous catheters to compare two care protocols. The control group received a 2% chlorhexidine solution covered with a self-adhesive semi-permeable polyurethane dressing, while the intervention group received a dressing with 2% chlorhexidine gluconate. Socio-clinical and infection-related data were collected, and descriptive and inferential analyses were performed. Results: A total of 50 patients were studied, with 25 in each group. The intervention group had two exit site infections, while the control group had twelve cases (OR: 0.176, 95% CI: 0.039-0.790; p=0.013). The intervention group had one case of bacteremia compared to two cases in the control group (OR: 0.533, 95% CI: 0.048-5.892; p=ns). Conclusion: Dressing with 2% chlorhexidine gluconate is a protective measure against exit site infection compared to dressing with 2% chlorhexidine solution and polyurethane dressing. (AU)

Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis / El cuidado bucal de rutina con clorhexidina reduce la incidencia de neumonía asociada al ventilador en pacientes de la UCI? Una revisión sistemática y metanálisis

Objective This study aimed to investigate chlorhexidine’s efficacy in preventing ventilator-associated pneumonia (VAP). Design A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Settings The data were obtained from Pubmed, Cochrane Library, and EMBASE. Patients or participants Only mechanically ventilated patients for at least 48h were included. Interventions Randomized clinical trials applying any dosage form of chlorhexidine were eligible. Main variables of interest The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised. Results Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]). Conclusions CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome (AU)

Objetivo Este estudio tuvo como objetivo investigar la eficacia de la clorhexidina en la prevención de la neumonía asociada al ventilador (NAV). Diseño se realizó una revisión sistemática y un metanálisis siguiendo los elementos de informe (PRISMA) Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ámbito Los datos se obtuvieron de Pubmed, Cochrane Library y EMBASE. Pacientes o participantes solo se incluyeron pacientes con ventilación mecánica durante al menos 48 horas. Intervenciones Fueron elegibles los ensayos clínicos aleatorios que aplicaban cualquier forma de dosificación de clorhexidina. Variables de interés principales Se evaluó el riesgo relativo (RR) de incidencia de NAVM y mortalidad por todas las causas mediante el modelo de efectos aleatorios. También se evaluó la diferencia media en los días de duración de la ventilación mecánica y la duración de la estancia en la unidad de cuidados intensivos (UCI). Resultados Diez estudios con 1233 pacientes se incluyeron en el metanálisis. La aplicación oral de CHX redujo la incidencia de VAP (RR, 0,73 [IC 95%, 0,55, 0,97]) y no mostró un aumento en la mortalidad por todas las causas (RR, 1,13 [IC 95%, 0,96, 1,32]. Conclusiones CHX demostró ser eficaz para prevenir la VAP. Sin embargo, no se pudo establecer una conclusión sobre las tasas de mortalidad porque la calidad de la evidencia fue muy baja para este resultado (AU)

Uso de Nobecutan® para la cura de vías centrales / Use of Nobecutan® for the cure of central venous catheters

El uso de catéteres venosos centrales para facilitar el manejo de los pacientes después de una cirugía mayor es muy f recuente. Los profesionales de enfermería son los responsables de su cuidado, manipulación y mantenimiento, jugando, por lo tanto, un papel muy importante para disminuir la incidencia de infecciones. Metodología: estudio descriptivo y longitudinal sobre un total de 14 pacientes portadores de catéteres, donde 7 de ellos fueron curados con cura tradicional (gasas estériles impregnadas de clorhexidina + apósito transparente) y otros 7 con cura experimental (gasas estériles impregnadas de clorhexidina + nobecutan® spray + apósito transparente). Resultados: los grupos fueron bastante homogéneos en cuanto a edad y sexo, encontrando sin embargo bastantes diferencias en lo relativo a la frecuencia de las curas, el dolor referido y la valoración de la piel pericatéter, obteniendo mejores resultados en el grupo en el cual se emplea nobecutan® spray. Conclusión: el uso de nobecutan® spray para la cura de catéteres venosos centrales es beneficioso a tres niveles, ya que disminuye el dolor y la frecuencia de las curas, y con ello la manipulación y por lo tanto el riesgo de infección. (AU)

The use of central venous catheters for the management of patients after major surgery is very common. Nursing professionals are responsible for the care, handling and maintenance of these catheters, playing an important role in preventing the incidence of infections. Methodology: Descriptive and longitudinal study of a total of fourteen cases of patients with central venous catheters, where seven of them were cured with traditional cure (sterile gauze impregnated with chlorhexidine and transparent dressing) and another seven with experimental cure (sterile gauze impregned with chlorhexidine and nobecutan® spray and transparent dressing). Results: The groups were quite homogeneous in terms of age and sex of patients, finding significant differences in the frequency of cures, patient pain and rating of the pericatheter skin; being much more beneficial in the group where nobecutan® spray was used for the cure. Conclusion: The use of nobecutan® spray for the treatment of central catheters is beneficial at three levels since it reduces pain. The risk of infection is lower as the frequency of treatment, manipulation decreases. (AU)

Higiene con clorhexidina en unidades de cuidados intensivos para prevenir infecciones nosocomiales. Revisión sistemática / Chlorhexidine bathing in intensive care units for the prevention of nosocomial infections. A systematic review

El objetivo de este estudio fue conocer la efectividad de la higiene con clorhexidina para prevenir infecciones nosocomiales en pacientes adultos ingresados en unidades de cuidados intensivos (UCI). Se realizó una revisión sistemática de los ensayos clínicos aleatorizados publicados en los últimos 10 años en diferentes bases de datos. Se extrajo información sobre distintos tipos de infecciones, mortalidad, microorganismos implicados y microorganismos multirresistentes. Se incluyeron cinco estudios. La intervención no fue efectiva en dos estudios debido a una baja frecuencia de infecciones y a una alta prevalencia de bacterias gramnegativas, frente a las que la clorhexidina no es tan eficaz. La intervención tampoco redujo las tasas de mortalidad. La intervención fue efectiva principalmente para prevenir bacteriemias e infecciones por bacterias grampositivas, por lo que podría ser útil en las UCI con altas prevalencias de infecciones de esas características.(AU)

The aim of this study was to determine the effectiveness of chlorhexidine use patients in adult intensive care units for preventing nosocomial infections. We carried out a systematic review of randomized clinical trials published over the past 10 years. We collected the following data: type of infection, mortality, isolated microorganisms, and multi-drug-resistant microorganisms. In two out of the five studies included in the review, bathing with chlorhexidine was ineffective due to low cross-infection rates at baseline and Gram-negative bacteria being the most prevalent type of microorganism, against which chlorhexidine is not as effective. No decline in death rates was either observed. Chlorhexidine bathing was mainly effective in preventing bloodstream infections and those caused by Gram-positive bacteria. Thus, its use may be effective in intensive care units with high prevalence of infections by this type of microorganisms.(AU)

Comparación de la actividad antifúngica in vitro del gluconato de clorhexidina 2% e hipoclorito de sodio 5, 25% contra Candida albicans / In vitro antifungal activity comparation of 2% chlorhexidine gluconate and 5, 25% sodium hypochlorite against Candida albicans

Introducción: la presencia de especies fúngicas es evidente en el sistema del conducto radicular dental. Objetivo: comparar la actividad antifúngica in vitro de dos soluciones contra Candida albicans. Metodología: Experimento in vitro. Se aislaron 90 muestras mediante hisopado de mucosa bucal de pacientes con estomatitis subprotésica, distrubuidas en dos grupos: 45 con discos de NaOCl 5,25% y los otros 45 con discos de CHX 2%. Prueba de Shapiro Wilk, p > 0,05 y prueba Levene, p > 0,05. Se usó T de Student para la comparación. Resultados: gluconato de clorhexidina 2% e hipoclorito de sodio 5,25% mostraron actividad antifúngica con halos de inhibición promedio de 24,6 mm y 25,2 mm, respectivamente. Conclusión: No existen diferencias significativas entre los dos agentes estudiados. (AU)

Background: the presence of fungal species is evident in the dental root canal system. Aim: to compare the in vitro antifungal activity of two solutions against Candida albicans. Methos: In vitro experiment. 90 samples were isolated by swabbing the buccal mucosa from patients with subprosthetic stomatitis, distributed in two groups: 45 with 5.25% Na OCl discs and the other 45 with 2% CHX discs. Shapiro Wilk test, p> 0.05 and Levene test, p> 0.05. Student's t was used for comparison. Results: 2% chlorhexidine gluconate and 5.25% sodium hypochlorite antifungal activity with mean inhibition halos of 24.6 mm and 25.2 mm, respectively. Conclusion: There are no significant differences between the two agents studied. (AU)

Should oral chlorhexidine remain in ventilator-associated pneumonia prevention bundles? / ¿Debe permanecer la clorhexidina oral en los paquetes de prevención de la neumonía asociada al respirador?

Ventilator-associated pneumonia (VAP) is related with high mortality, duration of mechanical ventilation and costs. Recent studies have questioned the safety and effectiveness of oral chlorhexidine to prevent VAP. We sought to verify whether the adverse effects of this substance outweigh its benefits. We searched several databases and selected studies that investigated the use of oral chlorhexidine and its impact on mortality. No association between oral chlorhexidine and lower VAP rates was found on meta-analyses of double-blind randomized trials, however significant increase in mortality was reported. It is speculated that chlorhexidine can cause damage to several organic sectors and cytotoxicity. Although it still can be beneficial in specific settings, robust evidence to recommend its routine application for all mechanically ventilated patients is lacking; therefore, given the possibility of harm, it would be better to follow the principle of non-maleficence until more studies becomes available (AU)

La neumonía asociada al respirador (VAP) está relacionada con una elevada mortalidad, mayor duración de la ventilación mecánica y costes elevados. Estudios recientes han cuestionado la seguridad y la eficacia de la clorhexidina oral para prevenir la VAP. Hemos intentado verificar si los efectos adversos de esta sustancia superan sus beneficios. Se realizaron búsquedas en diversas bases de datos y se seleccionaron estudios que habían investigado el uso de la clorhexidina oral y su impacto sobre la mortalidad. En los metaanálisis de los ensayos aleatorizados a doble ciego no se encontró ninguna asociación entre clorhexidina oral y tasas de VAP más bajas; sin embargo, sí se informó de un aumento significativo de la mortalidad. Se especula que la clorhexidina puede causar daño a varias partes del organismo y citotoxicidad. Pese a que todavía podría ser beneficiosa en entornos específicos, no se dispone de evidencias sólidas para recomendar su aplicación rutinaria para todos los pacientes sometidos a ventilación mecánica; por lo tanto, dada la posibilidad de ocasionar daños, sería mejor seguir el principio de no maleficencia hasta que se disponga de más estudios (AU)

Sustained release varnish containing chlorhexidine for prevention of Streptococcus mutans biofilm formation on voice prosthesis surface: an in vitro study / Barniz de liberación sostenida que contiene clorhexidina para la prevención de la formación de biopelículas de Streptococcus mutans en la superficie de la prótesis de voz: un estudio in vitro

Objectives: In this study, we aimed to develop a novel, sustained release varnish (SRV) for voice prostheses (VP) releasing chlorhexidine (CHX), for the prevention of biofilm formation caused by the common oral bacteria Streptococcus mutans on VP surfaces. Methods: This study was performed in an in vitro model as a step towards future in vivo trials. VPs were coated with a SRV containing CHX (SRV-CHX) or SRV alone (placebo-SRV) that were daily exposed to S. mutans. The polymeric materials of SRV were composed of ethylcellulose and PEG-400. Biofilm formation was assessed by DNA quantification (qPCR), crystal violet staining, confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM), and kinetics experiments. Results: The amount of DNA in the biofilms formed by S. mutans on VP surfaces coated once with SRV-CHX (1.024 ± 0.218 ng DNA/piece) was 58.5 ± 8.8% lower than that of placebo-SRV-coated VPs (2.465 ± 0.198 ng DNA/piece) after a 48-h exposure to S. mutans (p = 0.038). Reduced biofilm mass on SRV-CHX-coated VPs was visually confirmed by CLSM and SEM. CV staining of SRV-CHX single-coated VPs that have been exposed to S. mutans nine times showed a 98.1 ± 0.2% reduction in biofilm mass compared to placebo-SRV-coated VPs (p = 0.003). Kinetic experiments revealed that SRV-CHX triple-coated VPs could delay bacterial growth for 23 days. Conclusions: Coating VPs with SRV-CHX has an inhibitory effect on biofilm formation and prevents bacterial growth in their vicinities. This study is a proof-of-principle that paves the way for developing new clinical means for reducing both VPs’ bacterial biofilm formation and device failure.(AU)

Erythritol-enriched powder and oral biofilm regrowth on dental implants: an in vitro study / Polvo enriquecido con eritritol y crecimiento de biopelículas orales sobre implantes dentales: un estudio in vitro

Backgroud: Peri-implant mucositis and peri-implantitis are the main biological complications associated withdental implants. Since most authors agree that bacteria play a major etiological role, the main aims of this studywere to determine if a formulation of erythritol and chlorhexidine applied with an air polishing system inhibitsbiofilm re-growth over dental implants and to compare the decontamination capacity of this therapy with that ofmechanical removal by saline and gauze.Material and Methods: A multispecies biofilm (P. gingivalis, A. actinomycetemcomitans, F. nucleatum, A. naes-lundii, V. parvula and S. oralis) was grown for 14 days on 52 dental implants in an artificial mouth. These implantswere divided into three groups according to the applied treatment: 14 negative control (CON), 19 erythritol-chlorhexidine (ERY) and 19 gauze with saline (GAU) samples. Twelve dental implants from the ERY and GAUgroups and 8 implants from the CON group were re-incubated for 7 additional days after treatment. The bacterialcount was performed by quantitative polymerase chain reaction (qPCR) using propidium monoazide (PMA). Adescriptive and bivariate analysis of the data was performed.Results: The erythritol and chlorhexidine formulation significantly inhibited biofilm regrowth in comparison withthe mechanical treatment (GAU), since a significant decrease in all the species was observed in the ERY group(except for Aggregatibacter actinomycetemcomitans). The antibiofilm and antibacterial capacity of the two activetreatment groups (ERY and GAU) was similar for a 14 days multispecies in vitro biofilm, except for the lowercount of A. naeslundii in the GAU group. Conclusions: The use of erythritol powder with chlorhexidine applied with an air polishing system reduces biofilmregrowth over dental implants when compared with mechanical removal by saline and gauze. This effect might bebeneficial for patients included in peri-implant maintenance programs.(AU)

Pilot clinical study of the efficacy of a hyaluronic acid (1%) and chlorhexidine (0.20%) gel in post-extraction dentistry

Objective: The objective of the present study was to compare the efficacy, in terms of oral healing and post-surgical pain, in a group of patients treated with an oral application of 1% hyaluronic acid (HA) together with 0.20% chlorhexidine (CHX), compared to patients treated with placebo and a third group treated with HA 0.20%, CHX 0.20% + Panthenol. Method: The study design is an analytical, experimental, randomised, blind, prospective longitudinal study. A sampleof 45 patients was randomised and divided into 3 comparison groups of 15, with each group receiving a different composition gel after a dental extraction. The control group received a gel of 0.20% hyaluronic acid and 0.20% chlorhexidine; the placebo group was applied a gel of similar consistency but without the active ingredients; and the experimental group received a gel with 1% hyaluronic acid and 0.20% chlorhexidine. Efficacy variables were measured at 24, 48 and 72 hours and 7 days. Results: For post-operative pain, we found no statistically significant differences in any of the groups analysed. For healing, the group receiving 1% hyaluronic acid and 0.20% chlorhexidine had the best results from a statistical point of view in the first 24-48 hours compared to the other two groups. Conclusions: The results obtained seemed to show that topical application of 1% hyaluronic acid together with 0.20% chlorhexidine influences soft tissue healing positively after a tooth extraction; however, it does not seem to have any beneficial effects on post-operative oral pain. (AU)

Colonization of the nasal airways by Staphylococcus aureus on admission to a major heart surgery operating room: A real-world experience / Colonización nasal por Staphylococcus aureus en el ingreso quirúrgico para una cirugía cardíaca mayor: una experiencia en la práctica clínica real

INTRODUCTION: Nasal swab culture is used to identify Staphylococcus aureus colonization, as this is a major risk factor for surgical site infection (SSI) in patients who are going to undergo major heart surgery (MHS). We determined nasal carriage of S. aureus in patients undergoing MHS by comparing the yield of a conventional culture with that of a rapid molecular test (Xpert(R) SA Nasal Complete, Cepheid). METHODS: From July 2015 to April 2017, all patients who were to undergo MHS were invited to participate in the study. We obtained two nasal cultures from each patient just before entering the operating room, independently of a previous test for the determination of nasal colonization by this microorganism performed before surgery. One swab was used for conventional culture in the microbiology laboratory, and the other was used for the rapid molecular test. We defined nasal colonization as the presence of a positive culture for S. aureus using either of the two techniques. All patients were followed up until hospital discharge or death. RESULTS: Overall, 57 out of 200 patients (28.5%) were colonized by S. aureus at the time of surgery. Thirty-three patients had both conventional culture- and PCR-positive results. Twenty-four patients had a negative culture and a positive PCR test. Only twenty-one percent (12/57) of colonized patients had undergone an attempt to decolonise before the surgical intervention. CONCLUSION: A significant proportion of patients undergoing MHS are colonized by S. aureus in the nostrils on entering the operating room. New strategies to prevent SSI by this microorganism are needed. Rapid molecular tests immediately before MHS, followed by immediate decolonisation, must be evaluated

INTRODUCCIÓN: Los cultivos nasales se usan para identificar colonización por Staphylococcus aureus, ya que la colonización es un factor de riesgo para la infección de la herida quirúrgica en pacientes que van a ser sometidos a cirugía cardiaca mayor (CCM). En este trabajo, identificamos portadores de S. aureus en el momento quirúrgico en pacientes que van a ser sometidos a CCM, comparando el resultado del cultivo convencional con un test molecular rápido (Xpert(R) SA Nasal Complete, Cepheid). MÉTODOS: Desde julio del 2015 hasta abril del 2017, a todos los pacientes que iban a ser intervenidos con CCM se les invitó a participar en el estudio. Se obtuvieron 2 cultivos nasales de cada paciente, justo antes de entrar en el quirófano, independientemente de si había un test previo de colonización nasal realizada. Una torunda fue usada en el laboratorio de microbiología para cultivo convencional y la otra para el test molecular rápido. Se definió colonización nasal como la positividad para S.aureus por cualquiera de las 2 técnicas. Todos los pacientes fueron seguidos hasta el alta hospitalaria o éxitus. RESULTADOS: Un total de 57 de 200 pacientes (28,5%), estaban colonizados por S. aureus en el momento de la cirugía. En total, 33 pacientes tuvieron ambas muestras positivas (convencional y PCR); 24 pacientes tuvieron cultivo negativo y PCR positiva. Solo el 21% (12/57) de los pacientes colonizados habían tenido un intento de descolonización antes de la cirugía. CONCLUSIÓN: Un porcentaje alto de pacientes están colonizados por S. aureus en el momento de ser sometidos a CCM. Son necesarias nuevas estrategias para prevenir la infección de la herida quirúrgica por este microorganismo. Un test molecular rápido inmediatamente antes de la CCM y descolonización posterior inmediata debe ser evaluado

Estudio clínico piloto de la eficacia de un gel de ácido hialurónico 1% y clorhexidina 0.20% postextracción dental / Pilot clinical study of the effectiveness of a post-dental extraction gel of 1% hyaluronic acid and 0.20% Chlorhexidine

OBJETIVO: El objetivo del presente estudio es comparar la eficacia, en términos de cicatrización oral y dolor postquirúrgico, en un grupo de pacientes tratados con una aplicación oral de ácido hialurónico al 1% junto con clorhexidina al 0,20% frente a pacientes tratados con placebo y un tercer grupo con CHX 0,20% + AH 0,20% + Pantenol. MÉTODO: El diseño del estudio es de un estudio analítico, experimental, aleatorizado, ciego, longitudinal prospectivo. Se randomizó una muestra de 45 pacientes, 15 en cada grupo de comparación, en los que se aplicaron postextracción dental unos geles de distinta composición en función del grupo objeto de estudio. En el grupo control se aplicó un gel de ácido hialurónico al 0,20%, clorhexidina al 0,20% y pantenol, en el grupo placebo se aplicó un gel de consistencia similar al anterior pero en ausencia de compuesto y en el grupo experimental se aplicó ácido hialurónico al 1% y clorhexidina al 0,20%. Las variables de eficacia fueron medidas a las 24h., 48h, 72h y 7 días. RESULTADOS: En relación al dolor postoperatorio no encontramos diferencias estadísticamente significativas en ninguno de los grupos analizados. En relación a la cicatrización el grupo en el que se aplicó ácido hialurónico 1% junto con clorhexidina 0,20% fue el que mejores resultados ofreció desde un punto de vista estadístico en las primeras 24-48h con respecto a los otros dos. CONCLUSIONES: En vista de los resultados obtenidos parece que las aplicaciones tópicas de ácido hialurónico al 1% junto con la clorhexidina al 0,20% influyen de manera positiva en cuanto a la cicatrización del tejido blando post extracción dental, sin embargo, no parece que tenga efectos beneficiosos en cuanto a los niveles de dolor oral post-intervención

OBJECTIVE: The objective of the present study is to compare the efficacy, in terms of oral healing and post-surgical pain, in a group of patients treated with an oral application of 1% hyaluronic acid (HA) together with 0.20% chlorhexidine (CHX), compared to patients treated with placebo and a third group treated with HA 0.20%, CHX 0.20% + Panthenol. METHOD: The study design is an analytical, experimental, randomized, blind, prospective longitudinal study. A sample of 45 patients was randomized and divided into 3 comparison groups of 15, with each group receiving a different composition gel after a dental extraction. The control group received a gel of 0.20% hyaluronic acid, 0.20% chlorhexidine; the placebo group was applied a gel of similar consistency to the previous but without active ingredients; and the experimental group received a gel with 1% hyaluronic acid and 0.20% chlorhexidine. Efficacy variables were measured at 24 hours, 48 hours, 72 hours and 7 days. RESULTS: For post-operative pain, we found no statistically significant differences in any of the groups analysed. For healing, the group receiving 1% hyaluronic acid and 0.20% chlorhexidine had the best results from a statistical point of view in the first 24-48 hours compared to the other two groups. CONCLUSIONS: The results obtained seemed to show that topical applications of 1% hyaluronic acid together with 0.20% chlorhexidine have a positive influence on the healing of soft tissue after dental extraction; however, it does not seem to have any beneficial effects in terms of post-operative oral pain

Clorhexidina para reducir las infecciones del tracto urinario asociadas al catéter: una solución efectiva, aunque poco estudiada / Chlorhexidine for reducing catheter-associated urinary tract infection: An effective yet understudied solution

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Does chlorhexidine improve outcomes in non-surgical management of peri-implant mucositis or peri-implantitis?: a systematic review and meta-analysis

BACKGROUND: With greater number of implants being placed in clinical practice, incidence of peri-implant diseases are on the rise. It is not known whether chlorhexidine (CHX) improves outcomes in the management of peri-implant diseases. The aim of this systematic review and meta-analysis was to evaluate the role of CHX in improving outcomes with non-surgical management of peri-implant mucositis and periimplantitis. MATERIAL AND METHODS: An electronic search of PubMed, Scopus, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases up to 1st August 2019 was carried out to search for studies evaluating the efficacy of CHX for non-surgical management of peri-implant diseases. RESULTS: Seven studies were included. Four studies evaluated the role of CHX in peri-implant mucositis and three in peri-implantitis. Oral prophylaxis with mechanical cleansing of implant surface prior to CHX use was carried out in all seven studies. Meta-analysis indicated that use of CHX did not improve probing depths in peri-implant mucositis (SMD = 0.11; 95% CI: -0.16 to 0.38; p = 0.42, I2= 0%). Similarly, CHX did not significantly reduce probing depths in patients with peri-implantitis (MD= 1.57; 95% CI: -0.88 to 4.0; p = 0.21, I2 = 98%). Results on the efficacy of CHX in reducing BOP in peri-implantitis are conflicting. CONCLUSIONS: Results of our study indicate that adjunctive therapy with CHX may not improve outcomes with non-surgical management of periimplant mucositis. Conclusions with regards to its role in non-surgical management of periimplantitis cannot be drawn. There is a need for more homogenous RCTs with large sample size to define the role of CHX in non-surgical management of peri-implant mucositis and peri-implantitis

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