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1.
Pak J Pharm Sci ; 37(1(Special)): 185-189, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38747268

RESUMO

Burn is a debilitating and devastating emergency with many physical and psychological sequelae. Essential steps in burn wound management include cleansing/wound debridement, application of topical antimicrobial and dressing of affected body areas. Objective of this study is comparison in effectiveness of Hydro-fiber Silver dressing and 1% silver sulfadiazine dressing in management of pediatric burn patients in terms of wound healing. After ethical approval, 264 patients were enrolled and divided into two groups. Patients were managed with hydro-fiber silver dressing in group A and 1% silver sulfadiazine dressing in group B. An experienced pediatric surgeon examined the wounds for re epithelialization and efficacy was labeled after 15 days. Out of 264 enrolled patients 148(56.06%) were males and 116(43.94%) were females. Mean age of patients was 3.73±2.34 years. Type of burn was Scald in 215(81.4%) patients and flame in 49(18.6%). Depth of burn was 2nd degree in 185(70.08%) patients and 3rd degree in 79(29.92%) patients. Mean TBSA was 19.93±9.62%. In group A the efficacy was achieved in 91(68.9%) patients whereas in group B the efficacy was achieved in 73(55.3%) patients (p-value<0.05). Hydro-fiber Silver dressing is significantly more efficacious as compared to 1% silver sulfadiazine dressing for treatment of pediatric burn.


Assuntos
Bandagens , Queimaduras , Sulfadiazina de Prata , Humanos , Sulfadiazina de Prata/uso terapêutico , Sulfadiazina de Prata/administração & dosagem , Queimaduras/terapia , Queimaduras/tratamento farmacológico , Feminino , Masculino , Pré-Escolar , Criança , Cicatrização/efeitos dos fármacos , Resultado do Tratamento , Lactente , Anti-Infecciosos Locais/uso terapêutico , Anti-Infecciosos Locais/administração & dosagem , Prata/uso terapêutico
2.
Pediatr Crit Care Med ; 25(5): e232-e238, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38695702

RESUMO

OBJECTIVES: Ethanol lock therapy (ELT) is a potential method of central catheter salvage following central line-associated bloodstream infection (CLABSI) although there is potential risk of catheter damage in polyurethane catheters. Further, there is limited efficacy data across the spectrum of common pediatric catheters, and published ELT protocols describe dwell times that are not feasible for critically ill children. We sought to evaluate the safety and efficacy of ELT in polyurethane catheters using brief (30 min to 2 hr) dwell times in our PICU. DESIGN: Investigational pilot study using historical control data. SETTING: PICU in quaternary care, free-standing children's hospital. INTERVENTIONS: ELT in polyurethane central venous catheters for catheter salvage. RESULTS: ELT with brief dwell times was used in 25 patients, 22 of whom were bacteremic. Ultimately 11 patients, comprising 14 catheters, were diagnosed with a primary CLABSI. The catheter salvage rate in primary CLABSI patients receiving ELT was 92% (13/14) and significantly higher than the salvage rate in patients receiving antibiotics alone (non-ELT) (62%, 39/64; mean difference 0.32, 95% CI [0.14-0.50], p = 0.03). The rate of catheter fracture in all patients receiving ELT was 8% (2/25) while the rate of fracture in the non-ELT group was 13% (8/64; mean difference -0.05, 95% CI [-0.18 to 0.09], p = 0.72). The rate of tissue plasminogen activator (tPA) use in the ELT group was 8% (2/25), whereas the rate of tPA use in the non-ELT group was significantly higher at 42% (26/64; mean difference -0.34, 95% CI [-0.49 to -0.17], p = 0.002). CONCLUSIONS: The use of ELT for catheter salvage and prophylaxis in the PICU is safe in a variety of polyurethane catheters. Dwell times ranging from 30 minutes to 2 hours were effective in sterilizing the catheters while allowing other therapies to continue. This approach may decrease the need for frequent line changes in a medically fragile pediatric population.


Assuntos
Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateteres Venosos Centrais , Etanol , Unidades de Terapia Intensiva Pediátrica , Poliuretanos , Humanos , Infecções Relacionadas a Cateter/prevenção & controle , Criança , Projetos Piloto , Etanol/administração & dosagem , Masculino , Pré-Escolar , Feminino , Lactente , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres Venosos Centrais/efeitos adversos , Cateteres de Demora/efeitos adversos , Adolescente , Bacteriemia/prevenção & controle , Bacteriemia/etiologia , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/uso terapêutico
3.
Dent Med Probl ; 61(2): 181-190, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38652926

RESUMO

BACKGROUND: Chemical plaque control with mouthwashes as an adjunct to mechanical plaque control with a toothbrush and dental floss has been considered an effective method for controlling gingivitis. The anti-inflammatory effects of chemical plaque control benefit the oral tissues by reducing inflammation and bleeding. OBJECTIVES: The aim of the present study was to evaluate and compare the clinical efficacy of probiotic, Aloe vera, povidine-iodine, and chlorhexidine (CHX) mouthwashes in treating gingivitis patients by assessing changes in their clinical parameters. MATERIAL AND METHODS: This prospective study was conducted on 40 patients from our outpatient department, divided into 4 groups of 10 patients each: probiotic mouthwash group (group 1); herbal (Aloe vera) mouthwash group (group 2); povidone-iodine mouthwash group (group 3); and CHX mouthwash group (group 4). All participants were provided with the same type of manual toothbrush, the Pepsodent® toothpaste and a respective mouthwash for twice-daily use until the end of a 28-day observation period. Clinical parameters, such as the marginal plaque index (MPI) and bleeding on interdental brushing (BOIB), were recorded at baseline, and on the 14th and 28th day of the study period. RESULTS: All groups showed a significant decrease in the MPI and BOIB scores. The results were similar in patients who used a probiotic mouthwash and those who used a CHX mouthwash. A comparable change in the mean scores was observed among the herbal and povidone-iodine groups from baseline to day 28. CONCLUSIONS: In the treatment of chronic gingivitis patients,a probiotic mouthwash was nearly as effective as CHX in reducing the plaque and bleeding scores. It showed better results in all clinical parameters than herbal and povidone-iodine mouthwashes. Using a mouthwash along with routine tooth brushing can help in treating gingivitis and slow the progression of the periodontal disease.


Assuntos
Aloe , Clorexidina , Gengivite , Antissépticos Bucais , Povidona-Iodo , Probióticos , Humanos , Gengivite/tratamento farmacológico , Gengivite/terapia , Gengivite/prevenção & controle , Antissépticos Bucais/uso terapêutico , Probióticos/uso terapêutico , Clorexidina/uso terapêutico , Clorexidina/administração & dosagem , Feminino , Adulto , Masculino , Estudos Prospectivos , Povidona-Iodo/administração & dosagem , Povidona-Iodo/uso terapêutico , Pessoa de Meia-Idade , Adulto Jovem , Índice Periodontal , Resultado do Tratamento , Anti-Infecciosos Locais/uso terapêutico , Anti-Infecciosos Locais/administração & dosagem , Índice de Placa Dentária , Fitoterapia , Preparações de Plantas/uso terapêutico , Preparações de Plantas/administração & dosagem
4.
World J Urol ; 42(1): 252, 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38652324

RESUMO

BACKGROUND: To prevent infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB), some studies have investigated the efficacy of rectal disinfection using povidone-iodine (PI) and antibiotic prophylaxis (AP). OBJECTIVE: To summarize available data and compare the efficacy of rectal disinfection using PI with non-PI methods prior to TRUS-PB. EVIDENCE ACQUISITION: Three databases were queried through November 2023 for randomized controlled trials (RCTs) analyzing patients who underwent TRUS-PB. We compared the effectiveness of rectal disinfection between PI groups and non-PI groups with or without AP. The primary outcomes of interest were the rates of overall infectious complications, fever, and sepsis. Subgroups analyses were conducted to assess the differential outcomes in patients using fluoroquinolone groups compared to those using other antibiotics groups. EVIDENCE SYNTHESIS: We included ten RCTs in the meta-analyses. The overall rates of infectious complications were significantly lower when rectal disinfection with PI was performed (RR 0.56, 95% CI 0.42-0.74, p < 0.001). Compared to AP monotherapy, the combination of AP and PI was associated with significantly lower risk of infectious complications (RR 0.54, 95% CI 0.40-0.73, p < 0.001) and fever (RR 0.47, 95% CI 0.30-0.75, p = 0.001), but not with sepsis (RR 0.49, 95% CI 0.23-1.04, p = 0.06). The use of fluoroquinolone antibiotics was associated with a lower risk of infectious complications and fever compared to non-FQ antibiotics. CONCLUSION: Rectal disinfection with PI significantly reduces the rates of infectious complications and fever in patients undergoing TRUS-PB. However, this approach does not show a significant impact on reducing the rate of sepsis following the procedure.


Assuntos
Anti-Infecciosos Locais , Biópsia Guiada por Imagem , Povidona-Iodo , Próstata , Reto , Humanos , Masculino , Anti-Infecciosos Locais/uso terapêutico , Anti-Infecciosos Locais/administração & dosagem , Antibioticoprofilaxia/métodos , Desinfecção/métodos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Povidona-Iodo/uso terapêutico , Povidona-Iodo/administração & dosagem , Próstata/patologia , Neoplasias da Próstata/patologia
7.
Am J Infect Control ; 52(6): 731-738, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38342345

RESUMO

BACKGROUND: Recommendations for different types of bathing to prevent central line-associated bloodstream infections (CLABSI) are still divergent. The objective of this study was to verify whether bed bathing with wipes impregnated with 2% chlorhexidine (CHG) compared to conventional bed bathing is more effective in preventing CLABSI. METHODS: Systematic review of the literature by consulting the electronic databases PubMed/Medline, Embase, CINAHL, Scopus, and Web of Science from the date of inception until July 1, 2023, with no language or time restrictions. RESULTS: A total of 84,462 studies were examined, of which 6 were included in the meta-analysis. Data from 20,188 critical care patients included in primary studies were analyzed. The meta-analysis found that bed bathing with wipes impregnated with 2% CHG reduced the risk of CLABSI by 48% compared to conventional bed bathing (risk ratio 0.52; 95% confidence interval, 0.37-0.73), and this is moderate-quality evidence. The reduction in length of stay in the intensive care unit and length of hospital stay as well as the risk of death were not significantly different between the study groups. Whether bed bathing with 2% CHG-impregnated wipes increases the occurrence of skin reactions is unclear. CONCLUSIONS: This meta-analysis provides moderate-quality evidence that daily bathing with 2% CHG-impregnated wipes is safe and helps prevent CLABSI among adult intensive care unit patients.


Assuntos
Banhos , Infecções Relacionadas a Cateter , Clorexidina , Estado Terminal , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Humanos , Infecções Relacionadas a Cateter/prevenção & controle , Banhos/métodos , Anti-Infecciosos Locais/administração & dosagem , Unidades de Terapia Intensiva , Cateterismo Venoso Central/efeitos adversos
8.
J Perinatol ; 44(5): 724-730, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38351274

RESUMO

OBJECTIVE: To assess the impact of active surveillance and decolonization strategies on methicillin-resistant Staphylococcus aureus (MRSA) infection rates in a NICU. STUDY DESIGN: MRSA infection rates were compared before (2014-2016) and during (2017-2022) an active surveillance program. Eligible infants were decolonized with chlorohexidine gluconate (CHG) bathing and/or topical mupirocin. Successful decolonization and rates of recolonization were assessed. RESULTS: Fifty-two (0.57%) of 9 100 hospitalized infants had invasive MRSA infections from 2014 to 2022; infection rates declined non-significantly. During the 6-year surveillance program, the risk of infection was 16.9-times [CI95 8.4, 34.1] higher in colonized infants than uncolonized infants. Those colonized with mupirocin-susceptible MRSA were more likely successfully decolonized (aOR 9.7 [CI95 4.2, 22.5]). Of 57 infants successfully decolonized who remained hospitalized, 34 (60%) became recolonized. CONCLUSIONS: MRSA infection rates did not significantly decline in association with an active surveillance and decolonization program. Alternatives to mupirocin and CHG are needed to facilitate decolonization.


Assuntos
Antibacterianos , Clorexidina , Infecção Hospitalar , Unidades de Terapia Intensiva Neonatal , Staphylococcus aureus Resistente à Meticilina , Mupirocina , Infecções Estafilocócicas , Humanos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/tratamento farmacológico , Recém-Nascido , Mupirocina/administração & dosagem , Mupirocina/uso terapêutico , Clorexidina/análogos & derivados , Clorexidina/administração & dosagem , Clorexidina/uso terapêutico , Feminino , Masculino , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/uso terapêutico , Banhos
9.
Int J Gynaecol Obstet ; 165(3): 1167-1171, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38205879

RESUMO

OBJECTIVE: To compare the amounts of water and plastic used in surgical hand washing with medicated soaps and with alcohol-based products and to compare costs and consumption in a year, based on scheduled surgical activity. METHOD: This retrospective study was carried out at Udine's Gynecology Operating Block from October to November 2022. We estimated the average amount of water with a graduated cylinder and the total cost of water usage based on euros/m3 indicated by the supplier; for each antiseptic agent we collected the data relevant to wash time, amount of water and product used per scrub, number of handscrubs made with every 500 mL bottle and cost of a single bottle. We put data into two hypothetical contexts, namely WHO guidelines and manufacturers' recommendations. Data were subjected to statistical analysis. RESULTS: The daily amount of water using povidone-iodine, chlorhexidine-gluconate and alcohol-based antiseptic agents was 187.6, 140.7 and 0 L/day (P value = 0.001), respectively; A total of 69 000 L/year of water would be saved if alcohol-based products were routinely used. A single unit of an alcohol-based product allows three times as many handscrubs as any other product (P value = 0.001) with consequent reduction in plastic packaging. CONCLUSION: Despite the cost saving being negligible, choosing alcohol-based handrub over medicated soap handrub - on equal antiseptic efficacy grounds - could lead to a significant saving of water and plastic, thus making our operating theaters more environmentally friendly.


Assuntos
Anti-Infecciosos Locais , Desinfecção das Mãos , Salas Cirúrgicas , Povidona-Iodo , Humanos , Estudos Retrospectivos , Salas Cirúrgicas/economia , Anti-Infecciosos Locais/economia , Anti-Infecciosos Locais/administração & dosagem , Povidona-Iodo/economia , Povidona-Iodo/administração & dosagem , Água , Clorexidina/economia , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Sabões/economia , Feminino , Custos e Análise de Custo , Plásticos , Procedimentos Cirúrgicos em Ginecologia/economia
10.
N Engl J Med ; 390(5): 409-420, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38294973

RESUMO

BACKGROUND: Studies evaluating surgical-site infection have had conflicting results with respect to the use of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate as skin antisepsis before surgery to repair a fractured limb (i.e., an extremity fracture). METHODS: In a cluster-randomized, crossover trial at 25 hospitals in the United States and Canada, we randomly assigned hospitals to use a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) as preoperative antisepsis for surgical procedures to repair extremity fractures. Every 2 months, the hospitals alternated interventions. Separate populations of patients with either open or closed fractures were enrolled and included in the analysis. The primary outcome was surgical-site infection, which included superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days. The secondary outcome was unplanned reoperation for fracture-healing complications. RESULTS: A total of 6785 patients with a closed fracture and 1700 patients with an open fracture were included in the trial. In the closed-fracture population, surgical-site infection occurred in 77 patients (2.4%) in the iodine group and in 108 patients (3.3%) in the chlorhexidine group (odds ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00; P = 0.049). In the open-fracture population, surgical-site infection occurred in 54 patients (6.5%) in the iodine group and in 60 patients (7.3%) in the chlorhexidine group (odd ratio, 0.86; 95% CI, 0.58 to 1.27; P = 0.45). The frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar in the two groups. CONCLUSIONS: Among patients with closed extremity fractures, skin antisepsis with iodine povacrylex in alcohol resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in alcohol. In patients with open fractures, the results were similar in the two groups. (Funded by the Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research; PREPARE ClinicalTrials.gov number, NCT03523962.).


Assuntos
Anti-Infecciosos Locais , Clorexidina , Fixação de Fratura , Fraturas Ósseas , Iodo , Infecção da Ferida Cirúrgica , Humanos , 2-Propanol/administração & dosagem , 2-Propanol/efeitos adversos , 2-Propanol/uso terapêutico , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/efeitos adversos , Anti-Infecciosos Locais/uso terapêutico , Antissepsia/métodos , Canadá , Clorexidina/administração & dosagem , Clorexidina/efeitos adversos , Clorexidina/uso terapêutico , Etanol , Extremidades/lesões , Extremidades/microbiologia , Extremidades/cirurgia , Iodo/administração & dosagem , Iodo/efeitos adversos , Iodo/uso terapêutico , Cuidados Pré-Operatórios/efeitos adversos , Cuidados Pré-Operatórios/métodos , Pele/microbiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Fraturas Ósseas/cirurgia , Estudos Cross-Over , Estados Unidos
11.
Knee ; 47: 53-62, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38244239

RESUMO

BACKGROUND: Currently, in the field of total joint arthroplasty (TJA), there are no studies that have demonstrated the value of the sequential application of hydrogen peroxide, povidone-iodine, and physiological saline during the surgical procedure in decreasing postoperative infections in total knee arthroplasty (TKA), and in decreasing the incidence of periprosthetic joint infections (PJI) in particular. This study aimed to assess the efficacy of the sequential application of hydrogen peroxide, povidone-iodine, and physiological saline in reducing postoperative infections in TKA. METHODS: The study prospectively included 4743 patients, with Group A (2371, 49.9%) receiving sequential intraoperative application of hydrogen peroxide, povidone-iodine, and physiological saline irrigation of the incision, and Group B (2372, 50.1%) receiving intraoperative application of physiological saline irrigation of the incision only, to collect the patients' baseline data and clinical characteristics, and to statistically assess the incidence of superficial infections and the PJI during the follow up period to evaluate the clinical value of the study. RESULTS: The baseline levels of patients in Groups A and B were comparable. There were 132 (2.8%) lost visits during the study period. The incidence of superficial infections within 30 days after surgery was 0.22% in Group A and 1.17% in Group B, the difference between the two groups was statistically significant (P = 0.007). The incidence of PJI was 0.17% in Group A and 1.26% in Group B, the difference between the two groups was statistically significant (P = 0.0121). CONCLUSION: Sequential application of hydrogen peroxide, povidone-iodine, and physiological saline to irrigate incision in TKA can significantly reduce the incidence of postoperative superficial infections and PJI. The scientific and rational application of this therapy intraoperatively greatly reduces the incidence of PJI and postoperative superficial infections, which is of great benefit to the patient's prognosis.


Assuntos
Anti-Infecciosos Locais , Artroplastia do Joelho , Peróxido de Hidrogênio , Povidona-Iodo , Infecções Relacionadas à Prótese , Solução Salina , Infecção da Ferida Cirúrgica , Humanos , Artroplastia do Joelho/efeitos adversos , Povidona-Iodo/administração & dosagem , Povidona-Iodo/uso terapêutico , Peróxido de Hidrogênio/administração & dosagem , Masculino , Feminino , Estudos Prospectivos , Anti-Infecciosos Locais/administração & dosagem , Idoso , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/epidemiologia , Solução Salina/administração & dosagem , Irrigação Terapêutica/métodos , Incidência
12.
N Engl J Med ; 389(19): 1766-1777, 2023 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-37815935

RESUMO

BACKGROUND: Nursing home residents are at high risk for infection, hospitalization, and colonization with multidrug-resistant organisms. METHODS: We performed a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. The trial included an 18-month baseline period and an 18-month intervention period. Decolonization entailed the use of chlorhexidine for all routine bathing and showering and administration of nasal povidone-iodine twice daily for the first 5 days after admission and then twice daily for 5 days every other week. The primary outcome was transfer to a hospital due to infection. The secondary outcome was transfer to a hospital for any reason. An intention-to-treat (as-assigned) difference-in-differences analysis was performed for each outcome with the use of generalized linear mixed models to compare the intervention period with the baseline period across trial groups. RESULTS: Data were obtained from 28 nursing homes with a total of 28,956 residents. Among the transfers to a hospital in the routine-care group, 62.2% (the mean across facilities) were due to infection during the baseline period and 62.6% were due to infection during the intervention period (risk ratio, 1.00; 95% confidence interval [CI], 0.96 to 1.04). The corresponding values in the decolonization group were 62.9% and 52.2% (risk ratio, 0.83; 95% CI, 0.79 to 0.88), for a difference in risk ratio, as compared with routine care, of 16.6% (95% CI, 11.0 to 21.8; P<0.001). Among the discharges from the nursing home in the routine-care group, transfer to a hospital for any reason accounted for 36.6% during the baseline period and for 39.2% during the intervention period (risk ratio, 1.08; 95% CI, 1.04 to 1.12). The corresponding values in the decolonization group were 35.5% and 32.4% (risk ratio, 0.92; 95% CI, 0.88 to 0.96), for a difference in risk ratio, as compared with routine care, of 14.6% (95% CI, 9.7 to 19.2). The number needed to treat was 9.7 to prevent one infection-related hospitalization and 8.9 to prevent one hospitalization for any reason. CONCLUSIONS: In nursing homes, universal decolonization with chlorhexidine and nasal iodophor led to a significantly lower risk of transfer to a hospital due to infection than routine care. (Funded by the Agency for Healthcare Research and Quality; Protect ClinicalTrials.gov number, NCT03118232.).


Assuntos
Anti-Infecciosos Locais , Infecções Assintomáticas , Clorexidina , Infecção Hospitalar , Casas de Saúde , Povidona-Iodo , Humanos , Administração Cutânea , Administração Intranasal , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/uso terapêutico , Banhos , Clorexidina/administração & dosagem , Clorexidina/uso terapêutico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/terapia , Hospitalização/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Povidona-Iodo/administração & dosagem , Povidona-Iodo/uso terapêutico , Higiene da Pele/métodos , Infecções Assintomáticas/terapia
14.
Med Intensiva (Engl Ed) ; 46(5): 259-268, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35598950

RESUMO

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.


Assuntos
Anti-Infecciosos Locais , Clorexidina , Antissépticos Bucais , Pneumonia Associada à Ventilação Mecânica , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/efeitos adversos , Clorexidina/administração & dosagem , Clorexidina/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Antissépticos Bucais/administração & dosagem , Antissépticos Bucais/efeitos adversos , Higiene Bucal/efeitos adversos , Higiene Bucal/métodos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Med. intensiva (Madr., Ed. impr.) ; 46(5): 259-268, mayo. 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-204313

RESUMO

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)


Assuntos
Humanos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Anti-Infecciosos Locais/administração & dosagem , Clorexidina/administração & dosagem , Unidades de Terapia Intensiva , Antissépticos Bucais/administração & dosagem , Higiene Bucal/métodos , Anti-Infecciosos Locais/efeitos adversos , Clorexidina/efeitos adversos , Antissépticos Bucais/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Drug Deliv ; 29(1): 561-573, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35156501

RESUMO

Dental caries is a biofilm-related preventable infectious disease caused by interactions between the oral bacteria and the host's dietary sugars. As the microenvironments in cariogenic biofilms are often acidic, pH-sensitive drug delivery systems have become innovative materials for dental caries prevention in recent years. In the present study, poly(DMAEMA-co-HEMA) was used as a pH-sensitive carrier to synthesize a chlorhexidine (CHX)-loaded nanomaterial (p(DH)@CHX). In vitro, p(DH)@CHX exhibited good pH sensitivity and a sustained and high CHX release rate in the acidic environment. It also exhibited lower cytotoxicity against human oral keratinocytes (HOKs) compared to free CHX. Besides, compared with free CHX, p(DH)@CHX showed the same antibacterial effects on S. mutans biofilms. In addition, it had no effect on eradicating healthy saliva-derived biofilm, while free CHX exhibited an inhibitory effect. Furthermore, the 16s rDNA sequencing results showed that p(DH)@CHX had the potential to alter oral microbiota composition and possibly reduce caries risk. In conclusion, the present study presents an alternative option to design an intelligent material to prevent and treat dental caries.


Assuntos
Anti-Infecciosos Locais/farmacologia , Biofilmes/efeitos dos fármacos , Clorexidina/farmacologia , Nanopartículas/química , Streptococcus mutans/efeitos dos fármacos , Anti-Infecciosos Locais/administração & dosagem , Sobrevivência Celular/efeitos dos fármacos , Química Farmacêutica , Clorexidina/administração & dosagem , Relação Dose-Resposta a Droga , Portadores de Fármacos/química , Liberação Controlada de Fármacos , Humanos , Concentração de Íons de Hidrogênio , Queratinócitos/efeitos dos fármacos , Metacrilatos/química , Testes de Sensibilidade Microbiana , Tamanho da Partícula , Ácidos Polimetacrílicos/química , Saliva , Propriedades de Superfície
17.
Sci Rep ; 12(1): 834, 2022 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-35039588

RESUMO

Surgical site infections (SSIs) account for a massive economic, physiological, and psychological burden on patients and health care providers. Sutures provide a surface to which bacteria can adhere, proliferate, and promote SSIs. Current methods for fighting SSIs involve the use of sutures coated with common antibiotics (triclosan). Unfortunately, these antibiotics have been rendered ineffective due to the increasing rate of antibiotic resistance. A promising new avenue involves the use of metallic nanoparticles (MNPs). MNPs exhibit low cytotoxicity and a strong propensity for killing bacteria while evading the typical antibiotic resistance mechanisms. In this work, we developed a novel MNPs dip-coating method for PDS-II sutures and explored the capabilities of a variety of MNPs in killing bacteria while retaining the cytocompatibility. Our findings indicated that our technique provided a homogeneous coating for PDS-II sutures, maintaining the strength, structural integrity, and degradability. The MNP coatings possess strong in vitro antibacterial properties against P aeruginosa and S. aureus-varying the %of dead bacteria from ~ 40% (for MgO NPs) to ~ 90% (for Fe2O3) compared to ~ 15% for uncoated PDS-II suture, after 7 days. All sutures demonstrated minimal cytotoxicity (cell viability > 70%) reinforcing the movement towards the use MNPs as a viable antibacterial technology.


Assuntos
Antibacterianos/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Infecções Bacterianas/prevenção & controle , Materiais Revestidos Biocompatíveis/administração & dosagem , Materiais Revestidos Biocompatíveis/farmacologia , Nanopartículas Metálicas , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas , Tecnologia Farmacêutica/métodos , Triclosan/administração & dosagem , Infecções Bacterianas/etiologia , Farmacorresistência Bacteriana , Pseudomonas aeruginosa/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos , Infecção da Ferida Cirúrgica/etiologia , Suturas/efeitos adversos , Suturas/microbiologia
18.
Biol Pharm Bull ; 45(2): 220-225, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34819410

RESUMO

Olanexidine gluconate-containing preoperative antiseptic (OLG-C) is colorless, which makes it difficult to determine its area of application. To overcome this drawback, we realized a stable orange-tinted antiseptic (OLG-T) by adding new additives to OLG-C and investigated its pharmaceutical properties compared with OLG-C and povidone iodine (PVP-I). We evaluated the influence of the additives on the antimicrobial activity and adhesiveness of medical adhesives to OLG-T-applied skin by in vitro time-kill/ex vivo micropig skin assays and a peel test using excised micropig skin, respectively. In the in vitro time-kill assay, the bactericidal/fungicidal activity of OLG-T and OLG-C were equivalent. In the ex vivo micropig skin assay, their fast-acting and persistent bactericidal activities against vancomycin-resistant Enterococcus faecalis were higher than that of PVP-I. In the peel test, the adhesion force of the incise drape and the amount of stripped corneocytes on the peeled drape were comparable between OLG-T- and OLG-C-applied skin, but both were less than those of PVP-I-applied skin. The drapes for OLG-T- and OLG-C-applied skin had moderate adhesion force, and the drape-related injuries were expected to be weak. These results suggest that OLG-T performs no worse than OLG-C in terms of its antimicrobial activity and medical adhesive compatibility. Therefore, we expect OLG-T to lead to more convenient preoperative skin preparation and further contribute to lowering surgical site infection rates.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Compostos Azo/administração & dosagem , Bactérias/efeitos dos fármacos , Biguanidas/administração & dosagem , Corantes de Alimentos/administração & dosagem , Glucuronatos/administração & dosagem , Pele/efeitos dos fármacos , Adesividade , Animais , Bactérias/crescimento & desenvolvimento , Composição de Medicamentos , Feminino , Pele/microbiologia , Suínos
19.
Comput Math Methods Med ; 2021: 3171547, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34938352

RESUMO

BACKGROUND: Patients' clinical antibiotic treatment of deep II degree burns usually fails to achieve the ideal effect; in order to avoid the late result in pigmentation, scarring, and even limb dysfunction, it also needs to deal effectively with burn wounds. AIM: The purpose of this study is to evaluate nanosilver dressing in treating deep II degree burn wound infection in patients with clinical studies. MATERIALS AND METHODS: 106 burn patients were classified into the Sulfadiazine Silver Cream (SSC) group (n = 53) and the Nanosilver Burn Dressing (NSBD) group (n = 53). Both of them received basic wound treatment, and wound healing time and pigmentation fading away time of all patients were recorded. And the wound healing rate of the patients was calculated. Serum levels of tumor necrosis factor alpha (TNF-α) and interleukin-1beta (IL-1ß) were detected pre- and posttreatment. RESULTS: After basic treatment for all patients, Sulfadiazine Silver Cream was used in the SSC group, and Nanosilver Burn Dressing was used in the NSBD group. It was observed that after treatment, compared with the SSC group, there was significant efficiency; wound healing rate, healing time, and pigmentation fading away time were shortened in the NSBD group, and IL-1ß levels were decreased, and the positive rate of bacterial culture was decreased (all P < 0.05). CONCLUSION: Nanosilver Burn Dressing in treating deep II degree burns can effectively reduce the wound infection and promote wound healing. The curative effect was distinct, which was worthy of popularization and application.


Assuntos
Bandagens , Queimaduras/terapia , Nanopartículas Metálicas/administração & dosagem , Prata/administração & dosagem , Infecção dos Ferimentos/terapia , Adulto , Anti-Infecciosos Locais/administração & dosagem , Queimaduras/tratamento farmacológico , Queimaduras/patologia , Biologia Computacional , Feminino , Humanos , Masculino , Sulfadiazina de Prata/administração & dosagem , Fatores de Tempo , Resultado do Tratamento , Cicatrização/efeitos dos fármacos , Infecção dos Ferimentos/tratamento farmacológico
20.
Front Endocrinol (Lausanne) ; 12: 738980, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34721297

RESUMO

Triclosan (TCS) is a phenolic compound with broad-spectrum antimicrobial action that has been incorporated into a variety of personal care products and other industry segments such as toys, textiles, and plastics. Due to its widespread use, TCS and its derivatives have been detected in several environmental compartments, with potential bioaccumulation and persistence. Indeed, some studies have demonstrated that TCS may act as a potential endocrine disruptor for the reproductive system. In the current study, we are reporting on the results obtained for male rats after a two-generation reproduction toxicity study conducted with TCS. Female and male Wistar rats were treated daily by gavage with TCS at doses of 0.8, 2.4, and 8.0 mg/kg/day or corn oil (control group) over 10 weeks (F0) and over 14 weeks (F1) before mating and then throughout mating, until weaning F2 generations, respectively. TCS exposure decreased sperm viability and motility of F1 rats at the dose of 2.4 mg/kg. The effects of TCS on sperm quality may be related to the exposure window, which includes the programming of reproductive cells that occurs during fetal/neonatal development.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Disruptores Endócrinos/administração & dosagem , Reprodução/efeitos dos fármacos , Comportamento Sexual/efeitos dos fármacos , Espermatozoides/efeitos dos fármacos , Triclosan/administração & dosagem , Administração Oral , Animais , Comportamento Animal/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Ingestão de Alimentos/efeitos dos fármacos , Feminino , Masculino , Ratos , Ratos Wistar , Contagem de Espermatozoides , Motilidade dos Espermatozoides/efeitos dos fármacos , Testosterona/sangue
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