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1.
BMC Health Serv Res ; 21(1): 1249, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34794442

RESUMO

BACKGROUND: Omphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya. METHODS: We employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions. RESULTS: The model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated. CONCLUSIONS: Estimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.


Assuntos
Anti-Infecciosos Locais , Clorexidina , Humanos , Mortalidade Infantil , Recém-Nascido , Quênia/epidemiologia , Cordão Umbilical
2.
Niger J Clin Pract ; 24(11): 1694-1705, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34782511

RESUMO

Background: To determine and compare the effects of different honey types on wound healing in an animal model, with silver sulfadiazine as the standard treatment. Materials and Methods: Five different groups were created with eight rats in each group. Partial-depth burns were created, and different types of honey and silver sulfadiazine were applied to the respective groups. Rats were monitored for 21 days, and wound cultures were obtained. Histopathological evaluation and cytokine analysis of final tissue samples were performed. In addition, the biochemical and microbiological analyses of the four types of honey used in the study were performed. Results: Wound shrinkage comparisons showed that all four honey-treated groups (Bingöl, Konya, cotton, and citrus) performed better than the silver sulfadiazine group (honey groups, respectively, 86.86%, 84.72%, 89.61%, and 95.33% vs. control 82.90%). However, only citrus honey caused a significant difference in wound shrinkage rate when compared with other groups as well with control group (95.34% vs. 82.9%, P < 0.05). In tissues, all honey groups had higher cytokine (interleukin [IL]-6, IL-1B, tumor necrosis factor [TNF]-α) values compared with controls (P < 0.001). Honey analysis showed a significant inverse relationship between Fe (iron) and the number of diastases. Conclusions: The results of this study support the role of honey in wound healing, due to its antibacterial and immunomodulatory effects. More studies are needed to identify the role of honey composition in wound healing.


Assuntos
Anti-Infecciosos Locais , Queimaduras , Mel , Animais , Queimaduras/tratamento farmacológico , Ratos , Sulfadiazina de Prata , Cicatrização
3.
Medicine (Baltimore) ; 100(41): e27539, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731153

RESUMO

ABSTRACT: The present study aimed to compare infectious complications in men undergoing transrectal ultrasound-guided prostate biopsy (TRUS-Bx) with and without povidone-iodine transrectal injection using a gavage syringe.The records of 112 patients, who underwent TRUS-Bx between January 2016 and December 2019, were retrospectively reviewed. The biopsy indication was considered high prostate-specific antigen (PSA) level and/or suspicious digital rectal prostate examination findings. Patients' ages, underlying diseases, PSA levels, prostate volumes, pathologic results, and infectious complications after the biopsy were investigated. All the patients received 1500 mg of ciprofloxacin (750 mg twice a day) for 5 days, starting from the day before the procedure. Forty-seven (41.96%) patients received ciprofloxacin prophylaxis with povidone-iodine transrectal injection, while 65 (58.03%) only received ciprofloxacin prophylaxis. All the patients, who were readmitted to the hospital after the procedure, especially with a temperature of higher than 37.8°C, were detected. For the purposes of the study, the priority was placed on the emergence of the rate of febrile infectious complications. Differences in febrile infectious complications in patients, who received ciprofloxacin prophylaxis with transrectal povidone-iodine, and those, who received ciprofloxacin prophylaxis alone before TRUS-Bx, were studied.Febrile infectious complications developed in 10 cases (15.38%) in patients, who received ciprofloxacin antibiotics prophylaxis alone. In the povidone-iodine rectal disinfection group, there was only 1 case of febrile infectious complication (2%). There was no significant difference by clinicopathologic features, age, PSA level, and cancer detection rate between both groups (P > .05). Multivariate logistic regression analysis did not identify any patient subgroups at a significantly higher risk of infection after prostate biopsy. There was no significant side effect associated with povidone iodine.In addition to the use of prophylactic antibiotics, transrectal povidone-iodine was useful in reducing the febrile infection complications following TRUS-Bx.


Assuntos
Infecções Bacterianas/prevenção & controle , Biópsia Guiada por Imagem/efeitos adversos , Povidona-Iodo/farmacologia , Próstata/patologia , Ultrassonografia de Intervenção/métodos , Administração Retal , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/farmacologia , Antibioticoprofilaxia/métodos , Infecções Bacterianas/tratamento farmacológico , Estudos de Casos e Controles , Ciprofloxacina/administração & dosagem , Ciprofloxacina/uso terapêutico , Eficiência , Humanos , Biópsia Guiada por Imagem/tendências , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Povidona-Iodo/administração & dosagem , Antígeno Prostático Específico/sangue , Reto/cirurgia , Estudos Retrospectivos , Fatores de Risco
4.
Vestn Oftalmol ; 137(5): 86-92, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34726862

RESUMO

Effective and safe antiseptic eye preparations are necessary for prevention and treatment of infectious and inflammatory eye diseases. PURPOSE: in vitro evaluation of the effect of antiseptic eye drops on corneal and conjunctival epithelial cells. MATERIAL AND METHODS: Antiseptic eye drops «Bactavit¼, «Vitabact¼ and «Ocomistin¼ were the object of the study. Immortalized human corneal epithelial cell lines (HCE) and human conjunctiva (Chang Conjunctiva, Clone 1-5c-4) were used as the test systems. The viability of the cells was assessed by their metabolic activity and morphology using the MTT test and phase-contrast microscopy. RESULTS: Antiseptic eye drops belonging to different groups of chemical compounds induced cytotoxic effects on the cells of corneal epithelium (HCE) and human conjunctiva (Chang Conjunctiva, Clone 1-5c-4) of varying degrees, leading to morphological and functional changes in those cells. CONCLUSION: The study confirms the possibility of using cultured cells for the in vitro comparative assessment of the cytotoxic effect of antiseptic ophthalmic agents.


Assuntos
Anti-Infecciosos Locais , Células Epiteliais/efeitos dos fármacos , Anti-Infecciosos Locais/farmacologia , Células Cultivadas , Túnica Conjuntiva/citologia , Córnea/citologia , Humanos , Soluções Oftálmicas
5.
Vestn Oftalmol ; 137(5. Vyp. 2): 238-247, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34669333

RESUMO

The preoperative and postoperative use of antiseptics can be an alternative to antibiotics in repeated courses of anti-VEGF therapy for reducing the risk of developing antibiotic resistance in eye microflora. Among gram-negative bacteria, the most frequently isolated pathogen that causes eye infections is Pseudomonas aeruginosa, which is characterized by reduced sensitivity to antibiotics and disinfectants. PURPOSE: To study the effect of the antiseptic picloxydine dihydrochloride on the gram-negative bacteria Escherichia coli, Pseudomonas luteola and P. aeruginosa isolated from the conjunctiva. MATERIAL AND METHODS: The identification of bacterial isolates and study of their sensitivity to antibiotics were carried out using the automated bacteriological analyzer BD Phoenix 100. To determine the bactericidal concentration, the method of serial dilutions of the antiseptic in a liquid nutrient medium was used. The binding of cationic molecules of picloxydine dihydrochloride to bacterial cells was detected by neutralizing the bacterial surface with increasing amounts of antiseptic, and measuring the zeta potential on the Zetasizer Nano ZS analyzer. The ultrastructure of bacterial cells was studied using the two-beam scanning ion-electron microscope Quanta 200 3D. RESULTS: The most resistant was P. aeruginosa. The interaction mechanism of picloxydine dihydrochloride with bacterial cells includes electrostatic binding of positively charged antiseptic molecules to negatively charged cell walls. Picloxydine dihydrochloride has a destructive effect on the bacterial cell wall and plasma membrane, which leads to cell lysis and release of intracellular components. CONCLUSION: Picloxydine dihydrochloride exhibits bactericidal activity against gram-negative conjunctival isolates and is promising for preventive use during repeated courses of intravitreal injections.


Assuntos
Anti-Infecciosos Locais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/farmacologia , Túnica Conjuntiva , Testes de Sensibilidade Microbiana , Piperazinas , Pseudomonas
6.
Enferm Clin ; 31: S84-S88, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34629855

RESUMO

Objective: To synthesize the available evidence on the use of antiseptics and disinfectants in the face of VIDOC-19 infection. Method: Bibliographic search in the main databases (WOS, CCC, DIIDW, KJD, MEDLINE, RSCI, SCIELO, PubMed, BMJ Best Practice, Cochrane Library, UptoDate) and on the web of official bodies in March 2020, using descriptors and truncations. The search was limited to reviews published between 2016-2020. Results: Thirty-six papers were identified (no duplicates) of which 17 were selected for relevance and specificity and one paper was added from the literature review. In the documents finally used, no evidence was located, but experiences and recommendations of interest were found, highlighting the importance of material, environmental and, very significantly, hand disinfection. Conclusion: There is no clear evidence, nor are there clear recommendations for the use of one or another antiseptic, although the action of sodium hypochlorite, ethanol and hydrogen peroxide is highlighted in comparison to others such as benzalkonium chloride, chlorhexidine digluconate, povidoeyodine and diluted ethyl alcohol. Particular importance is attached to their use in hand hygiene, the use of protective equipment and environmental disinfection.


Assuntos
Anti-Infecciosos Locais , Infecções por Coronavirus , Coronavirus , Desinfetantes , Desinfecção das Mãos , Humanos
7.
BMJ Open ; 11(10): e052823, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620667

RESUMO

OBJECTIVES: The incidence of Neisseria gonorrhoeae and its antimicrobial resistance is increasing in many countries. Antibacterial mouthwash may reduce gonorrhoea transmission without using antibiotics. We modelled the effect that antiseptic mouthwash may have on the incidence of gonorrhoea. DESIGN: We developed a mathematical model of the transmission of gonorrhoea between each anatomical site (oropharynx, urethra and anorectum) in men who have sex with men (MSM). We constructed four scenarios: (1) mouthwash had no effect; (2) mouthwash increased the susceptibility of the oropharynx; (3) mouthwash reduced the transmissibility from the oropharynx; (4) the combined effect of mouthwash from scenarios 2 and 3. SETTING: We used data at three anatomical sites from 4873 MSM attending Melbourne Sexual Health Centre in 2018 and 2019 to calibrate our models and data from the USA, Netherlands and Thailand for sensitivity analyses. PARTICIPANTS: Published available data on MSM with multisite infections of gonorrhoea. PRIMARY AND SECONDARY OUTCOME MEASURES: Incidence of gonorrhoea. RESULTS: The overall incidence of gonorrhoea was 44 (95% CI 37 to 50)/100 person-years (PY) in scenario 1. Under scenario 2 (20%-80% mouthwash coverage), the total incidence increased (47-60/100 PY) and at all three anatomical sites by between 7.4% (5.9%-60.8%) and 136.6% (108.1%-177.5%). Under scenario 3, with the same coverage, the total incidence decreased (20-39/100 PY) and at all anatomical sites by between 11.6% (10.2%-13.5%) and 99.8% (99.2%-100%). Under scenario 4, changes in the incidence depended on the efficacy of mouthwash on the susceptibility or transmissibility. The effect on the total incidence varied (22-55/100 PY), and at all anatomical sites, there were increases of nearly 130% and large declines of almost 100%. CONCLUSIONS: The effect of mouthwash on gonorrhoea incidence is largely predictable depending on whether it increases susceptibility to or reduces the transmissibility of gonorrhoea.


Assuntos
Anti-Infecciosos Locais , Gonorreia , Minorias Sexuais e de Gênero , Gonorreia/epidemiologia , Gonorreia/prevenção & controle , Homossexualidade Masculina , Humanos , Incidência , Masculino , Modelos Teóricos , Antissépticos Bucais , Neisseria gonorrhoeae
8.
Sci Rep ; 11(1): 20502, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654867

RESUMO

The COVID-19 is difficult to contain due to its high transmissibility rate and a long incubation period of 5 to 14 days. Moreover, more than half of the infected patients were young and asymptomatic. Virus transmission through asymptomatic patients is a major challenge to disease containment. Due to limited treatment options, preventive measures play major role in controlling the disease spread. Gargling with antiseptic formulation may have potential role in eliminating the virus in the throat. Four commercially available mouthwash/gargle formulations were tested for virucidal activity against SARS-CoV-2 in both clean (0.3 g/l BSA) and dirty (0.3 g/l BSA + 3 mL/L human erythrocytes) conditions at time points 30 and 60 s. The virus was isolated and propagated in Vero E6 cells. The cytotoxicity of the products to the Vero E6 was evaluated by kill time assay based on the European Standard EN14476:2013/FprA1:2015 protocol. Virus titres were calculated as 50% tissue culture infectious dose (TCID50/mL) using the Spearman-Karber method. A reduction in virus titer of 4 log10 corresponds to an inactivation of ≥ 99.99%. Formulations with cetylperidinium chloride, chlorhexidine and hexitidine achieved > 4 log10 reduction in viral titres when exposed within 30 s under both clean and dirty conditions. Thymol formulations achieved only 0.5 log10 reduction in viral titres. In addition, salt water was not proven effective. Gargle formulations with cetylperidinium chloride, chlorhexidine and hexetidine have great potential in reducing SAR-CoV-2 at the source of entry into the body, thus minimizing risk of transmission of COVID-19.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/prevenção & controle , Eritrócitos/virologia , Antissépticos Bucais , SARS-CoV-2/efeitos dos fármacos , Animais , Anti-Infecciosos Locais , Antivirais , Cetilpiridínio , Clorexidina/análogos & derivados , Clorexidina/química , Chlorocebus aethiops , Eritrócitos/efeitos dos fármacos , Humanos , Timol/química , Células Vero , Carga Viral , Água
9.
Evid Based Dent ; 22(3): 98-99, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-34561658

RESUMO

Data sources PubMed, CENTRAL, Scopus and Cochrane electronic databases were used as the data sources for the systematic review. All randomised control trials that reviewed antiseptics published up to and including 26 February 2019 were included. A manual search of reference lists of the selected studies was conducted, including information from previous systematic reviews conducted by the same authors.Study selection Two trained and calibrated reviewers screened titles and abstracts that investigated the efficacy of adjuncts to mechanical plaque control, in systematically healthy patients aged 18 years or older with dental plaque biofilm-induced gingivitis, in an intact periodontium (GP) or in patients previously treated for periodontitis with gingival inflammation (PP_GI). Studies with at least one test group and a control group were included, where changes from baseline up to six months in gingival or bleeding indices was the primary outcome.Data extraction and synthesis Data was extracted by three reviewers and reported outcomes extracted at baseline, six months and the longest to follow-up visit. Meta-analysis was conducted for six-month data on antiseptics investigating gingival indices, bleeding indices and plaque indices. Studies were compared via mean treatment effect, calculated for baseline to six months, and analysed using weighted mean differences (WMD) or standardised mean differences (SMD). Statistical heterogeneity was assessed using Cochran's Q and I squared statistic. Study-specific estimates were pooled using the random-effect model and meta-regression analysis performed. Sensitivity analysis was performed to assess the contribution of each study to the evidence and Begg's rank correlation test utilised to assess publication bias.Results Following screening of 1,101 articles, 70 were included in quantitative synthesis. Adjuncts yielded statistically significant reductions in gingival index, plaque index and plaque. Meta-regression analysis showed use of mouth rinses resulted in greater reductions in plaque when compared with dentifrices, whereas antiseptic agents were similarly effective in reducing gingivitis in plaque in patients with GP and PP_GI.Conclusions Based on the present evidence, adjunctive antiseptics in mouth rinses and dentifrices demonstrate statistically significant reductions in gingival, bleeding and plaque indices, when used in adjunct to mechanical plaque control. Clinical significance must be interpreted with caution due to the heterogeneity among studies included and significant publication bias.


Assuntos
Anti-Infecciosos Locais , Placa Dentária , Gengivite , Placa Dentária/prevenção & controle , Índice de Placa Dentária , Gengivite/prevenção & controle , Humanos , Antissépticos Bucais/uso terapêutico
10.
Orthop Nurs ; 40(5): 276-280, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34583372

RESUMO

Surgical-site infections (SSI) contribute to increased hospital length of stay, readmission rates, cost, and morbidity and mortality rates. The spine service line at a suburban Level II trauma center encountered 2 SSIs among the spine fusion population within a 6-month period. This did not meet the organization's internal benchmark of zero. A pilot quasi-experimental design was used to determine whether preoperative cleansing with 2% chlorhexidine gluconate (CHG)-impregnated cloths versus current practice of bathing with 4% CHG solution would reduce SSIs. Infection rates were measured using simple percentages. Level of significance was p < .05. Outcome data showed a reduction in SSIs from 3.9% to 1.9% with use of 2% CHG-impregnated cloths. There was no significant difference found between the use of 2% CHG-impregnated cloths and 4% CHG solution (p = .524). This quality improvement change, combined with a strengthened preoperative bundle approach, has permanently been adopted within the spine service line. From October 2017 to March 2021, the spine service line has had zero SSIs within the spine fusion population.


Assuntos
Anti-Infecciosos Locais , Humanos , Cuidados Pré-Operatórios , Infecção da Ferida Cirúrgica/prevenção & controle
11.
J Korean Acad Nurs ; 51(4): 414-429, 2021 Aug.
Artigo em Coreano | MEDLINE | ID: mdl-34497251

RESUMO

PURPOSE: This systematic review and meta-analysis analyzed the effects of 2% chlorhexidine bathing on the incidence of hospital-acquired infection (HAI) and multidrug-resistant organisms (MDRO) in adult intensive care units. METHODS: PubMed, CINAHL, Cochrane library, and RISS database were systematically searched, and 12 randomized studies were included in the analysis. Comprehensive Meta-Analysis version 3.0 was used to calculate the effect size using the odds ratio (OR) and a 95% confidence interval (CI). Subgroup analysis was performed according to the specific infection and intervention types. RESULTS: In general, 2% chlorhexidine bathing has a significant effect on the incidence of HAI (OR, 0.59; 95% CI, 0.40~0.86) and MDRO (OR, 0.52; 95% CI, 0.34~0.79). Subgroup analyses show 2% chlorhexidine bathing is effective in bloodstream infections (OR, 0.51; 95% CI, 0.39~0.66) but not for urinary tract infections, ventilator-associated pneumonia infections, and Clostridium difficile infections. Moreover, 2% chlorhexidine bathing alone or its combination with other interventions has a significant effect on the incidence of HAI and MDRO (OR, 0.59; 95% CI, 0.38~0.92). CONCLUSION: This meta-analysis reveals that 2% chlorhexidine bathing significantly reduces the incidence of HAI and MDRO in intensive care units. The effect of 2% chlorhexidine bathing on pediatric patients or patients at general wards should be further assessed as a cost-effective intervention for infection control.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Bacteriemia/prevenção & controle , Clorexidina/uso terapêutico , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Unidades de Terapia Intensiva , Adulto , Bacteriemia/microbiologia , Banhos , Hospitais , Humanos
12.
Br J Community Nurs ; 26(Sup9): S26-S36, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34473541

RESUMO

Wound infection is an important complicating factor in the wound healing process, and infections can be even more complex and difficult to manage in the case of wounds with biofilms. Silver has been used to treat infected wounds for a long time now, and the strength of the product depends on the number of Ag ions, where the greater the number of ions, the higher and faster the reactivity is. Ag Oxysalts technology-used in 3M Kerracontact Ag dressing-has three times more ions than standard silver dressings. The technology also does not show the typical disadvantages of silver, such as cytotoxicity and systemic toxicity. This article discusses the use of Ag Oxysalts technology for infected wounds and presents case studies to support the efficacy of this product in promoting wound healing.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Bandagens , Prata/uso terapêutico , Infecção dos Ferimentos/terapia , Ferimentos e Lesões/terapia , Queimaduras , Humanos , Tecnologia
13.
Hu Li Za Zhi ; 68(5): 74-82, 2021 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-34549410

RESUMO

BACKGROUND: Drug-resistant strains of bacteria are associated with severe consequences such as bacteremia, shock, and death, and increase hospital stay durations and medical health expenses. Therefore, reducing the spread of drug-resistant strains is a priority concern. PURPOSE: This project was developed to reduce the number of colonization cases of drug-resistant strains and subsequently increase the quality of care provided in our intensive care unit. RESOLUTIONS: In this project, a chlorhexidine gluconate (CHG) bath standard protocol and CHG bath skill checklist were established, education and training courses were planned, a regular bed curtain replacement schedule and sink cleaning protocols were implemented, and regular audits were conducted. RESULTS: Immediately following project implementation (October - December 2018), the average monthly cases of Vancomycin-resistant enterococci colonization decreased from 6.08 to 4.33, and the average monthly cases of multi-drug resistant Acinebacter baumannii colonization decreased from 4.08 to 1.33. Furthermore, between January and July 2019, the average monthly cases of colonization for the abovementioned bacteria numbered 4 and 0.86, respectively, which met the level of reduction targeted in this project. CONCLUSIONS: The results of this project indicate that implementing CHG bed baths is effective in reducing the incidence of drug resistant strain colonization and rate of related infections in patients. CHG bed baths should be applied clinically to improve the quality of intensive care.


Assuntos
Anti-Infecciosos Locais , Infecção Hospitalar , Preparações Farmacêuticas , Banhos , Clorexidina/análogos & derivados , Infecção Hospitalar/prevenção & controle , Humanos , Unidades de Terapia Intensiva
14.
J Am Acad Orthop Surg ; 29(23): e1151-e1158, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34520439

RESUMO

Periprosthetic joint infection is a leading cause for failure of contemporary total hip arthroplasty and total knee arthroplasty projected to nearly double in the next decade and reach an economic burden of $1.85 billion in the United Sates by 2030. Although multiple treatments for periprosthetic joint infection have been described, a thorough débridement and joint lavage to decrease bacterial bioburden and to remove biofilm remains a critical component of treatment. Various adjunct antiseptic agents such as chlorhexidine, povidone-iodine, hydrogen peroxide, acetic acid, and chlorine compounds are currently in off-label use in this capacity. Each antiseptic agent, however, has a distinct mechanism of action and targets different organisms, and some combinations of agents may lead to tissue toxicity. In this review, currently available adjunct antiseptic washes will be described in detail based on their mechanism of action and the evidence for their use will be reviewed. Furthermore, this review puts forward an evidence-based treatment algorithm based on the specific causative organism.


Assuntos
Anti-Infecciosos Locais , Artrite Infecciosa , Infecções Relacionadas à Prótese , Antibacterianos , Clorexidina/uso terapêutico , Humanos , Povidona-Iodo , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/prevenção & controle , Irrigação Terapêutica
15.
J Infect Chemother ; 27(12): 1729-1734, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34521590

RESUMO

INTRODUCTION: The preoperative skin antiseptic, olanexidine gluconate (OLG), which has been available in Japan since 2015, is also known to be effective against methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Pseudomonas aeruginosa. This study attempted to clarify OLG efficacy against surgical site infections and antiseptic-related adverse events as compared to conventionally used povidone iodine (PVP-I). METHODS: Propensity score matching was performed on 307 patients who underwent surgery for colorectal tumors at our hospital. All 116 cases (58 PVP-I cases, 58 OLG cases) who were diagnosed with colorectal cancer were included. We examined surgical site infection rate after disinfection using PVP-I and OLG, length of hospitalization stay (days) after surgery, adverse events associated with antiseptics, and additional medical costs associated with adverse events caused by antiseptics. RESULTS: The surgical site infection rate was 8.6% in both the PVP-I and OLG groups, with no significant difference observed. The number of postoperative hospitalization days in the PVP-I group was 12.9 (±6.9) days and 16.4 (±14.6) days in the OLG group, which exhibited no significant difference (p = 0.10). Although no complications due to antiseptics were observed in the PVP-I group, skin-related side effects were observed in 8 patients (13.8%) in the OLG group. The median additional medical cost was 730 [120-1823] yen. CONCLUSIONS: OLG was as effective as the conventional PVP-I for surgical site infections during colorectal cancer elective surgery. However, significantly higher skin disorders occurred in OLG, thereby making it necessary to evaluate antiseptic use in conjunction with patient burden.


Assuntos
Anti-Infecciosos Locais , Neoplasias Colorretais , Staphylococcus aureus Resistente à Meticilina , Anti-Infecciosos Locais/efeitos adversos , Biguanidas , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Glucuronatos , Humanos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle
16.
J Evid Based Dent Pract ; 21(3): 101584, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34479668

RESUMO

OBJECTIVES: The oral cavity is potentially high-risk transmitter of COVID-19. Antimicrobial mouthrinses are used in many clinical preprocedural situations for decreasing the risk of cross-contamination in the dental setting. It is important to investigate the efficacy of mouthwash solutions against salivary SARS-CoV-2 in order to reduce the exposure of the dental team during dental procedures. AIMS: The aim of this in vivo study was to evaluate the efficacy of 2 preprocedural mouthrinses in the reduction of salivary SARS-CoV-2 viral load and to compare the results of the mouthwashes to a control group. MATERIALS AND METHODS: In this randomized-controlled clinical trial, studied group comprised laboratory-confirmed COVID-19 positive patients through nasopharyngeal swabs. Participants were divided into 3 groups. For 30 s, the control group mouthrinsed with distilled water, the Chlorhexidine group mouthrinsed with 0.2% Chlorhexidine and the Povidone-iodine group gargled with 1% Povidone-iodine. Saliva samples were collected before and 5 min after mouthwash. SARS-CoV-2 rRT-PCR was then performed for each sample. Evaluation of the efficacy was based on difference in cycle threshold (Ct) value. The analysis of data was carried out using GraphPad Prism version 5 for Windows. Kristal wullis and Paired t-test were used. A probability value of less than 0.05 was regarded as statistically significant. RESULTS: Sixty-one compliant participants (36 female and 25 male) with a mean age 45.3 ± 16.7 years-old were enrolled. A significant difference was noted between the delta Ct of distilled water wash and each of the 2 solutions Chlorhexidine 0.2% (P = .0024) and 1% Povidone-iodine (P = .012). No significant difference was found between the delta Ct of patients using Chlorhexidine 0.2% and 1% Povidone-iodine solutions (P = .24). A significant mean Ct value difference (P < .0001) between the paired samples in Chlorhexidine group (n = 27) and also in Povidone-iodine group (n = 25) (P < .0001) was found. In contrast, no significant difference (P = .566) existed before and after the experiment in the control group (n = 9). CONCLUSION: Chlorhexidine 0.2% and 1% Povidone-iodine oral solutions are effective preprocedural mouthwashes against salivary SARS-CoV-2 in dental treatments. Their use as a preventive strategy to reduce the spread of COVID-19 during dental practice should be considered.


Assuntos
Anti-Infecciosos Locais , COVID-19 , Adulto , Anti-Infecciosos Locais/farmacologia , Clorexidina/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antissépticos Bucais/farmacologia , Povidona-Iodo/farmacologia , SARS-CoV-2
17.
Artigo em Inglês | MEDLINE | ID: mdl-34534147

RESUMO

INTRODUCTION: Surgical site infection (SSI) remains a major complication after adult spinal surgery. We investigated whether adding preoperative nasal decontamination by antiseptic swab (skin and nasal antiseptic povidone-iodine, SNA-PI) to our antimicrobial protocol reduces the SSI rate among our patients undergoing thoracolumbar spinal surgery. METHODS: We retrospectively reviewed all adult thoracolumbar spinal surgeries performed between June 2015 and May 2017 at a single hospital. Patients were divided into those who received nasal decontamination (SNA-PI+) and those who did not (SNA-PI-). SSI rates and responsible pathogens were compared between the cohorts. RESULTS: A total of 1,555 surgeries with nasal decontamination (SNA-PI+) and 1,423 surgeries without (SNA-PI-) were included. The SSI rate in the SNA-PI+ group was 13 of 1,555 (0.8%) versus 10 of 1,423 (0.7%) for SNA-PI- group (P = 0.68). The infection rate was the highest among posterior instrumented fusions in the SNA-PI+ group (1.4%). Methicillin-sensitive Staphylococcus aureus was responsible for 70% of infections in the SNA-PI- group and 38% in the SNA-PI+ group (P = 0.13). CONCLUSIONS: Routine nasal antiseptic swab before spine surgery did not affect the overall rate of SSI in thoracolumbar spinal surgeries. The incidence of methicillin-sensitive S aureus was lower in patients who received nasal decontamination (5/1,555, 0.3%) compared with those who did not (7/1,423, 0.5%); however, this result was not statistically significant (P = 0.57).


Assuntos
Anti-Infecciosos Locais , Infecções Estafilocócicas , Adulto , Humanos , Povidona-Iodo/uso terapêutico , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia
18.
J Dent Res ; 100(11): 1258-1264, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34334033

RESUMO

The persisting outbreak of SARS-CoV-2 has posed an enormous threat to global health. The sustained human-to-human transmission of SARS-CoV-2 via respiratory droplets makes the medical procedures around the perioral area vulnerable to the spread of the disease. Such procedures include the ultrasonic dental cleaning method, which occurs within the oral cavity and involves cavitation-induced sprays, thus increasing the risk of pathogen transmission via advection. To understand the associated health and safety risks for patients and clinicians, it is critical to understand the flow pattern of the spray cloud around the operating region, the size and velocity distribution of the emitted droplets, and the extent of fluid dispersion until ultimate deposit on surfaces or escape through air vents. In this work, the droplet size and velocity distributions of the spray emerging from the tip of a free-standing common ultrasonic dental cleaning device were characterized via high-speed imaging. Deionized water and 1.5% and 3% aqueous hydrogen peroxide (H2O2) solutions were used as working fluids, with the H2O2-an established oxidizing agent-intended to curb the survival of virus released in aerosols generated from dental procedures. The measurements reveal that the presence of H2O2 in the working fluid increases the mean droplet size and ejection velocity. Detailed computational fluid dynamic simulations with multiphase flow models reveal benefits of adding small amounts of H2O2 in the feed stream of the ultrasonic cleaner; this practice causes larger droplets with shorter residence times inside the clinic before settling down or escaping through air vents. The results suggest optimal benefits (in terms of fluid spread) of adding 1.5% H2O2 in the feed stream during dental procedures involving ultrasonic tools. The present findings are not specific to the COVID-19 pandemic but should also apply to future outbreaks caused by airborne droplet transmission.


Assuntos
Anti-Infecciosos Locais , COVID-19 , Aerossóis , Humanos , Peróxido de Hidrogênio/efeitos adversos , Pandemias , SARS-CoV-2
19.
Int J Mol Sci ; 22(16)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34445643

RESUMO

The development and spread of antibiotics and biocides resistance is a significant global challenge. To find a solution for this emerging problem, the discovery of novel bacterial cellular targets and the critical pathways associated with antimicrobial resistance is needed. In the present study, we investigated the role of the two most critical envelope stress response regulators, RpoE and CpxR, on the physiology and susceptibility of growing Salmonella enterica serovar enteritidis cells using the polycationic antimicrobial agent, chlorhexidine (CHX). It was shown that deletion of the cpxR gene significantly increased the susceptibility of this organism, whereas deletion of the rpoE gene had no effect on the pathogen's susceptibility to this antiseptic. It has been shown that a lack of the CpxR regulator induces multifaceted stress responses not only in the envelope but also in the cytosol, further affecting the key biomolecules, including DNA, RNA, and proteins. We showed that alterations in cellular trafficking and most of the stress responses are associated with a dysfunctional CpxR regulator during exponential growth phase, indicating that these physiological changes are intrinsically associated with the lack of the CpxR regulator. In contrast, induction of type II toxin-antitoxin systems and decrease of abundances of enzymes and proteins associated with the recycling of muropeptides and resistance to polymixin and cationic antimicrobial peptides were specific responses of the ∆cpxR mutant to the CHX treatment. Overall, our study provides insight into the effects of CpxR on the physiology of S. Enteritidis cells during the exponential growth phase and CHX treatment, which may point to potential cellular targets for the development of an effective antimicrobial agent.


Assuntos
Anti-Infecciosos Locais/farmacologia , Proteínas de Bactérias/metabolismo , Clorexidina/farmacologia , Regulação Bacteriana da Expressão Gênica , Salmonella enteritidis/crescimento & desenvolvimento , Proteínas de Bactérias/genética , Mutação , Proteoma/análise , Proteoma/metabolismo , Salmonella enteritidis/efeitos dos fármacos , Salmonella enteritidis/metabolismo
20.
Int J Mol Sci ; 22(16)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34445656

RESUMO

Neuroblastoma (Nb), the most common extracranial tumor in children, exhibited remarkable phenotypic diversity and heterogeneous clinical behavior. Tumors with MYCN overexpression have a worse prognosis. MYCN promotes tumor progression by inducing cell proliferation, de-differentiation, and dysregulated mitochondrial metabolism. Cyclophosphamide (CFF) at minimum effective oral doses (metronomic therapy) exerts beneficial actions on chemoresistant cancers. Molecular iodine (I2) in coadministration with all-trans retinoic acid synergizes apoptosis and cell differentiation in Nb cells. This work analyzes the impact of I2 and CFF on the viability (culture) and tumor progression (xenografts) of Nb chemoresistant SK-N-BE(2) cells. Results showed that both molecules induce dose-response antiproliferative effects, and I2 increases the sensibility of Nb cells to CFF, triggering PPARγ expression and acting as a mitocan in mitochondrial metabolism. In vivo oral I2/metronomic CFF treatments showed significant inhibition in xenograft growth, decreasing proliferation (Survivin) and activating apoptosis signaling (P53, Bax/Bcl-2). In addition, I2 decreased the expression of master markers of malignancy (MYCN, TrkB), vasculature remodeling, and increased differentiation signaling (PPARγ and TrkA). Furthermore, I2 supplementation prevented loss of body weight and hemorrhagic cystitis secondary to CFF in nude mice. These results allow us to propose the I2 supplement in metronomic CFF treatments to increase the effectiveness of chemotherapy and reduce side effects.


Assuntos
Biomarcadores Tumorais/metabolismo , Ciclofosfamida/farmacologia , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Sinergismo Farmacológico , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Iodo/farmacologia , Neuroblastoma/tratamento farmacológico , Animais , Anti-Infecciosos Locais/farmacologia , Antineoplásicos Alquilantes/farmacologia , Apoptose , Biomarcadores Tumorais/genética , Diferenciação Celular , Proliferação de Células , Quimioterapia Combinada , Humanos , Masculino , Camundongos , Camundongos Nus , Neuroblastoma/metabolismo , Neuroblastoma/patologia , Células Tumorais Cultivadas , Ensaios Antitumorais Modelo de Xenoenxerto
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