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1.
Sci Rep ; 13(1): 347, 2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36611032

RESUMO

Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is concern that  resistance to topical biocides may be emergeing, although the potential clinical implications remain unclear. The objective of this systematic review was to determine whether the minimum bactericidal concentration (MBC) of topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. We included studies reporting the MBC of laboratory and clinical isolates of common microbes to CHX and PVI. We excluded studies using non-human samples and antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses and the change in MBC over time was explored using meta-regression. Seventy-nine studies were included, analysing 6218 microbes over 45 years. Most studies investigated CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in the MBC of CHX to Staphylococci or Streptococci over time. Overall, we find no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. This provides reassurance and confidence in the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.


Assuntos
Anti-Infecciosos Locais , Humanos , Anti-Infecciosos Locais/farmacologia , Povidona-Iodo/farmacologia , Clorexidina/farmacologia , Cuidados Pré-Operatórios , Infecção da Ferida Cirúrgica/prevenção & controle
2.
Med J Malaysia ; 78(1): 126-127, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36715203

RESUMO

Chlorhexidine is labelled as hidden allergen as the health care professionals (HCPs) are unaware of the wide range of products containing chlorhexidine. Adverse events from chlorhexidine allergy can be reduced by appropriate perioperative management especially heeding on positive history during preoperative assessment, awareness regarding this hidden allergen, and educating HCPs on possible chlorhexidine-containing products. The regulatory agencies all over the world have issued recommendations regarding safety and risk of hypersensitivity reactions with chlorhexidine-containing products. The onus lies on HCPs to disseminate this knowledge to the stakeholders. We present a brief update to combat chlorhexidine allergy in perioperative setting.


Assuntos
Anti-Infecciosos Locais , Hipersensibilidade a Drogas , Hipersensibilidade , Humanos , Clorexidina/efeitos adversos , Anti-Infecciosos Locais/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/prevenção & controle , Alérgenos
3.
Jt Dis Relat Surg ; 34(1): 42-49, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36700262

RESUMO

OBJECTIVES: In this meta-analysis, we aimed to compare the differences in surgical site infection (SSI) between triclosan-coated and uncoated sutures after hip and knee arthroplasty. MATERIALS AND METHODS: We searched PubMed, Embase, and Cochrane databases for randomized-controlled studies (RCTs) comparing triclosan-coated sutures with uncoated sutures for the prevention of SSIs after hip and knee arthroplasty. Literature screening and data curation were performed according to inclusion and exclusion criteria and the risk of bias was assessed for included research using Cochrane Handbook criteria. RESULTS: Three RCTs with a total of 2,689 cases were finally included, including 1,296 cases in the triclosan-coated suture group and 1,393 cases in the control group. The overall incidence of SSI was lower in the group with triclosan antimicrobial sutures (1.9%) than in the uncoated suture group (2.5%), but the difference was statistically significant (odds ratio=0.76, 95% confidence interval: [0.45-1.27], p=0.30). The differences in the results of the incidence of superficial SSI and deep SSI were not statistically significant (p>0.05). CONCLUSION: The application of triclosan antimicrobial sutures did not reduce the incidence of SSI after hip and knee arthroplasty compared to the controls, and it needs further high-quality RCT studies to be improved.


Assuntos
Anti-Infecciosos Locais , Anti-Infecciosos , Triclosan , Humanos , Triclosan/uso terapêutico , Anti-Infecciosos Locais/uso terapêutico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas/efeitos adversos
4.
JAMA ; 329(3): 244-252, 2023 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-36648463

RESUMO

Importance: Approximately 0.5% to 3% of patients undergoing surgery will experience infection at or adjacent to the surgical incision site. Compared with patients undergoing surgery who do not have a surgical site infection, those with a surgical site infection are hospitalized approximately 7 to 11 days longer. Observations: Most surgical site infections can be prevented if appropriate strategies are implemented. These infections are typically caused when bacteria from the patient's endogenous flora are inoculated into the surgical site at the time of surgery. Development of an infection depends on various factors such as the health of the patient's immune system, presence of foreign material, degree of bacterial wound contamination, and use of antibiotic prophylaxis. Although numerous strategies are recommended by international organizations to decrease surgical site infection, only 6 general strategies are supported by randomized trials. Interventions that are associated with lower rates of infection include avoiding razors for hair removal (4.4% with razors vs 2.5% with clippers); decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures (0.8% with decolonization vs 2% without); use of chlorhexidine gluconate and alcohol-based skin preparation (4.0% with chlorhexidine gluconate plus alcohol vs 6.5% with povidone iodine plus alcohol); maintaining normothermia with active warming such as warmed intravenous fluids, skin warming, and warm forced air to keep the body temperature warmer than 36 °C (4.7% with active warming vs 13% without); perioperative glycemic control (9.4% with glucose <150 mg/dL vs 16% with glucose >150 mg/dL); and use of negative pressure wound therapy (9.7% with vs 15% without). Guidelines recommend appropriate dosing, timing, and choice of preoperative parenteral antimicrobial prophylaxis. Conclusions and Relevance: Surgical site infections affect approximately 0.5% to 3% of patients undergoing surgery and are associated with longer hospital stays than patients with no surgical site infections. Avoiding razors for hair removal, maintaining normothermia, use of chlorhexidine gluconate plus alcohol-based skin preparation agents, decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures, controlling for perioperative glucose concentrations, and using negative pressure wound therapy can reduce the rate of surgical site infections.


Assuntos
Anti-Infecciosos Locais , Infecção da Ferida Cirúrgica , Humanos , Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Etanol/uso terapêutico , Glucose , Povidona-Iodo/uso terapêutico , Cuidados Pré-Operatórios/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Controle de Infecções/métodos
5.
Braz. j. oral sci ; 22: e238076, Jan.-Dec. 2023. ilus
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1393427

RESUMO

Triclosan (TCS) is a chlorinated diphenyl ether and a possible active agent against microorganisms. Due to its probability of reducing dental plaque accumulation, TCS can be added as a substance for oral hygiene. Aim: To evaluate the efficacy and antimicrobial capacity of TCS against Pseudomonas aeruginosa and Streptococcus mutans. Methods: This work evaluates the percentage of bacteria inhibition of P. aeruginosa (ATCC 27853) and S. mutans (ATCC 25175). TCS concentrations between 2 and 128 µg.mL-1 were tested. Results: An inhibitory potential of TCS was found against S. mutans. No percentage of inhibition was detected against P. aeruginosa (technical and biological triplicate). Conclusion: TCS, an antimicrobial agent used in dentifrices, can reduce S. mutans levels therefore these dentifrices should be indicated for patients with a high risk of caries. However, further study is needed, including antimicrobial analyses against other microbial conditions


Assuntos
Pseudomonas aeruginosa , Streptococcus mutans , Triclosan/antagonistas & inibidores , Cárie Dentária , Produtos para Higiene Dental e Bucal , Anti-Infecciosos Locais , Doenças da Boca
6.
J Mater Chem B ; 11(2): 345-358, 2023 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-36484404

RESUMO

Infections related to osseointegrated implants have sparked the interest in studying titanium modification for long-term effective soft tissue sealing. Constructing a silver (Ag)-hydroxyapatite (HA) coating is regarded as an effective strategy for integrating antibiosis with osteanagenesis; however, the outcome for long-term cervical soft tissue sealing in vivo is compromised. It is challenging to construct an Ag-HA coating for long-term efficient soft tissue integration that instills a maximum antibacterial effect while retaining favorable bioactivity to normal gingival mesenchymal cells in vivo. In this study, we employed gradient concentrations of Ag/CaP by pulsed electrochemical deposition to fabricate optimal Ag-HA nanocoatings. By physicochemical analyses, these uniform coatings were mainly formed with spherical metallic and hydroxyapatite nanoparticles, which facilitated good hydrophilicity, moderate rough surfaces and corrosion protection. Furthermore, the nanocoating of the 1.5Ag/CaP group exhibited superior performances in dental follicle cells' proliferation, osteogenic differentiation and antibacterial properties mainly through direct contact inhibition and partially through sustained silver ion release, which resulted in functional cervical soft tissue sealing in beagles lasting for one year. Our investigations provide a feasible strategy to balance the long-term antibacterial demand and bioactive induction around osseointegrated implants for long-term efficient cervical soft tissue sealing.


Assuntos
Anti-Infecciosos Locais , Durapatita , Cães , Animais , Durapatita/farmacologia , Durapatita/química , Osteogênese , Materiais Revestidos Biocompatíveis/farmacologia , Materiais Revestidos Biocompatíveis/química , Anti-Infecciosos Locais/farmacologia , Antibacterianos/farmacologia , Antibacterianos/química
7.
Pediatr Dermatol ; 40(1): 151-153, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36511886

RESUMO

Contact allergy to skin disinfectants is not often recognized in children. We report the cases of six children (1-16.5 years old) with allergic contact dermatitis to ingredients commonly contained in commercial antiseptic and cosmetic products. Patch test responses to chlorhexidine, benzyl alcohol, and benzalkonium chloride varied from one child to another one, but most children were sensitized to at least two components. In several of the cases, exposure had initially occurred in the neonatal period, but diagnosis occurred only after multiple reactions of increasing severity.


Assuntos
Anti-Infecciosos Locais , Dermatite Alérgica de Contato , Recém-Nascido , Criança , Humanos , Lactente , Pré-Escolar , Adolescente , Anti-Infecciosos Locais/efeitos adversos , Clorexidina/efeitos adversos , Excipientes , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Compostos de Benzalcônio/efeitos adversos , Testes do Emplastro , Alérgenos
9.
J Clin Anesth ; 85: 111043, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36566648

RESUMO

BACKGROUND: Earlier a randomized trial showed efficacy of a multifaceted intervention approach for reducing surgical site infection: hand hygiene, vascular care, environmental cleaning, patient decolonization (nasal povidone iodine, chlorhexidine wipes), with feedback on pathogen transmission. The follow-up prospective observational study showed effectiveness when applied to all operating rooms of an inpatient surgical suite. In practice, many organizations will at baseline not be using conditions equivalent to the control groups but instead functionally have had ongoing a single intervention for infection control (e.g., encouraging better hand hygiene). Organizations also differ in how well and long they survey every surgical patient for postoperative surgical site infection. Thus, estimation of the expected net cost savings from implementing multifaceted intervention depends on the relative efficacy of multifaceted approach versus single intervention approaches and on the incidence of surgical site infection, the latter depending itself on the monitoring period for infection development. METHODS: The retrospective cohort analysis included 4865 patients from two single intervention and two multifaceted studies, each of the four studies with matched control groups. We used Poisson regression with robust variance to estimate the relative risk reduction in surgical site infections for the multifaceted approach versus single interventions and, with 30-day follow-up versus ≥60-day follow-up for infection. RESULTS: The multifaceted approach was associated with an estimated 68% reduction in postoperative surgical site infections relative to single interventions (risk ratio 0.32, 97.5% confidence interval 0.15-0.70, P = 0.001). There were approximately 2.61-fold more surgical site infections detected with follow-up for at least 60 days of medical records relative to 30 days of records reviewed (97.5% CI 1.62 to 4.21, P < 0.001). CONCLUSIONS: An evidence-based, multifaceted approach to anesthesia work area infection control can generate substantial reductions in surgical site infections. A follow-up period of at least 60-days is indicated for infection detection.


Assuntos
Anestesia , Anti-Infecciosos Locais , Humanos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Estudos Retrospectivos , Seguimentos , Clorexidina , Controle de Infecções , Anti-Infecciosos Locais/uso terapêutico
10.
J Pediatr Orthop ; 42(1): e39-e44, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34545019

RESUMO

BACKGROUND: Adult literature has demonstrated chlorhexidine (CH) superiority at preventing surgical-site infections when compared with povidone-iodine (P-I). The purpose of this study is to compare the rate of postoperative infections after preoperative skin cleansing with either CH or P-I in pediatric orthopaedic surgery in an effort to identify superiority. METHODS: We retrospectively identified all patients (18 y and below) that underwent orthopaedic surgery at our institution in 2015, when P-I was the preoperative skin antisepsis of choice, and in 2018, when a change in protocol resulted in more frequent use of CH. Open fractures, infections, neuromuscular, and tumor surgeries were excluded. Orthopaedic surgeries were classified according to their subspecialty (sports-related/upper extremity, hip and lower extremity, trauma-related, or spine procedure). A 1:1 propensity score matching was conducted within each procedure group on the basis of age, sex, and year using nearest-neighbor matching. Spine procedures could not be matched and were subsequently excluded from analyses. RESULTS: Propensity score matching matched 1416 CH cases with 1416 P-I controls. The infection rate for CH was 19 infections per 1000 cases (27/1416; 1.9%) compared with an infection rate of 11 infections per 1000 cases (16/1416; 1.1%) for P-I subjects. No difference was detected in infection rate across preoperative skin antisepsis groups (P=0.12). Moreover, it was found that CH and P-I resulted in significantly equivalent infection rates to within ±1.5% (P=0.004). When stratified by procedure type, CH used in sports/upper extremity procedures resulted in 29 more infections per 1000 cases compared with P-I use (16/450; 3/450; P=0.005). No difference was detected in infection rate across CH and P-I skin antisepsis groups in lower extremity procedures (9/792; 8/792; P=1.00) or in trauma-related procedures (3/174; 4/174; P=1.00). CONCLUSIONS: CH and P-I are both protective against postoperative infections after sports/upper extremity, lower extremity, and trauma-related pediatric orthopaedic procedures. P-I may provide improved protection over CH as a preoperative skin antisepsis in upper extremity and sports-related procedures. LEVEL OF EVIDENCE: Level III-comparative cohort.


Assuntos
Anti-Infecciosos Locais , Procedimentos Ortopédicos , Adulto , Criança , Clorexidina , Humanos , Procedimentos Ortopédicos/efeitos adversos , Povidona-Iodo/uso terapêutico , Cuidados Pré-Operatórios , Estudos Retrospectivos , Pele , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
11.
Am J Dent ; 35(6): 291-296, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36508184

RESUMO

PURPOSE: To evaluate the influence of brushing with a specific antiseptic soap solution on the surface (roughness and hardness) and biological properties of a specific hard chairside reline resin. METHODS: The hard chairside reline resin specimens were made and distributed to the following groups according to disinfectant solution: sodium hypochlorite 0.5% (SH), Lifebuoy solution 0.78%; experimental group (LS) and phosphate-buffered saline PBS to be submitted to the brushing cycle for 10 seconds. The roughness and hardness were assessed before and after the cycle. For the biological properties, the colony-forming unit and Alamar Blue assays were performed. For all the properties evaluated the sample size consisted of nine specimens. The data were submitted to two-factor ANOVA (surface properties) and one-way ANOVA (biological properties) and Tukey's post-test with a significance level of 5% (α= 0.05). RESULTS: The Lifebuoy group did not present a statistical difference (P> 0.05) in relation to the other groups for the evaluated surface properties. Furthermore, the Lifebuoy solution showed a statistically significant difference (P> 0.05) in relation to the negative control in the reduction of biofilm on the resin and no significant difference (P> 0.05) was observed when compared to the positive control group. Thus, it was concluded that brushing with the Lifebuoy soap solution did not interfere with the surface properties of the hard chairside reline resin, and was able to reduce the biofilm of C. albicans. CLINICAL SIGNIFICANCE: Disinfectant liquid soap can be used for brushing of relined removable dentures as a simple, low-cost, and effective method for removing the biofilm.


Assuntos
Anti-Infecciosos Locais , Desinfetantes , Sabões , Resinas Acrílicas , Escovação Dentária , Propriedades de Superfície , Candida albicans , Teste de Materiais , Bases de Dentadura
12.
PLoS One ; 17(12): e0278699, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36490265

RESUMO

INTRODUCTION: The composition of the nasal microbiota in surgical patients in the context of general anesthesia and nasal povidone-iodine decolonization is unknown. The purpose of this quality improvement study was to determine: (i) if general anesthesia is associated with changes in the nasal microbiota of surgery patients and (ii) if preoperative intranasal povidone-iodine decolonization is associated with changes in the nasal microbiota of surgery patients. MATERIALS AND METHODS: One hundred and fifty-one ambulatory patients presenting for surgery were enrolled in a quality improvement study by convenience sampling. Pre- and post-surgery nasal samples were collected from patients in the no intranasal decolonization group (control group, n = 54). Pre-decolonization nasal samples were collected from the preoperative intranasal povidone-iodine decolonization group (povidone-iodine group, n = 97). Intranasal povidone-iodine was administered immediately prior to surgery and continued for 20 minutes before patients proceeded for surgery. Post-nasal samples were then collected. General anesthesia was administered to both groups. DNA from the samples was extracted for 16S rRNA sequencing on an Illumina MiSeq. RESULTS: In the control group, there was no evidence of change in bacterial diversity between pre- and post-surgery samples. In the povidone-iodine group, nasal bacterial diversity was greater in post-surgery, relative to pre-surgery (Shannon's Diversity Index (P = 0.038), Chao's richness estimate (P = 0.02) and Inverse Simpson index (P = 0.027). Among all the genera, only the relative abundance of the genus Staphylococcus trended towards a decrease in patients after application (FDR adjusted P = 0.06). Abundant genera common to both povidone-iodine and control groups included Staphylococcus, Bradyrhizobium, Corynebacterium, Dolosigranulum, Lactobacillus, and Moraxella. CONCLUSIONS: We found general anesthesia was not associated with changes in the nasal microbiota. Povidone-iodine treatment was associated with nasal microbial diversity and decreased abundance of Staphylococcus. Future studies should examine the nasal microbiota structure and function longitudinally in surgical patients receiving intranasal povidone-iodine.


Assuntos
Anti-Infecciosos Locais , Povidona-Iodo , Humanos , Melhoria de Qualidade , RNA Ribossômico 16S/genética , Nariz/cirurgia , Nariz/microbiologia , Administração Intranasal , Staphylococcus , Bactérias/genética , Anti-Infecciosos Locais/uso terapêutico
13.
PLoS One ; 17(12): e0278939, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36520813

RESUMO

OBJECTIVES: To assess the effectiveness of Triclosan coated suture in reducing surgical site infections (SSIs) rate after caesarian delivery (CD). STUDY DESIGN: Three hundred eighty patients were randomly assigned to closure with polyglactin non coated suture VICRYL, or with polyglactin coated suture VICRYL Plus after caesarian section. The primary outcome was the rate of SSIs within 30 days after surgery and secondary outcomes were the rate of wound healing complications. RESULTS: SSI rate was 2.5% in Triclosan group compared to 8.1% with non-coated suture. Use of Triclosan coated suture (TCS) was associated with 69% reduction in SSI rate (p = 0.037; ORa:0.294; 95% CI:0.094-0.921). The use of Triclosan coated suture was associated with statistically lower risk of wound oedema (2.5% vs 10%), (p = 0.019; OR:0.595), dehiscence (3.8% vs 10.6%), (p = 0.023; OR:0.316) and hematoma (p = 0.035; OR:0.423). CONCLUSION: Our results confirm the effectiveness of Triclosan coated suture in reducing SSI rate and wound healing disturbances. TRIAL REGISTRATION: Registered at ClinicalTrials.gov / ID (NCT05330650).


Assuntos
Anti-Infecciosos Locais , Triclosan , Feminino , Gravidez , Humanos , Triclosan/uso terapêutico , Poliglactina 910 , Estudos Prospectivos , Anti-Infecciosos Locais/uso terapêutico , Suturas , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Obstétricos
14.
Vestn Otorinolaringol ; 87(6): 47-54, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36580509

RESUMO

OBJECTIVE: To analyze the effectiveness of methods of antiseptic and hygienic preoperative preparation of the operating field in otosurgery. MATERIAL AND METHODS: A review and an expert assessment of the corresponding research objectives of scientific publications contained in the PubMed and Google Scholar databases have been carried out. RESULTS: Various studies indicate a lower ototoxicity of 5-10% of the drug povidone-iodine compared to others. Drugs, such as Miramistin, Okomistin, Dioxidine, are actively used in otiatrics in Russia, but no data on their ototoxicity have been noted. The collected data point to the relevance and prospects of studying the microbiome of the external auditory canal, assessing its effect on the course of the postoperative period, depending on various methods of preparation (antiseptic, removal of earwax and hair depilation) of the surgical field for otosurgery.


Assuntos
Anti-Infecciosos Locais , Microbiota , Ototoxicidade , Humanos , Clorexidina , Meato Acústico Externo/cirurgia , Cuidados Pré-Operatórios/métodos , Infecção da Ferida Cirúrgica
15.
Trials ; 23(1): 1029, 2022 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-36539884

RESUMO

BACKGROUND: Postoperative surgical site infections (SSIs) remain common after laparotomy for resections of the gastrointestinal or hepatobiliary tract. Especially organ/space infections (CDC class III SSI) can be life-threatening, require relaparotomy, intensive care or interventional drainage of intraabdominal abscesses. The PAISI study aims to investigate whether the use of prophylactic peritoneal irrigation with NaOCl/HOCl solution can reduce the SSI rates following laparotomy for resections of the gastrointestinal or hepatobiliary tract, compared to standard irrigation with physiological electrolyte solution (Ringer's solution). Secondarily, to evaluate whether the use of prophylactic peritoneal irrigation with NaOCl/HOCl solution can reduce postoperative morbidity and mortality as well as the rate of re-operations and length of hospital stay. METHODS: PAISI is a prospective, randomized, observer- and patient-blinded, monocentric, two-arm surgical study in an adaptive parallel groups design, comparing peritoneal and wound irrigation with NaOCl/HOCl (50/50ppm) solution to irrigation with Ringer's solution. The primary endpoint of the study is the SSI rate within 30 days postoperatively. Since there is no data on incidence rates from randomized clinical trials, the rates for sample size calculation were estimated according to the clinical experience at our institution. Therefore, the study design includes one unblinded look at the data by a second statistician, which will be performed after half of the patients reached the primary endpoint. This interim information will be used to check the assumptions and if needed, the sample size will be adjusted. The O'Brien-Fleming spending function is used to determine the efficacy test boundary and the non-binding futility boundary. The one-sided z-test (Group sequential test of two proportions) at the 2.5% significance level with a total of two looks at the data will have overall 80% power. DISCUSSION: The results of this study will provide high-level evidence for future research and clinical recommendations regarding the use of NaOCl/HOCl solution in abdominal surgery and provide the participating patients the opportunity of a potentially improved treatment. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00028037. Registered on 27 May 2022.


Assuntos
Anti-Infecciosos Locais , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Laparotomia/efeitos adversos , Lavagem Peritoneal , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Estudos Prospectivos , Solução de Ringer , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
BMC Oral Health ; 22(1): 646, 2022 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-36575444

RESUMO

BACKGROUND: The efficacy of mouth-rinses strongly depends upon their substantivity. The use of natural and non-toxic products that avoid secondary effects is gaining interest in preventive dentistry. The purpose of this study was to evaluate the substantivity of two formulations of mouth-washing solutions based on cetylpyridinium (CPC) and O-cymen-5-ol. METHODS: This was a randomized, double-blind, crossover trial conducted at the Faculty of Medicine and Health Sciences of the University of Barcelona. Bacterial re-colonization was followed by live/dead (SYTOTM9 + propidium iodide) bacterial staining and measured by confocal laser scanning microscopy and fluorometry. Unstimulated saliva samples were collected from 16 healthy individuals at baseline saliva and then, at 15 min, 30 min and 1, 2, 3, and 4 h after the following mouth-rinses: (i) a single, 1-min mouth-rinse with 15 ml of placebo (negative control); (ii) a single, 1-min mouth-rinse with 15 ml of CPC (0.05%) ; (iii) a single, 1-min mouth-rinse with 15 ml of O-cymen-5-ol (0.09%); (iv) a single, 1-min mouth-rinse with 15 ml of CPC (0.05%) + O-cymen-5-ol (0.09%). RESULTS: Proportion of dead bacteria was significantly higher for all mouthrinses during the first 15 min compared to baseline (CPC = 48.0 ± 13.9; 95% CI 40.98-56.99; p < 0.001, O-cymen-5-ol = 79.8 ± 21.0; 95% CI 67.71-91.90; p < 0.05, CPC + O-cymen-5-ol = 49.4 ± 14; 95% CI 40.98-56.99; p < 0.001 by fluorometry and 54.8 ± 23.0; 95% CI 41.50-68.06; p < 0.001, 76.3 ± 17.1; 95% CI 66.36-86.14; p < 0.001, 47.4 ± 11.9; 95% CI 40.49-54.30; p < 0.001 by confocal laser scanning microscopy, respectively). Nevertheless, after 4 h, CPC + O-cymen-5-ol was the only one that obtained significant values as measured by the two quantification methods used (80.3 ± 22.8; 95% CI 67.15-93.50; p < 0.05 and 81.4 ± 13.8; 95% CI 73.45-89.43; p < 0.05). The combined use of CPC + O-cymen-5-ol increased the substantivity of the mouthrinse with respect to mouthrinses prepared with either of the two active products alone. CONCLUSION: The synergistic interaction of CPC and O-cymen-5-ol prolongs their substantivity. The resulting formulation may be as effective as other antimicrobials, such as triclosan or chlorhexidine, but without their undesirable secondary effects. Thus, mouthrinsing products based on Combinations of CPC and O-cymen-5-ol may replace in the near future Triclosan and Chlorhexidine-based mouthrinses.


Assuntos
Anti-Infecciosos Locais , Placa Dentária , Triclosan , Humanos , Antissépticos Bucais/uso terapêutico , Cetilpiridínio/uso terapêutico , Clorexidina/uso terapêutico , Triclosan/uso terapêutico , Estudos Cross-Over , Placa Dentária/microbiologia , Bactérias , Boca , Anti-Infecciosos Locais/uso terapêutico , Método Duplo-Cego , Índice de Placa Dentária
18.
PLoS One ; 17(12): e0278569, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36516147

RESUMO

BACKGROUND: Routine use of chlorhexidine or octenidine for antiseptic bathing may have unintended consequences. Our analysis aimed to assess the phenotypic susceptibility of bacterial isolates from clinical samples to chlorhexidine and octenidine collected from intensive care units (ICU) that routinely used 2% chlorhexidine-impregnated wash cloths or 0.08% octenidine wash mitts (intervention) or water and soap (control) for daily patient care. METHODS: This study was conducted within the context of a three armed cluster-randomised controlled decolonisation trial (Registration number DRKS00010475, registration date August 18, 2016). Bacterial isolates were collected prior to and at the end of a 12-month-intervention period from patients with ≥ 3 days length of stay at an ICU assigned to one of two intervention groups or the control group. Phenotypic susceptibility to chlorhexidine and octenidine was assessed by an accredited contract research laboratory determining minimal inhibitory concentrations (MIC) as percentage of extraction solutions used. MIC were reported as estimated concentrations in µg/ml derived from the chlorhexidine and octenidine extraction solutions. Statistical analyses including generalized estimating equation models were applied. RESULTS: In total, 790 ICU-attributable bacterial isolates from clinical samples (e.g. blood, urine, tracheal aspirate) were eligible for all analyses. Pathogens included were Staphylococcus aureus (n = 155), coagulase-negative staphylococci (CoNS, n = 122), Escherichia coli (n = 227), Klebsiella spp. (n = 150) and Pseudomonas aeruginosa (n = 136). For all species, chlorhexidine and octenidine MIC did not increase from baseline to intervention period in the antiseptic bathing groups. For proportions of bacterial isolates with elevated chlorhexidine / octenidine MIC (≥ species-specific chlorhexidine / octenidine MIC50), adjusted incidence rate ratios (aIRR) showed no differences between the intervention groups and the control group (intervention period). CONCLUSION: We found no evidence for reduced phenotypic susceptibilities of bacterial isolates from clinical samples to chlorhexidine or octenidine in ICUs 12 months after implementation of routine antiseptic bathing with the respective substances.


Assuntos
Anti-Infecciosos Locais , Clorexidina , Humanos , Clorexidina/farmacologia , Iminas/farmacologia , Anti-Infecciosos Locais/farmacologia , Piridinas/farmacologia , Unidades de Terapia Intensiva
19.
BMC Oral Health ; 22(1): 461, 2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36324127

RESUMO

BACKGROUND: This single-center, randomized controlled trial aimed to determine the effectiveness of a novel, biofilm-disrupting, mouth rinse that combines Cetylpyridinium chloride (CPC) and essential oils in preventing re-accumulation of supragingival plaque and supragingival microbiome in patients with gingivitis after dental prophylaxis. METHODS: One hundred eighteen participants were randomly assigned in a 1:1 ratio to receive twice-daily test mouth rinse (59) or carrier rinse control (59) for 12 weeks after dental prophylaxis. RESULTS: In a per-protocol analysis that included patients who completed the intervention, the treatment group (39) had significantly lower supragingival plaque scores at 6 and 12 weeks compared to the control group (41; p = 0.022). Both groups showed similar improvement in gingivitis score, but neither group had improvement in bleeding score or probing depth. Thirty-eight (29%) patients did not complete the study due to loss of follow-up (17) or early discontinuation of the assigned intervention (21). Microbiome sequencing showed that the treatment rinse significantly depleted abundant and prevalent members of the supragingival plaque microbiome consortium. CONCLUSIONS: Among patients with gingivitis, the novel mouth rinse significantly reduced re-accumulation of supragingival plaque following dental prophylaxis by depleting supragingival plaque microbiome. However, long-term adherence to the rinse may be limited by adverse effects ( ClinicalTrials.gov number, NCT03154021).


Assuntos
Anti-Infecciosos Locais , Placa Dentária , Gengivite , Humanos , Antissépticos Bucais/uso terapêutico , Placa Dentária/prevenção & controle , Placa Dentária/tratamento farmacológico , Anti-Infecciosos Locais/uso terapêutico , Método Duplo-Cego , Gengivite/prevenção & controle , Gengivite/tratamento farmacológico , Índice de Placa Dentária
20.
Can J Surg ; 65(6): E756-E762, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36384686

RESUMO

BACKGROUND: The use of an effective antimicrobial preoperative skin preparation solution is essential in preventing infections after surgery, but the findings in the literature regarding efficacy are not necessarily applicable to surgery involving the hip. The purpose of the present study was twofold: 1) to examine the native bacteria on the skin at the hip and 2) to determine the efficacy of 2 surgical skin preparation solutions at eliminating bacteria from the hip site in patients undergoing total hip arthroplasty. METHODS: We conducted a prospective randomized controlled trial in consecutive adult patients who underwent primary total hip arthroplasty at a single institution from October 2014 to December 2015. Each patient was randomly allocated to be treated with 1 of 2 commonly used surgical skin preparation solutions: ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol) or DuraPrep (0.7% iodophor and 74% isopropyl alcohol). Aerobic and anaerobic samples were obtained for culture before skin preparation, immediately after skin preparation and after skin closure. RESULTS: Full data were obtained for 105 patients: 54 in the ChloraPrep group and 51 in the DuraPrep group. Staphylococcus epidermidis, Corynebacterium and Micrococcus luteus were the organisms most commonly isolated from the hip before skin preparation. Positive bacterial culture results were obtained in 50 patients (93%) in the ChloraPrep group and 48 patients (94%) in the DuraPrep group. Immediately after skin preparation, the overall proportion of positive culture results was significantly lower in the DuraPrep group than the ChloraPrep group (14% v. 35%, adjusted relative risk 0.40, 95% confidence interval 0.18-0.85). After wound closure, there was no significant difference in the rate of positive culture results between the 2 groups. CONCLUSION: DuraPrep was more effective than ChloraPrep at eliminating skin flora at the hip initially on application, but the 2 solutions were equally effective at the time of closure. Further study with larger samples is required to identify any influence of skin preparation solution on the incidence of prosthetic joint infection.


Assuntos
Anti-Infecciosos Locais , Artroplastia de Quadril , Adulto , Humanos , 2-Propanol , Estudos Prospectivos , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/microbiologia
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