1079 CHLORHEXIDINE VERSUS POVIDONE-IODINE FOR SURGICAL SKIN SITE ANTISEPSIS DURING GENITOURINARY PROSTHETIC SURGERY A RANDOMIZED CONTROL TRIAL

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20121079 CHLORHEXIDINE VERSUS POVIDONE-IODINE FOR SURGICAL SKIN SITE ANTISEPSIS DURING GENITOURINARY PROSTHETIC SURGERY A RANDOMIZED CONTROL TRIAL Shaun Grewal, Lawrence Yeung, Arnold Bullock, Henry Lai, and Steven Brandes Shaun GrewalShaun Grewal St Louis, MO More articles by this author , Lawrence YeungLawrence Yeung Gainesville, FL More articles by this author , Arnold BullockArnold Bullock St Louis, MO More articles by this author , Henry LaiHenry Lai St Louis, MO More articles by this author , and Steven BrandesSteven Brandes St Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1186AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Infection after genitourinary prosthetics implantation is uncommon (1−3%), The primary source of bacterial colonization is staphylococcus from the skin. Chlorhexidine has been shown to decrease positive skin cultures around the surgical skin site (SSS) from 31% (povidone−iodine alone) to 7%, for orthopaedic prosthesis implants (J Bone Joint Surg Am. 2009;91:1949-1953). We compared the efficacy of chlorhexidine (ChloraPrep) to that of povidone−iodine (current standard) at decreasing the rate of positive bacterial skin cultures at the SSS for genitourinary prosthetic device implantations. METHODS Single−institution, prospective, randomized, controlled study to evaluate 100 consecutive patients undergoing initial genitourinary prosthetic implantation. Patients randomized to a standard 10 minute scrub and paint with povidone−iodine or chlorhexidine to the SSS. Patients excluded for preexisting GU implants or history of surgical site infection. Skin culture obtained from the SSS (scrotum or perineum) before and after skin preparation. RESULTS 100 consecutive patients were randomized to two types of skin preparation arms - 50 chlorhexidine and 50 povidone−iodine. 65 patients underwent inflatable penile prosthesis (IPP), 14 patients had male urethral sling (MUS), 14 patients had artificial urinary sphincter, 5 patients had combination IPP and MUS, and 2 patients testicular prothesis placement. Mean operative time was 86.2 + 32.4 min (range 45−204 min). Pre−preparation cultures were positive in 79%. In post−preparation cultures, 4 patients in Chlorhexidine group had a positive culture compared to 16 in the povidone−iodine group (8% vs 32%, p=0.0051). Coagulase negative staphylococus was the most commonly isolated organism in post prep cultures in the povidone-iodine group (13/16 patients), as opposed to propionobacterium in the chloraprep group (3/4 patients). Clinical infection requiring additional operations or device removal occurred in 6 patients (6%), with no significant difference between the two groups. No urethral (dysuria, meatitis) or genital skin complications (rash) occurred in either group. CONCLUSIONS Chlorhexidine is superior to povidone−iodine at eradicating skin flora at the SSS prior to genitourinary prosthetic implantation. Chloraprep is well tolerated on the external genitalia, with no increased risk of urethral or genital skin irritation compared to povidone−iodine. Chlorhexidine should be the standard of care for skin preparation prior to GU prosthetic procedures. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e438 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shaun Grewal St Louis, MO More articles by this author Lawrence Yeung Gainesville, FL More articles by this author Arnold Bullock St Louis, MO More articles by this author Henry Lai St Louis, MO More articles by this author Steven Brandes St Louis, MO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...