Comparative efficacy of two different topical povidone-iodine 5% regimens in reducing conjunctival bacterial flora: A randomized parallel double-masked clinical trial.

Luiza Toscano,Sarah Pereira Cazella,Rodrigo Jorge,Ingrid U Scott,Liliane Ângela De Souza Castilho,Andrzej Grzybowski,Eloísa Marcela Rueda Furlan,André Messias,Antonio Brunno Nepomuceno,Letícia Fernandes Barroso

doi:10.1371/journal.pone.0189206

Luiza Toscano, Sarah Pereira Cazella + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0189206

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Abstract

IntroductionThe increasing prevalence of multi-resistant bacteria is a major public health concern. Infections acquired during ophthalmic surgery are devastating. The purpose of the current study is to compare the proportion of eyes with negative bacterial cultures on all tested media after 1 versus 3 sequential drops of povidone-iodine (PI) 5% into the inferior conjunctival fornix.MethodsPatients were randomly assigned to receive 1 (PI group) drop (at time 28 minutes) or 3 (PI plus group) sequential drops (at time 0, 20 minutes and 28 minutes) of PI 5% into the inferior conjunctival sac of one randomly selected eye. A swab culture was obtained from the inferior conjunctival fornix 5 minutes before and 30 minutes after time 0. Central corneal thickness (CCT) was measured shortly before time 0 and shortly after time 30. Conjunctival swabs were incubated aerobically in enriched Thioglycolate liquid medium (meat broth) and in three solid culture media (chocolate agar, trypticase soy agar with 5% sheep blood, and Sabouraud agar).ResultsThere was no significant difference in the proportion of negative cultures after intervention between groups (p = 0.1638). Also in the PI group (n = 59), the proportion of eyes with negative cultures after PI (79.7%) did not differ significantly from baseline (76.3%; p = 0.7539). However in the PI plus group (n = 61), the proportion of eyes with all negative cultures after PI (85.3%) was significantly higher than before PI (70.5%) (p = 0.0177). There was no significant difference in mean CCT before and after the intervention in both groups.ConclusionInstillation of 3 sequential drops of PI was associated with a significant increase in the proportion of eyes with all negative cultures, while instillation of a single drop of PI was not associated with a significant increase in the proportion of negative cultures. Further study is warranted to determine whether the difference between the PI administration regimens is also associated with differences in the rates of postoperative ocular infections.

Highlights

The increasing prevalence of multi-resistant bacteria is a major public health concern
Instillation of 3 sequential drops of PI was associated with a significant increase in the proportion of eyes with all negative cultures, while instillation of a single drop of PI was not associated with a significant increase in the proportion of negative cultures
In 82% of patients with endophthalmitis from whom microorganisms were isolated from the vitreous fluid, the bacteria were genetically indistinguishable from bacteria isolated from the eyelid, conjunctiva or nose of the patient.[1,2]

Summary

Objectives

The purpose of the current study is to compare the proportion of eyes with negative bacterial cultures on all tested media after 1 versus 3 sequential drops of povidone-iodine (PI) 5% into the inferior conjunctival fornix. The purpose of the current study is to compare the proportion of eyes with negative bacterial conjunctival cultures on all tested media after instillation of 3 sequential drops of PI 5% over 28 minutes to the instillation of 1 drop of PI 5% into the inferior conjunctival fornix

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