Application Of Povidone-iodine Research Articles

Antibiotic Susceptibility Patterns of Ocular Bacterial Flora in Patients Undergoing Intravitreal Injections

To determine the antibiotic susceptibility patterns of conjunctival flora in patients undergoing intravitreal (IVT) injection. Prospective, observational study. Patients (n = 85) scheduled to undergo 136 IVT injections at California Vitreoretinal Center at Stanford University. Conjunctival cultures were obtained on the day of the IVT injection from the injection site bulbar conjunctiva before the application of povidone-iodine or antibiotics. Bacterial isolates were identified and tested for antibiotic susceptibility using either the Kirby-Bauer disc-diffusion technique or MicroScan-WalkAway system. Our analysis included 136 samples collected from 90 eyes of 85 patients. Of those with positive cultures (n = 65), the most common bacterial isolates were coagulase-negative staphylococci (CNS), comprising 59 (83%) of the 71 bacterial strains. Among the CNS, all were susceptible to vancomycin and >80% were susceptible to gentamicin, chloramphenicol, tetracycline, and imipenem. Between 60% and 80% of the CNS were susceptible to the cephalosporins and newer generation fluoroquinolones. Fewer than 60% were susceptible to the penicillin analogs, erythromycin, and the earlier generation fluoroquinolones. Nearly half of the CNS (47%) were resistant to oxacillin/methicillin. Bacteria isolated from the injection site of patients undergoing IVT injections were mostly CNS. Most are sensitive to vancomycin, gentamicin, and chloramphenicol. Proprietary or commercial disclosure may be found after the references.

Conservative management of giant omphalocele with topical povidone-iodine and its effect on thyroid function

Purpose The aim of the study was to evaluate topical povidone-iodine as a bridge to delayed fascial closure of giant omphaloceles with emphasis on its effect on thyroid function. Methods Newborns from a single institution with giant omphaloceles treated with topical povidone-iodine for a 10-year period were reviewed. Recorded data included sex, associated anomalies, length of stay, frequency of povidone-iodine application, thyroid function tests, frequency of laboratory draws, and thyroid supplementation administration. Results Six neonates with giant omphaloceles were treated with povidone-iodine. Thyroid function testing occurred weekly as inpatients and monthly as outpatients, with abnormal values normalized by the subsequent laboratory draw. One patient demonstrated persistent hypothyroidism and subsequently died secondary to cardiac complications, but this infant's newborn thyroid screening suggested congenital hypothyroidism. Five patients remained euthyroid and ultimately achieved fascial closure without the need for a prosthetic implant. None of these patients had abnormal outpatient thyroid tests nor did they require thyroid hormone supplementation. Conclusion Topical povidone-iodine promotes escharification and epithelialization of the omphalocele sac. Because transient hypothyroidism may occur, thyroid function studies may guide inpatient therapy. After sac desiccation, systemic effects of iodine are minimal and thyroid supplementation is not necessary. Topical povidone-iodine is an effective initial strategy for giant omphaloceles and does not produce clinically significant hypothyroidism.

Efficacy of 10% Povidone Iodine in Children Affected with Early Childhood Caries: An In Vivo Study

For prevention of dental caries, S. mutans numbers must be reduced and prevented from returning to the original level. An antibacterial agent that is effective and also acceptable to young children can help to establish a favorable oral environment and halt the caries process. This study was conducted to evaluate the efficacy of topical antimicrobial (10% Povidone- Iodine) on S. mutans counts in children with Early Childhood Caries after full mouth rehabilitation. Also its effects on the clinical outcomes in terms of incidence of new caries and secondary caries were evaluated. Full mouth rehabilitation was done in 30 children (mean age 4.2 years) suffering from Severe Early Childhood Caries (SECC). Stimulated saliva samples were collected to determine the post operative baseline S. mutans counts. Thereafter the subjects were randomly divided into two groups. The experimental group received 10% Povidone Iodine at 3 months interval for a period of 12 months while the control group received placebo (deionized water) at similar intervals. Change in the S.mutans count at 6 and 12 month intervals were compared to the baseline post-operative mutans score. Results revealed that application of 10% Povidone Iodine caused a significant reduction in the rise of Streptococcus mutans levels from the baseline postoperative score after 12 months of treatment thus decreasing the oral load of the organisms. Reduction in counts; in turn decreased the relapse of caries in these children. Thus oral rehabilitation coupled with regular application of 10% Povidone Iodine application can be a good alternative to control dental caries in children affected with Early Childhood Caries (ECC).

A prospective study demonstrating the effect of 5% povidone-iodine application for anterior segment intraocular surgery in Paraguay

To determine the conjunctival bacterial flora in cataract surgery patients and the effect of presurgical irrigation with 5% povidone-iodine solution. Three samples from the inferior conjunctival fornix of the eye to be operated were obtained at baseline before washing (T0) with 10 ml 5% povidone-iodine solution, immediately after washing (T1), and upon completion of surgery (T2). Bacteria from the samples were inoculated in blood agar, chocolate agar, and thioglycolate broth. A total of 221 patients (n=224 eyes) with a mean age of 67 +/- 13 years were included in the study. Bacteria from the (T0) samples were successfully grown in 73.2% of the thioglycolate agars, 21.0% of the blood agars, and 19.2% of the chocolate agars. Compared with T1 samples, the use of povidone-iodine wash translated into a 60.8% reduction (from 73.2% to 12.5%) in colonization of the conjunctiva (p<0.001), while no significant difference was found between the T1 and T2 samples. Conjunctival irrigation with a 5% povidone-iodine solution effectively reduces conjunctival flora and is therefore strongly recommended as a means of preventing postsurgical endophthalmitis following cataract surgery.

Effect of Short-Time Povidone-Iodine Application on Osteoblast Proliferation and Differentiation

Background and Objective:Povidone-iodine [polyvinylpyrrolidone-iodine complex (PVP-I)] is a broad-spectrum antimicrobial agent, frequently used in dentistry. In this study we investigated the short- and longterm effects on osteoblast number, viability, and function after short exposure to PVP-I with and without additional bone-morphogenetic protein-2 (BMP-2). Material and Methods:Confluent osteoblast-like cell line (MC3T3-E1, subclone 24) cultures were exposed to pure PVP-I solution (7.7 mg/ml) and dilutions of 1:10, 1:100 and 1:1000 for 10 seconds and washed with phosphate buffer solution. Cell proliferation and viability was determined by MTT and differentiation status by alkaline phosphatase (ALP) activity 6 days after initial plating. In a separate experiment, long-term cell proliferation, viability and function were assessed 4 weeks after PVP-I treatment by MTT and deposited calcium using an Alizarin-red staining test.Results:PVP-I decreased ALP activity substantially. Stimulation by BMP-2 recovered ALP activity to near control levels at 1:100 and 1:1000 dilutions of PVP-I. The MTT assay showed reduced proliferation of the preosteoblastic cells for all treatments, irrespective whether BMP-2 was used or not. Only at PVP-I dilutions of 1:1000 proliferation rate was back to normal levels (95.6±2.4 %). No adverse long-term effect of PVP-I on mineralization of the extracellular matrix (Alizarinred) for dilutions higher than 1:100 was observed. Interestingly, undiluted and 1:10 diluted PVP-I even showed a significant increase in mineral deposition, especially in the presence of BMP-2.Conclusion:Short-time application of PVP-I in concentrations of 1:10 and higher lead to decreased viability and impaired differentiation. However, surviving cells showed good recovery and mineralization potential.

Comparison of the Effectiveness of Painting onto the Hand and Immersing the Hand in a Bag, in Pre-Operative Skin Preparation of the Hand

The main goal of pre-operative skin preparation is to reduce the risk of postoperative wound infections by removing transient and commensal organisms from the skin. The aim of this study was to compare two methods of application of antiseptic solution in their effectiveness in removing these organisms from the skin. Fifty volunteers participated in the study. In 25 patients, the left hand was prepared using a standard paint technique and the right hand using the bag technique; in the other 25 the right was painted and the left was prepared using the bag technique. Three areas of the hand were examined: the paronychium of the thumb, the second web space and the hyponychium of the middle finger. Bacterial cultures were assessed after 5 days for growth. The bag technique proved better at removing organisms from the skin when comparing each site, and when comparing the total number of colony forming units (P = 0.002 for the thumb, P = 0.013 for the second web space and P = 0.003 for the middle finger). We concluded that pre-operative application of povidoneiodine to a hand using a non-sterile bag technique is more effective in removing skin organisms than the standard paint technique.

Endophthalmitis

Endophthalmitis is an eye inflammation, involving the vitreous cavity and its surrounding tissues responsible for vision. In most cases, an infection triggers this inflammation. The infection can be caused by bacteria, fungi, viruses or parasites. The occurrence of this severe and devastating inflammation can be related to surgical procedures, penetrating ocular trauma, and endogenous infections. Post-operative endophthalmitis represents the most frequent event accounting for more than 70% of cases. They are schematically divided in three categories: i. acute-onset endophthalmitis (within few days from surgery); ii. delayed-onset endophthalmitis or chronic endophthalmitis (one month to years after surgery); iii. endophthalmitis related to glaucoma filtration surgery, bleb-associated endophthalmitis. This complication has been reported after both surgery breaking up the ocular integrity and external eye surgery. In the former group, secondary intraocular lens placement and pars plana vitrectomy are associated with the highest and lowest endophthalmitis rate, respectively. Because cataract surgery is the most frequently performed intraocular surgery, the 90% of post-operative endophthalmitis occurs after this surgical procedure. Clinical signs of post-operative endophthalmitis are variable in relation to the typology of the infecting agent, the level of the intraocular inflammation, and the duration of the disease. Its clinical diagnosis should be followed by the collection and culturing of aqueous and vitreous specimens; in fact, because the results of these cultures are often negative and positive, respectively, is essential to obtain specimens from both anterior and posterior ocular chambers for a proper clinical management of each patient. In the majority of cases, the infective agents of a post-operative endophthalmitis cannot be identified without any doubt, but several evidences indicate that the bacterial flora of eyelids and/or conjunctiva is the most common cause of this complication. Contaminated solutions and instruments, surgeon and operating-room personnel represent other potential sources of infection. In absence of a specific infectious condition, such as conjunctivitis, dacryocystitis and blepharitis (which should be diagnosed and treated before any intraocular surgery), the pre-operative administration of antibiotics has not been shown to reduce the incidence and/or the severity of post-operative bacterial endophthalmitis. On the contrary, numerous studies have documented that the pre-surgical application of povidone-iodine to skin and conjunctiva effectively downgrades endophthalmitis frequency. The Endophthalmitis Vitrectomy Study (EVS) has investigated about the management of post-operative endophthalmitis, considering the roles of pars plana vitrectomy and systemic antibiotics in addition to standard treatments with intravitreal antibiotic and topical or systemic corticosteroids. It demonstrated that immediate pars plana vitrectomy was beneficial for patients with very low residual vision, whereas systemic antibiotics had no effect on visual outcome or media clarity. Although EVS remains the major randomized study regarding this topic, there are some weak-points which leave its conclusions open to future modifications. Particularly, in the EVS cluster: i. the fourth-generation fluoroquinolones – characterized by a better efficacy profile in comparison with ceftazidime and amikacin – have been not tested; ii. only cases of acute-onset endophthalmitis – typically caused by coagulase-negative micrococci – were enrolled, resulting in a lack of data about the delayed-onset and bleb-associated endophthalmitis. For these reasons, the EVS outcomes should not be generalized to all forms of endophthalmitis, which could potentially benefit utilizing different or additional therapeutic approaches. Keywords: Endophthalmitis, eye inflammation, Endophthalmitis Vitrectomy Study (EVS), coagulase-negative micrococci, fluoroquinolones

Isopropyl Alcohol Compared with Isopropyl Alcohol plus Povidone-Iodine as Skin Preparation for Prevention of Blood Culture Contamination

Despite a number of studies on the efficacies of antiseptics for the prevention of blood culture contamination, it still remains unclear which antiseptic should be used. Although the combination of povidone-iodine and isopropyl alcohol has been traditionally used in many institutions, the application of povidone-iodine needs extra time, and there is little evidence that this combination could have an additive effect in reducing contamination rates. To elucidate the additive efficacy of povidone-iodine, we compared two antiseptics, 70% isopropyl alcohol only and 70% isopropyl alcohol plus povidone-iodine, in a prospective, nonrandomized, and partially blinded study in a community hospital in Japan between 1 October 2007 and 21 March 2008. All blood samples for culture were drawn by first-year residents who received formal training on collection techniques. Skin antisepsis was performed with 70% isopropyl alcohol plus povidone-iodine on all inpatient wards and with only 70% isopropyl alcohol in the emergency department. For the group of specimens from inpatient wards cultured, 13 (0.46%) of 2,797 cultures were considered contaminated. For the group of specimens from the emergency department cultured, 12 (0.42%) of 2,856 cultures were considered contaminated. There was no significant difference in the contamination rates between the two groups (relative risk, 0.90; 95% confidence interval, 0.41 to 1.98; P = 0.80). In conclusion, the use of a single application of 70% isopropyl alcohol is a sufficient and a more cost- and time-effective method of obtaining blood samples for culture than the use of a combination of isopropyl alcohol and povidone-iodine. The extremely low contamination rates in both groups suggest that the type of antiseptic used may not be as important as the use of proper technique.

Effect of lidocaine gel on povidone–iodine antisepsis and microbial survival

To determine whether the use of lidocaine gel prior to povidone-iodine antisepsis is associated with increased microbial survival. Ophthalmology Department, Madigan Army Medical Center, Fort Lewis, Washington, USA. A standardized suspension of Staphylococcus epidermidis was used to inoculate 5 blood agar plates that served as a control. A second group of 5 blood agar plates was inoculated, and then lidocaine gel was applied to the plates. A third group of 5 blood agar plates was inoculated, lidocaine gel was applied, and then povidone-iodine 5% was applied and allowed to cover the plates. A fourth group of 5 blood agar plates was inoculated, and then povidone-iodine 5% was allowed to cover the plates. Cultures of Staphylococcus aureus, Pseudomonas aeruginosa, and Haemophilus influenza were tested in a similar fashion. Microbial growth was evaluated after 24 hours. The number of colony forming units (CFUs) was similar in the control group and the S epidermidis, S aureus, and P aeruginosa lidocaine only and lidocaine with povidone-iodine groups. In these groups, each plate grew between 200 CFUs and 300 CFUs. In the Haemophilus influenza series, the lidocaine with povidone-iodine group had fewer CFUs than the control group. In all 4 series, the povidone-iodine only group had the least amount of CFUs, ranging from 0 to 6. The use of lidocaine gel before application of povidone-iodine 5% resulted in decreased effectiveness of antisepsis and increased microbial survivability. The increase in microbial survivability may increase the risk for postoperative infection in ocular surgery performed under topical anesthesia.

Flora bacteriana conjuntival após uso tópico de ciprofloxacino e gatifloxacino em cirurgia de catarata

To evaluate alterations of the conjunctival flora after the use of 0.3% ciprofloxacin and gatifloxacin in the prophylaxis of patients undergoing cataract surgery. 40 patients undergoing cataract surgery were distributed into two groups according to the use of antibiotic eye drops: Group A: 0.3% ciprofloxacin and Group B: 0.3% gatifloxacin. Both groups used antibiotic eye drops 1 hour before surgery and 14 days after surgery. Conjunctival material was collected at 5 time points: 1 hour before surgery, without any topical medication (t0); immediately before the application of povidone-iodine (PVPI) (t1), before the beginning of surgery, after povidone-iodine (t2), 14 days (t3) and 28 days after surgery (t4). Preoperative antibiotics reduced the positivity of the cultures before the use of PVPI in both groups, although in Group A this reduction was not significant (Group A - p=0.07 and Group B - p=0.04). The number of positive cultures was reduced in all groups after the use of povidone-iodine and on the 14th postoperative day (p<0.05). In t4 there was a reduction in the frequency of coagulase-negative Staphylococcus in Group A compared with Group B (p<0.05); the susceptibility to ciprofloxacin was also reduced in all groups, when compared with t0. Gatifloxacin eye drops applied one hour before surgery significantly reduced the number of positive conjunctival cultures. Both antibiotics reduced the conjunctival flora when administered in the postoperative period.

The Effect of Type of Delivery and Povidone-Iodine Application at Delivery on Cord Dried-Blood-Specimen Thyrotropin Level and the Rate of Hyperthyrotropinemia in Mature and Normal-Birth-Weight Neonates Residing in an Iodine-Replete Area: Report of Tehran Province, 1998–2005

The Effect of Type of Delivery and Povidone-Iodine Application at Delivery on Cord Dried-Blood-Specimen Thyrotropin Level and the Rate of Hyperthyrotropinemia in Mature and Normal-Birth-Weight Neonates Residing in an Iodine-Replete Area: Report of Tehran Province, 1998–2005

Traditional smallpox vaccination with reduced risk of inadvertent contact spread by administration of povidone iodine ointment

One concern with traditional smallpox vaccination is inadvertent spread of virus to atopic or immunocompromised contacts. To reduce this risk, we tested the ability of povidone iodine to inactivate infectious virus at the vaccination site beginning at 7 days after transcutaneous smallpox vaccination. This ointment rapidly inactivated virus on the skin without reducing neutralizing antibody titers or antiviral T cell responses. Moreover, there was no delay in healing/eschar separation following povidone iodine application. Together, this indicates that administration of an antiviral/antimicrobial cream can effectively block virus shedding after traditional smallpox vaccination and reduce the risks of autoinoculation or contact spread.

The Effect of Type of Delivery and Povidone-Iodine Application at Delivery on Cord Dried-Blood-Specimen Thyrotropin Level and the Rate of Hyperthyrotropinemia in Mature and Normal-Birth-Weight Neonates Residing in an Iodine-Replete Area: Report of Tehran Province, 1998–2005

To evaluate the effects of delivery type and of povidone-iodine disinfection at delivery on cord dried-blood-specimen (DBS) thyrotropin (TSH) concentrations. From 1998 to 2005, cord DBSs were collected from live deliveries in Tehran and Damavand, and TSH was assayed by a two-site immunoradiometric assay. Hyperthyrotropinemia was defined as TSH > or =20 mU/L. Vaginal deliveries prepared with povidone-iodine (VGL-PVP-I) or chlorhexidine (VGL-CHL), and cesarean sections prepared with povidone-iodine (CS-PVP-I) disinfection were assessed. Full-term, normal-size newborns were included. Iodine concentrations were measured in urine samples collected from 132 pregnant women immediately prior to delivery. Median (range) TSH was 5.3 (1.0 to >100) mU/L in VGL-PVP-I (n = 23,432), 5.3 (1.0 to >100) mU/L in VGL-CHL (n = 5658), and 5.0 (1.0 to >100) mU/L in CS-PVP-I (n = 19,016) (p < 0.0001). Median TSH was higher in VGL-PVP-I versus CS-PVP-I (p < 0.0001) and in VGL-CHL versus CS-PVP-I (p < 0.0001). Hyperthyrotropinemia was present in 1.4%, 1.2%, and 0.8% of VGL-PVP-I, VGL-CHL, and CS-PVP-I deliveries, respectively, and was significantly higher in VGL-PVP-I versus CS-PVP-I (p < 0.0001) and in VGL-CHL versus CS-PVP-I (p = 0.005). Median (range) urinary iodine concentration of pregnant women was 176 (20-4600) microg/L. Cord DBS TSH and rates of hyperthyrotropinemia are lower in cesarean section than in vaginal deliveries. Povidone-iodine disinfection at delivery has an effect neither on DBS TSH concentrations nor on the rate of hyperthyrotropinemia in the iodine-replete area of Iran.

Oral amoxicillin vs. oral erythromycin in the treatment of pyoderma in Bamako, Mali: an open randomized trial

Pyoderma (bacterial superficial skin infection) is an extremely common disorder in tropical developing countries. In these settings, Streptococcus pyogenes is considered to be the main etiological agent. Apart from epidemics of poststreptococcal glomerulonephritis where mass treatment with intramuscular benzathine-penicillin is recommended, no recommendation exists for the treatment of pyoderma in this setting. The aim of this study was to evaluate the efficacy of oral amoxicillin in the treatment of pyoderma in Mali, by comparison with oral erythromycin. In Bamako, 132 patients with pyoderma, diagnosed and graded as "severe" on clinical grounds, were randomly assigned to an oral treatment by either amoxicillin (50 mg/kg per day) or erythromycin; infections of the follicular appendage were excluded. Both drugs were associated with the topical application of povidone iodine. The patients were evaluated openly at the seventh day of treatment for cure or marked improvement of the clinical features, indicating successful treatment. Three patients were lost to follow-up. Treatment was successful in 57 of 64 patients treated with amoxicillin vs. 58 of 65 patients treated with erythromycin (P = 0.00). Amoxicillin was as efficacious as erythromycin in the treatment of severe pyoderma in Mali. Owing to its efficacy, added to high availability and low cost, this compound should be considered a first-line treatment of this disorder in this country, and perhaps in other countries where this condition presents in a similar way.

Feasibility and Clinical Applicability of Polihexanide for Treatment of Second-Degree Burn Wounds

Objectives: Due to a partial rejection of mesh split-thickness skin grafts (mesh grafts) after application of povidone-iodine and silver nitrate and due to its better in vitro tolerance, polihexanide was investigated as an alternative and its applicability in the treatment of second-degree burn wounds. Methods: In 4 patients with poorly healing decubitus ulcers the mesh grafts were each divided into three areas which were pre-treated with either undiluted povidone-iodine solution, 1% silver nitrate solution or 0.04% polihexanide solution. After 7 days of application the wound areas were compared clinically and histologically. Thereafter 14 patients (average extent of burns 28% TBSA) were treated in the same way. Results: Clinically and histologically the mesh grafts treated with polihexanide showed by far the best re-epithelialization compared with the deep tissue necrosis and marked fibrin discharge observed for application of povidone-iodine and silver nitrate. The second-degree burn wounds treated with polihexanide epithelialized without any further débridement after an average of 10 days with remarkable freedom from pain. Compared with silver nitrate treatment, no fibrin film was observed on the wound. Conclusion: Polihexanide proved clinically and histologically superior to povidone-iodine and silver nitrate. For the treatment of second-degree burns, which cannot primarily be covered by plastic surgery, polihexanide is suitable because in addition to its antiseptic efficacy it does not inhibit the re-epithelialization process.

Endophthalmitis prophylaxis.

The prevalence of postoperative endophthalmitis following cataract surgery appears to be increasing with the popularity of clear cornea incision. As a result, endophthalmitis prophylaxis will play and increasingly important role as the number of clear cornea cataract surgeries increases. In this article, the authors examine and critically evaluate techniques used to prevent endophthalmitis including proper preoperative patient preparation, application of povidone-iodine, and use of broad-spectrum antibiotics (topical, intracameral, and subconjunctival injection).

Addition of local antiseptic spray to parenteral antibiotic regimen reduces the incidence of stomal infection following percutaneous endoscopic gastrostomy: a randomized controlled trial

To study the effectiveness of local antiseptic spray with or without a three-dose antibiotic regimen in the prevention of stomal infection following percutaneous endoscopic gastrostomy. Ninety-six patients were randomized into three groups: A, intravenous cefuroxime 750 mg just before the procedure followed by two further doses every 8 h; B, single application of povidone-iodine (Betadine) antiseptic spray; C, combination of A and B. The stomal site was examined at midweek and at the end of week 1 for evidence of infection using a validated scoring system. Fisher's exact test was used for analysis of primary end point, namely, stomal infection at midweek and at the end of week 1. Logistic regression models were used for secondary analysis to consider the effects of diabetes, acid suppressants, steroids, age and sex on outcome. Group A had 34 patients, group B had 28 and group C had 34. Age, sex and indications in groups A, B and C are broadly comparable. Stomal infection was 32% in group B vs. groups A (6%) and C (9%) (P = 0.0114) at midweek, and 3% in group C vs. 32% each in groups A and B (P = 0.0013) at the end of week 1. Cumulative infections (n) at the end of week 1 were lower in group C (3) (9%) than in groups A (11) (32%) and B (12) (43%) (P = 0.003). No significant difference was observed between the three groups in terms of the number of patients who were given antibiotics for other indications (P = 0.363). By logistic regression only diabetes, but not other covariates, seems to have a significant effect on stomal infection (odds ratio, 33.34; 95% CI, 4.33-256.7). A combination of cefuroxime and Betadine spray significantly reduces stomal infection following percutaneous endoscopic gastrostomy at the end of week 1. Both the antibiotic group (A) and the combined group (C) did well compared with the Betadine only group (B) at midweek.

Povidone‐Iodine–Induced Burn: Case Report and Review of the Literature

Burns are a rare but potentially serious complication of povidone-iodine use. This rare adverse drug reaction developed in a 38-year-old woman who underwent laparoscopic right ovarian cystectomy and endometrial ablation as a day procedure involving application of the topical antiseptic 10% povidone-iodine solution. Two days later, the patient was admitted to the hospital with burning, pain, itching, marked redness, and blistering extending from her midback to buttocks. A stain on her back also was evident. Partial-thickness chemical burn was diagnosed. Review of the literature yielded 13 other cases of povidone-iodine-induced burn. This underrecognized adverse effect of povidone-iodine application typically occurs when the povidone-iodine has not been allowed to dry or has been trapped under the body of a patient in a pooled dependent position. The burn is usually seen immediately after the procedure or on the next day, and typically heals with minimum scarring within 3-4 weeks with conservative treatment. The commonly postulated mechanism is a chemical burn due to irritation coupled with maceration, friction, and pressure. Given the widespread use of povidone-iodine and the potential for development of infection after a burn, clinicians need to be aware of this possible povidone-iodine-associated adverse drug reaction, and of preventive measures.

Bacterial contamination in the anterior chamber after povidone–iodine application and the effect of the lens implantation device

To assess the incidence of anterior chamber bacterial contamination during cataract surgery, and compare results of injector implantation and forceps implantation of foldable intraocular lenses (IOLs). Department of Ophthalmology and Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary. This prospective randomized controlled clinical study comprised 97 eyes of 96 patients. Antibiotic eyedrops were not used; however, povidone-iodine 10% solution was used to prepare the eyebrow and eyelids and povidone-iodine 5% to disinfect the ocular surface. A Steri-Drape (3M) was used to surround the eye. Aqueous fluid samples were aspirated from the anterior chamber at the beginning and the end of surgery. The samples were cultured for 14 days under aerobic and anaerobic conditions simultaneously. Cataract surgery was performed using a sutureless, superotemporal, clear corneal phacoemulsification technique. The IOL was implanted with an injector (n = 47) or a forceps (n = 50), with the instrument randomly selected. The frequency of positive bacterial cultures with each implantation method was compared using the Fisher exact test. Bacteria were found in the conjunctival samples in 21 eyes (21.65%) before povidone-iodine application and in 4 eyes (4.12%) after disinfection. The anterior chamber sample before surgery was culture positive for Staphylococcus epidermidis in 2 eyes and for Micrococcus luteus in 1 eye. After surgery, the culture was positive for S epidermidis in 1 eye (2.15%) in the injector group and 1 eye (2.00%) in the forceps group (P = .74). Neither sample came from an eye that had a positive culture preoperatively. There were no intraoperative complications. In uneventful clear corneal phacoemulsification, meticulous technique can prevent antibiotic use during surgery. No difference in anterior chamber bacterial contamination was found between IOL implantation using an injector or a forceps.

Antibacterial Treatment Needed for Severe Early Childhood Caries

To assess the effects of a single 10% povidone iodine application as an adjunct to extensive surgical procedures in the clinical treatment of children with early childhood caries. Twenty-two children scheduled for dental treatment under general anesthesia were randomized into either an intervention group (10% povidone iodine), or a control group (phosphate buffered saline). Either povidone iodine or phosphate buffered saline was applied to teeth and soft tissues after prophylaxis and all operative dental procedures, followed by 1.23% acidulated phosphate fluoride gel. Saliva samples taken at baseline, and after 1 hour, 3 weeks and 3 months were assayed for mutans streptococci, lactobacilli and total viable bacteria. Caries lesions were recorded at baseline and at one year. Mutans streptococci and lactobacilli levels in the povidone iodine group were significantly reduced relative to baseline at 1 hour, 3 weeks and 3 months. At one year at least 60% of subjects had new caries lesions in each group, and there was no significant difference in caries increment between the two groups. Even prophylaxis, fluoride gel application and complete surgical treatment of caries at baseline were insufficient to prevent new caries in over 60% of the patients in these high caries risk infants. Although the one-time treatment with povidone iodine reduced mutans streptococci and lactobacilli levels for up to 3 months this therapy failed to additionally reduce future caries formation over one year, indicating that repeated antibacterial treatments will be needed to control high levels of cariogenic bacteria.