Chlorhexidine Gluconate Group Research Articles

Effectiveness of Antimicrobial Solutions on Streptococcus mutans in used Toothbrushes

ABSTRACTPurposeThe objective was to determine the effectiveness of antimicrobial solutions onStreptococcus mutansin used tooth brushes.MethodsSixty children used their toothbrushes twice a day, for seven consecutive days. The toothbrush bristles were then immersed into antimicrobial solutions for 12 hours: Group I-3% neem; group II-5% turmeric; group III-0.5% cetylpyridinium chloride, group IV-0.2% chlorhexidine gluconate. They were then placed into test tubes containing the resultant suspensions were three-fold diluted. Aliquots of 0.1 ml were plated in Mitis Salivarius Agar (enriched with sucrose) using dilution and plating method. Incubation was done in an anaerobic jar for 72 hours at 37°C.ResultsThe results obtained showed that there was 88% reduction in theStreptococcus mutansin the 3% neem group, 86% reduction in the Streptococcus mutans in the 0.5% cetylpyridinium chloride group,78% reduction in theStreptococcus mutansin the 5% turmeric group, 65% reduction in theStreptococcus mutansin the 0.2% chlorhexidine gluconate group. The difference between them was found to be statistically significant (p < 0.001).ConclusionBacterial contamination of toothbrushes was a major cause of concern. All the antimicrobial solutions used in this study proved to be effective toothbrush decontaminants. The efficacy of 3% neem was highest in our study followed by 0.5% cetylpyridinium chloride, 5% turmeric and 0.2% chlorhexidine gluconate.How to cite this articleBhat PK, Badiyani BK, Sarkar S, Chengappa S, Bhaskar NN. Effectiveness of Antimicrobial Solutions onStreptococcus mutansin used Toothbrushes. World J Dent 2012;3(1):6-10.

The effects of mycophenolate mofetil on encapsulated peritoneal sclerosis model in rats

Encapsulated peritoneal sclerosis (EPS) is a devastating complication of peritoneal dialysis. We aimed to investigate the effects of mycophenolate mofetil (MMF) treatment in experimental EPS in rats. 40 nonuremic Wistar albino rats were divided equally into 4 groups: control rats received 2 ml isotonic saline intraperitoneally daily for 3 weeks without any other treatment. The chlorhexidine gluconate group received intraperitoneally 2 ml/200 g injection of chlorhexidine gluconate and ethanol dissolved in saline for 3 weeks. The resting group received chlorhexidine gluconate (0 - 3rd week) + peritoneal resting (4th - 6th week). The MMF group received chlorhexidine gluconate (0 - 3rd week) + 125 mg/l MMF in drinking water (4th - 6th week). Dialysate cytokine levels, leukocyte count, peritoneal thickness, inflammation and fibroblast activities were evaluated. Although the MMF and resting groups showed beneficial effects on ultrafiltration and D1/D0 glucose compared to the chlorhexidine gluconate group, only MMF treatment improved dialysate TGFβ1, VEGF and MCP-1 levels compared to the resting group. Inflammatory activity and vascularity observed in a tissue biopsy, including capillaries number per mm2 of submesothelial area, decreased in the treatment group. MMF treatment has beneficial effects on EPS via inhibiting inflammation and neovascularisation by reducing dialysate VEGF overexpression.

Pioglitazone Reduces Peritoneal Fibrosis via Inhibition of TGF-β, MMP-2, and MMP-9 in a Model of Encapsulating Peritoneal Sclerosis

Objective: Matrix metalloproteinases (MMPs) and transforming growth factor beta (TGF-β) were increased in peritoneal dialysis patients with encapsulating peritoneal sclerosis (EPS) and in chlorhexidine gluconate (CG)-induced peritoneal sclerosing animal models. Peroxisome proliferator-activated receptors (PPARs) are the major regulators of key metabolic pathways of various inflammatory responses in fibrosing processes in most tissues. The objective of this study was to investigate the effect of pioglitazone (Pio), a synthetic PPAR-γ ligand, on the development of peritoneal fibrosis in CG-induced EPS rats. Methods: Thirty-two Wistar albino rats were intraperitoneally injected with saline (C group n = 8) or with CG (1.5 mL/100 g; CG group, n = 8). Pio (30 mg/kg/day) was administered orally to another group of CG injected rats (the CG + Pio group, n = 8) and to another control group (Pio group, n = 8) from initiation to the end of this study. After 14 days of Pio administration, the rats were killed and the parietal and visceral peritoneum were harvested. TGF-β, MMP-2, MMP-9, tissue inhibitor of metalloproteinases (TIMP)-1, and TIMP-2 activity assays and a morphological examination of the peritoneal tissues were performed. Results: Pio significantly inhibited thickening of the submesothelial layer, fibrosis, and inflammation in the peritoneum. It also prevented increases in pro-MMP-2, pro-MMP-9, TIMP-1, and TGF-β activities. Conclusion: Pio, via MMP and TGF-β inhibition, may lessen accumulation of peritoneal extracellular matrix and fibrosis to some extent in an EPS model and might be a new approach to the amelioration of EPS.

Gram-negative periodontal pathogens and bacterial endotoxin in metallic orthodontic brackets with or without an antimicrobial agent: An in-vivo study

High levels of periodontal pathogens can cause periodontal alterations. The presence of endotoxin might be responsible for the occurrence and progression of tissue inflammation and bone resorption. The aims of this study were to use checkerboard DNA-DNA hybridization and limulus amebocyte lysate assay to evaluate in metallic orthodontic brackets (1) the presence of 16 gram-negative periodontal pathogenic microorganisms of the orange complex and red complex +Treponema socranskii, (2) the amount of bacterial endotoxin, and (3) the efficacy of 0.12% chlorhexidine gluconate mouthwash in reducing bacterial contamination and endotoxin amount. Thirty-three patients (ages, 11-33 years) under orthodontic treatment with fixed appliances had 3 new metallic brackets bonded to 3 different premolars. Sixteen patients used a 0.12% chlorhexidine gluconate mouthwash (Periogard, Colgate-Palmolive, São Bernardo do Campo, São Paulo, Brazil) (experimental group), and 17 patients used a placebo mouthwash (control group) twice a week. After 30 days, the brackets were removed, and the samples were obtained. The data were analyzed statistically by Mann-Whitney, Kruskal-Wallis, and Dunn tests (α = 0.05). The 0.12% chlorhexidine gluconate group accumulated significantly lower levels of microorganisms than did the placebo group (P = 0.01). When each microbial complex was analyzed separately, a statistically significant difference between the experimental and control groups was found for the orange complex (P = 0.04). A greater amount of bacterial endotoxin was detected in the 0.12% chlorhexidine gluconate group than in the control group (P = 0.02). The 0.12% chlorhexidine gluconate oral rinses can be useful to reduce the levels of gram-negative periodontal pathogenic microorganisms in patients with fixed orthodontic appliances. Considering the increased amount of bacterial endotoxin after chlorhexidine gluconate use, further research is necessary to develop clinical procedures or antimicrobial agents with action against bacterial endotoxin adhering to metallic brackets.

The Effects of Interferon-α2b on Intestinal Flora in Peritoneal Fibrosis

Peritonitis is an important cause of the mortality and morbidity of peritoneal dialysis patients. The present study aims to investigate the effects of ýnterferon (IFN)-α2b on intestinal flora in peritoneal fibrosis. Twenty-four Wistar albino rats were divided into three groups. The control group received 0.9% saline (3 ml/d) intraperitoneally; the Chlorhexidine gluconate (CH) group received 3 ml daily injections of 0.1% CH intraperitoneally; the CH+IFN group received 3 ml daily injections of 0.1% CH intraperitoneally and pegylated IFN-α2b 1.5 μg/kg per week subcutaneously on days 0, 7, 14. On the twenty-first day rats were sacrificed and visseral peritoneum samples were obtained from the liver. Blood samples were obtained from the abdominal aorta and intestinal flora samples were obtained from distal small intestine and transverse colon. Histopathologic control of CH, CH+IFN groups peritoneal thickness were 6.04±2.32, 135.4±22.24, and 42.56±11.6 um, respectively. The decrease in thickness of parietal peritoneum in the CH+IFN group was statistically significant when compared to the CH group. Escherechia coli (E. Coli) had grown in cultures of the small intestine and colon samples of all the rats in the control group, whereas Proteus species (spp) had grown in one and Enterobacter spp. in seven cultures of the CH group. E. Coli had grown in four cultures, Proteus spp in three culture and Enterobacter spp. in one culture obtained from small intestine and transverse colon of the control group. The intestinal flora changed as the peritoneal thickness increased. The intestinal flora in the CH group completely changed compared with the control group (p<0.001). There was no correlation between visceral peritoneal thickness and intestinal flora change in the IFN group (p>0.05). IFN-α2b recovers the intestinal flora and the intestinal motility, thus reducing the experimental peritoneal fibrosis.

Thalidomide Prevents the Progression of Peritoneal Fibrosis in Mice

Thalidomide is clinically recognized as a therapeutic agent for multiple myeloma and has been known to exert anti-angiogenic actions. Recent studies have suggested the involvement of angiogenesis in the progression of peritoneal fibrosis. The present study investigated the effects of thalidomide on the development of peritoneal fibrosis induced by injection of chlorhexidine gluconate (CG) into the mouse peritoneal cavity every other day for 3 weeks. Thalidomide was given orally every day. Peritoneal tissues were dissected out 21 days after CG injection. Expression of CD31 (as a marker of endothelial cells), proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF), α-smooth muscle actin (as a marker of myofibroblasts), type III collagen and transforming growth factor (TGF)-β was examined using immunohistochemistry. CG group showed thickening of the submesothelial zone and increased numbers of vessels and myofibroblasts. Large numbers of VEGF-, PCNA-, and TGF-β-positive cells were observed in the submesothelial area. Thalidomide treatment significantly ameliorated submesothelial thickening and angiogenesis, and decreased numbers of PCNA- and VEGF-expressing cells, myofibroblasts, and TGF-β-positive cells. Moreover, thalidomide attenuated peritoneal permeability for creatinine, compared to the CG group. Our results indicate the potential utility of thalidomide for preventing peritoneal fibrosis.

EKSTRAK DAUN JAMBU METE KONSENTRASI 10% YANG DIKUMURKAN DAPAT MENGHAMBAT PERTUMBUHAN STREPTOCOCCUS MUTANS SALIVA: GARGLING 10% CASHEW LEAVES EXTRACT INHIBITS THE GROWTH OF STREPTOCOCCUS MUTANS IN SALIVA

Dental caries is the most dominant tooth disease that is caused predominantly by Streptococcus mutans. S. mutans is Gram positive facultative anaerobic bacteria and can be found in saliva. Cashew leaves extract (Anacardium occidentale L.) contains of antibacterial substance namely flavonoid, tanin and triterpenoid. The objective of this study was to examine the effect of gargling with 10% cashew leaves extract in S. mutans growth inhibition in saliva. In this study, 15 subjects were divided randomly into 3 groups (treatment, positive and negative control). Each group consists of 5 persons. Treatment group gargled with 10% cashew leaves extract, while positive control group gargled with 0.2% Chlorhexidine gluconate and negative control group gargled with aquades for 5 consecutive days in the morning and night after they brushed their teeth. S. mutans in saliva was cultivated anaerobicly on Trypticase soy extract of Yeast Sucrose Bacitracin agar for 24 hours. The results showed that 10% cashew leaves extract inhibited S. mutans growth in saliva (p 0.05). In conclusion, gargling with 10% cashew leaves extract may inhibit the growth of S. mutans in saliva. Ten percent cashew leaves extract may has similar potency as 0.2 % Chlorhexidine gluconate in S. mutans growth inhibition.

Lessons from a Community-Based Infection Prevention Study

From Rush University Medical Center and Stroger Hospital of Cook County, Chicago, Illinois. Received July 20, 2010; accepted July 21, 2010; electronically published October 18, 2010. Infect Control Hosp Epidemiol 2010; 31(12):1216-1218 2010 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2010/3112-0002$15.00. DOI: 10.1086/657137 Chlorhexidine gluconate (CHG) is an antiseptic agent that has been used for multiple purposes including catheter insertion preparation and maintenance, body antisepsis, and application in the nasopharynx and oropharynx. Antisepsis with this agent is believed to reduce colonization with potential pathogens, which in turn would lead theoretically to a reduction in the number of infections. Bathing medical intensive care unit patients with CHG cloths has been effective in reducing the rate of central venous catheter–associated bloodstream infections and the rate of colonization with vancomycin-resistant Enterococcus. CHG bathing, often in combination with nasal application of mupirocin and oral antimicrobial agents, also has been found to decrease rates of colonization with and possibly rates of acquisition of methicillin-resistant Staphylococcus aureus (MRSA). Although it is a promising infection control intervention, examination of the efficacy of CHG bathing outside of the hospital has been limited. MRSA was once considered to be solely a nosocomial pathogen. However, the epidemiology of MRSA has changed—it has emerged in community settings among individuals without prior healthcare exposures, so-called community-associated MRSA (CA-MRSA). Although CA-MRSA can cause invasive disease, such as bloodstream infection, it predominantly causes skin and soft-tissue infection (SSTI). Several distinct groups—military recruits, prisoners, and amateur and professional athletes—have been identified as being at increased risk for CA-MRSA colonization and infection, possibly because of crowding or close contact with other individuals. Military recruits are a unique community population for studying an infection control intervention, given their crowded living conditions, decreased access to bathing, and increased opportunity for cuts and abrasions. CA-MRSA colonization rates have been found to be higher among military recruits than among the general population, with outbreaks of CA-MRSA SSTIs among military recruits reported. Therefore, enhanced prevention efforts in a population such as this may be needed. Standard infection control recommendations for MRSA infection prevention in the community include hand hygiene, covering of wounds, not sharing personal items, and proper environmental cleaning. Decolonization regimens with agents such as CHG have been suggested as an option for individuals with recurrent MRSA infections or if MRSA transmission is occurring despite standard infection control measures; data on the efficacy of this approach, however, are limited. In this issue of the journal, the study by Whitman et al— a cluster-randomized study of military recruits attending Officer Candidate School in Quantico, Virginia—seeks to examine the effectiveness of bathing thrice weekly with CHG cloths (Sage) in this population. They found that there were no significant differences in development of SSTIs in the CHG group versus the control group (Comfort Bath), although the incidence of colonization in the nares and axilla with methicillin-susceptible S. aureus and MRSA was lower in the CHG group. However, colonization in both groups increased during the study, demonstrating the at-risk environment that a military training camp may create and underscoring the importance of infection control in this setting. Most studies examining patient bathing with CHG have occurred in hospital settings with cleansing occurring daily. Daily patient bathing with CHG has been shown to be effective at reducing colonization of skin with potential pathogens; theoretically, the reduction in pathogen burden on patient skin should lead to a decrease in the rate of SSTIs. Although studies have typically assessed daily bathing with CHG, the study by Whitman et al used self-applied thriceweekly bathing because of feasibility issues and data supporting CHG activity for as long as 24 hours. The assessment of CHG cleansing among military recruits in this study, however, was limited by the thrice-weekly bathing in conjunction with relatively poor self-reported adherence with CHG cloths (49.4% of individuals in the CHG group reported use of at least 50% of wipes by week 6). Although the authors found that there were no differences

Chlorhexidine-Impregnated Cloths to Prevent Skin and Soft-Tissue Infection in Marine Recruits: A Cluster-Randomized, Double-Blind, Controlled Effectiveness Trial

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) causes skin and soft-tissue infection (SSTI) in military recruits. To evaluate the effectiveness of 2% chlorhexidine gluconate (CHG)-impregnated cloths in reducing rates of SSTI and S. aureus colonization among military recruits. A cluster-randomized (by platoon), double-blind, controlled effectiveness trial. Marine Officer Candidate School, Quantico, Virginia, 2007. Military recruits. Application of CHG-impregnated or control (Comfort Bath; Sage) cloths applied over entire body thrice weekly. Recruits were monitored daily for SSTI. Baseline and serial nasal and/or axillary swabs were collected to assess S. aureus colonization. Of 1,562 subjects enrolled, 781 (from 23 platoons) underwent CHG-impregnated cloth application and 781 (from 21 platoons) underwent control cloth application. The rate of compliance (defined as application of 50% or more of wipes) at 2 weeks was similar (CHG group, 63%; control group, 67%) and decreased over the 6-week period. The mean 6-week SSTI rate in the CHG-impregnated cloth group was 0.094, compared with 0.071 in the control group (analysis of variance model rate difference, 0.025 ± 0.016; P = .14). At baseline, 43% of subjects were colonized with methicillin-susceptible S. aureus (MSSA), and 2.1% were colonized with MRSA. The mean incidence of colonization with MSSA was 50% and 61% (P = .026) and with MRSA was 2.6% and 6.0% (P = .034) for the CHG-impregnated and control cloth groups, respectively. CHG-impregnated cloths applied thrice weekly did not reduce rates of SSTI among recruits. S. aureus colonization rates increased in both groups but to a lesser extent in those assigned to the CHG-impregnated cloth intervention. Antecedent S. aureus colonization was not a risk factor for SSTI. Additional studies are needed to identify effective measures for preventing SSTI among military recruits. ClinicalTrials.gov identifier: NCT00475930.

471 Short Term Outcomes with Use of Chlorhexidine Gluconate (CHG) and Povidone-Iodine (PI) in VLBWI with Percutaneously Placed Central Venous Catheters

Background and aims: CHG's use as a skin antiseptic in neonates is limited because of concerns about systemic absorption and potential side-effects. No chlorhexidine-based antiseptic has been approved by the FDA for neonatal IV catheter placement. We compared the short-term risks of using CHG versus PI as an antiseptic for percutaneously placed central venous catheters (PPCVCs) in VLBWI. Methods: The records of VLBWI admitted to the NICU at Miami Children's Hospital from 2004-8 were reviewed. Initially, PI was used. After a change in hospital guidelines, CHG replaced PI. Every 10 days the site was re-cleansed with the same antiseptic. Outcomes compared: BPD, NEC, IVH, PVL, ROP, failed hearing test (FHT), length of stay (LOS) and death in infants with lines placed during the first 30 days of life. Results: PPCVCs were inserted in 187 infants (CHG=95, PI=92). Birthweight, gestational age, gender, total duration of PPCVCs and LOS were similar between CHG and PI groups. The mortality rates in CHG (12.8%) and PI (16.3%) were similar (p=0.54). COMORBIDITIES: PI group (%), CHG group (%), p value Table Conclusions: The use of CHG as an antiseptic for PPCVCs in VLBWI did not increase the risk of major adverse short-term outcomes and mortality when compared to the use of PI. Although this preliminary data is encouraging, prospective studies are needed to confirm its safety.

Preoperative Footbaths Reduce Bacterial Colonization of the Foot

Previous studies have demonstrated higher infection rates following elective procedures on the foot and ankle compared with procedures involving other areas of the body. Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery. The purpose of the present study was to ascertain if preoperative chlorhexidine bathing decreased the number of bacteria on the forefoot. From October 2005 to October 2006, a prospective study was undertaken to evaluate 44 consecutive patients undergoing planned, elective surgery of the foot and ankle. (mean age, 43.9 years; range, 17 to 85 years; 25 female, 19 male). Twenty-two patients were assigned to each group. They were randomly assigned to have preoperative footbath with chlorhexidine gluconate (Hibitane) (Group 1) 20 minutes before surgery or placebo (Group 2). Culture swabs were taken from all web spaces, nail folds, toe surfaces and proposed surgical incision sites before the preoperative bath, during the procedure and immediately after surgery. In Group 1, bacteria grew on the intraoperative culture in 60% and 0% of immediate postoperative cultures. In Group 2, 96% of intraoperative cultures and 16% of postoperative cultures. The difference in the intraoperative bacterial count was statistically significant (p = 0.002). The difference in postoperative bacterial counts was marginally significant (p = 0.055). No complications were recorded in either group. These data indicate that chlorhexidine provides better reduction in skin flora than placebo. Based of these data, we recommend the use of a chlorhexidine footbath in addition to standard surgical preparatory agent before foot and ankle surgery.

Does Immunosuppressive Treatment Ameliorate Morphology Changes in Encapsulating Peritoneal Sclerosis?

Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome associated with ileus symptoms and irreversible sclerosis of the peritoneal membrane. Inflammation, fibrosis, and neoangiogenesis are the main features of the pathophysiology. No evidence-based therapy is currently available for EPS. In recent years, anti-inflammatory and immunosuppressive (IS) treatment modalities have become more popular. The aim of the present study was to investigate the effects of various IS treatment strategies-glucocorticosteroid (GC), azathiopurine (AZT), and cyclosporin (CsA)- on regression of EPS. We divided 52 nonuremic Wistar albino rats into six groups: Control group-2 mL isotonic saline injected intraperitoneally (IP) daily for 3 weeks; CG group-2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for 3 weeks; Resting group-CG (weeks 1 - 3), plus peritoneal rest (weeks 4 - 6); Corticosteroid (GC) group-CG (weeks 1 - 3), plus 10 mg/L prednisolone in drinking water (weeks 4 - 6); AZT group- CG (weeks 1 - 3), plus 100 mg/L azathioprine in drinking water (weeks 4 - 6); and CsA group-CG (weeks 1 - 3), plus cyclosporin 7.5 mg/kg by subcutaneous injection daily (weeks 4 - 6). At the end of the study, under ketamine HCl anesthesia, the rats were humanely killed by bleeding. Parietal peritoneal samples were then taken from same location (away from the injection site) and changes of parietal peritoneum morphology were examined by a single pathologist. The CG severely disturbed parameters of peritoneal morphology, increasing peritoneal thickness, inflammatory activity, vascularity, and fibrosis score as compared with the Control group (p < 0.05). No benefit was observed for any parameter in the Resting group as compared withthose parameters in the CG group (p < 0.05). We observed a lower fibrosis score and less peritoneal thickness in the GC group as compared with the Resting group (p < 0.05). No beneficial effects of AZT on peritoneal morphology were observed as compared with the effects of peritoneal rest or corticosteroid therapy. Treatment with cyclosporin resulted in more fibrosis, vascularity, and inflammation than was seen with corticosteroid therapy (p < 0.05). Immunosuppressive therapies, especially those that are corticosteroid-based, may have therapeutic value in the management of EPS. Patients treated with cyclosporin may have a risk for developing EPS.

Can N-Acetylcysteine Preserve Peritoneal Function and Morphology in Encapsulating Peritoneal Sclerosis?

Long-term use of the peritoneum as a dialysis membrane results in progressive irreversible dysfunction, described as peritoneal fibrosis. Oxidative stress during peritoneal dialysis has been established in many studies. Generation of reactive oxygen species (ROS) by conventional peritoneal dialysis solutions, regardless of whether produced by high glucose, angiotensin II, or glucose degradation products may be responsible for progressive membrane dysfunction. The well-known antioxidant molecule N-acetylcysteine (NAC) is capable of direct scavenging of ROS. The aim of the present study was to investigate the effect of NAC therapy on both progression and regression of encapsulating peritoneal sclerosis (EPS). We divided 49 nonuremic Wistar albino rats into four groups: Control group-2 mL isotonic saline intraperitoneally (IP) daily for 3 weeks; CG group-2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for a total of 3 weeks; Resting group-CG (weeks 1 - 3), plus peritoneal resting (weeks 4 - 6); NAC-R group-CG (weeks 1 - 3), plus 2 g/L NAC (weeks 4 - 6). At the end of the experiment, all rats underwent a 1-hour peritoneal equilibration test with 25 mL 3.86% PD solution. Dialysate-to-plasma ratio (D/P) urea, dialysate white blood cell count (per cubic milliliter), ultrafiltration (UF) volume, and morphology changes of parietal peritoneum were examined. The CG group progressed to encapsulating peritoneal sclerosis, characterized by loss of UF, increased peritoneal thickness, inflammation, and ultimately, development of fibrosis. Resting produced advantages only in dialysate cell count; with regard to vascularity and dialysate cell count, NAC was more effective than was peritoneal rest. Interestingly, we observed no beneficial effects of NAC on fibrosis. That finding may be a result of our experimental severe peritoneal injury model. However, decreased inflammation and vascularity with NAC therapy were promising results in regard to membrane protection.

Development of a Peritoneal Sclerosis Rat Model Using a Continuous-Infusion Pump

Encapsulating peritoneal sclerosis (EPS) is a serious complication of continuous ambulatory peritoneal dialysis. Previous studies have created peritoneal sclerosis rat models using daily intraperitoneal injection of chlorhexidine gluconate (CG), but this technique is cumbersome and thickening of the peritoneum makes it difficult to evaluate the injection site. We therefore aimed to make a rat model using a continuous-infusion pump. Various concentrations of CG (5%, 8%, 10%, 12%, and 14%) in ethanol were dissolved in saline within the infusion pumps, each of which was placed in the lower abdominal cavity of a male Wister rat. After a peritoneal equilibration test was performed, the rats were sacrificed and the lower anterior parietal and visceral peritoneum was removed. Each excised peritoneum was analyzed by macroscopic and microscopic examinations, including immunohistochemistry for the expression of transforming growth factor-beta 1 (TGF-beta1), vascular endothelial growth factor (VEGF), and alpha-smooth muscle actin (alphaSMA). The results were compared with those of control rats injected with ethanol dissolved in saline within the infusion pump and with no-pump rats. Two of the 5 rats in the 12% CG group and 3 of the 5 rats in the 14% CG group died of ileus within 14 days. All the rats in the 5%, 8%, and 10% CG groups survived to 28 days. Macroscopic examination in the 10% CG group showed bowel dilatation, bowel adhesion, and bloody ascites, similar to those seen in human EPS patients. All rats in each CG group showed the same extent of thickening of the submesothelial compact zone, proliferation of collagen fibers, and presence of numerous cells and neovascularization. Within same CG groups, an equal degree of thickening was observed at all sites of the peritoneum. TGF-beta1, VEGF, and alphaSMA were highly expressed in the peritoneum of the 10% CG group. We developed a novel method of creating a peritoneal sclerosis rat model using a continuous-infusion pump. Our technique is simple and highly reproducible, and will be useful in the study of peritoneal sclerosis mechanisms.

The Effects of Renin–angiotensin System Inhibition on Regression of Encapsulating Peritoneal Sclerosis

Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome associated with symptoms of ileus and irreversible sclerosis of both visceral and parietal peritoneum. Peritoneal dialysis (PD) patients rarely develop EPS, a severe life-threatening condition of unknown pathogenesis. Angiotensin II is known to promote fibrosis and inflammation in various tissues. Renin-angiotensin system (RAS) blockade provides advantages in the course of diseases such as hypertension, chronic kidney disease, and proteinuria. We have also previously shown that RAS blockade has beneficial effects on hypertonic (3.86%) PD solution-induced peritoneal alterations. Because it shares the same characteristics as other fibrotic processes, peritoneal fibrosis can benefit from RAS blockade. To determine the advantages of RAS blockade in regression of EPS. We divided 56 nonuremic albino Wistar rats into 6 groups: control group (n = 10), daily intraperitoneal (IP) injection of 2 mL isotonic saline for 3 weeks; CG group (n = 10), daily IP injection of 2 mL/200 g chlorhexidine gluconate (CG) for 3 weeks; resting group (n = 10), daily IP injection of CG (0 - 3 weeks) plus peritoneal rest (4 - 6 weeks). After 3 weeks of being injected with CG (0 - 3 weeks), a fourth group (n = 9) was treated with 100 mg/L enalapril (ENA group); a fifth group (n = 10) was treated with 80 mg/L valsartan (VAL group), and a sixth group (n = 7) was treated with 100 mg/L enalapril + 80 mg/L valsartan (ENA+VAL group) in drinking water for an additional 3 weeks (4 - 6 weeks). At the end, a 1-hour peritoneal equilibration test was performed with 25 mL 3.86% PD solution. Dialysate-to-plasma ratio of urea (D/P urea), dialysate WBC count, ultrafiltration volume (UF), and morphological changes of parietal peritoneum were examined. Exposure to CG for 3 weeks resulted in alterations in peritoneal transport (increased D/P urea, decreased UF volume; p < 0.05) and morphology (increased inflammation, neovascularization, fibrosis, and peritoneal thickness; p < 0.05). Peritoneal rest had some beneficial effect only on UF failure and dialysate cell count (p < 0.05). However, RAS blockade was more effective than peritoneal rest with respect to UF volume, vascularity (p < 0.05), and peritoneal thickness (p > 0.05). Dual blockade of RAS had no additional beneficial effects. We suggest that RAS blockade either with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may be a more effective option than resting in the management of EPS.

The Effects of Colchicine on the Progression and Regression of Encapsulating Peritoneal Sclerosis

Encapsulating peritoneal sclerosis (EPS) is an infrequent but extremely serious complication of long-term peritoneal dialysis. Fibrosis of the submesothelial compact zone and neoangiogenesis underlie the pathophysiology of EPS. Colchicine is a well-known anti-inflammatory and antifibrotic agent that has been used for some fibrosing clinical states, such as liver fibrosis. To determine the antifibrotic and anti-inflammatory effects of colchicine in an EPS rat model in both progression (P) and regression (R). 48 nonuremic albino Wistar rats were divided into 5 groups: control group, 2 mL isotonic saline intraperitoneally (IP) daily for 3 weeks; CG group, IP injection of 2 mL/200 g chlorhexidine gluconate (CG) (0.1%) and ethanol (15%) dissolved in saline, daily for 3 weeks; resting group, CG (0 - 3 weeks) + peritoneal resting (4 - 6 weeks); C-R group, CG (0 - 3 weeks) + 1 mg/L colchicine (4 - 6 weeks); C-P group, CG (0 - 3 weeks) + 1 mg/L colchicine in drinking water (0 - 3 weeks). At the end, a 1-hour peritoneal equilibration test was performed with 25 mL 3.86% peritoneal dialysis solution. Dialysate-to-plasma ratio of urea (D/P urea), dialysate WBC count, ultrafiltration volume, and morphological changes of parietal peritoneum were examined. Exposure to CG for 3 weeks resulted in alterations in peritoneal transport (increased D/P urea, decreased ultrafiltration volume; p < 0.05) and morphology (increased inflammation, neovascularization, fibrosis, and peritoneal thickness; p < 0.05). Resting had some beneficial effects on peritoneal derangements; however, once the peritoneum had been stimulated, resting alone was not enough to reverse these pathological changes. Colchicine had more pronounced effects on membrane integrity via decreased inflammation, cell infiltration, and vascularity compared to the resting group. We suggest that colchicine may have therapeutic value in the management of EPS.

Water versus antiseptic periurethral cleansing before catheterization among home care patients: A randomized controlled trial

There is a lack of research studies on periurethral cleansing before catheterization among home care patients. The purpose of this study was to compare the risk of acquiring symptomatic urinary tract infections through the conventional practice of using 0.05% chlorhexidine gluconate (CHG) versus sterile water for periurethral cleansing before insertion of an indwelling urinary catheter. A randomized controlled trial was used, and subjects were randomly allocated to either the sterile water group or the 0.05% CHG group. Urine specimens for culture were collected 4 times for each subject within 2 weeks. Seventy-four urine samples were collected in 20 subjects (sterile water group, 8; 0.05% CHG group, 12). There was no significant difference in colonization count between the 2 groups. In addition, none of the subjects in the 2 groups developed symptomatic bacteriuria. Using sterile water to clean the periurethral area before catheterization among home care patients will not increase the risk for urinary tract infections.

Preoperative Shower Revisited: Can High Topical Antiseptic Levels Be Achieved on the Skin Surface Before Surgical Admission?

Skin asepsis is a sentinel strategy for reducing risk of surgical site infections. In this study, chlorhexidine gluconate (CHG) skin concentrations were determined after preoperative showering/skin cleansing using 4% CHG soap or 2% CHG-impregnated polyester cloth. Subjects were randomized to one of three shower (4% soap)/skin cleansing (2% cloth) groups (n = 20 per group): (group 1 A/B) evening, (group 2 A/B) morning, or (group 3 A/B) evening and morning. After showering or skin cleansing, volunteers returned to the investigator's laboratory where CHG skin surface concentrations were determined at five separate skin sites. CHG concentrations were compared with CHG minimal inhibitory concentration that inhibits 90% (MIC(90)) of staphylococcal skin isolates. CHG MIC(90) for 61 skin isolates was 4.8 parts per million (ppm). In group 1A, 4% CHG skin concentrations ranged from 17.2 to 31.6 ppm, and CHG concentrations were 361.5 to 589.5 ppm (p < 0.0001) in group 1B (2%). In group 2A (4%), CHG levels ranged from 51.6 to 119.6 ppm and 848.1 to 1,049.6 ppm in group 2B (2%), respectively (p < 0.0001). CHG levels ranged from 101.4 to 149.4 ppm in the 4% CHG group (group 3A) compared with 1,484.6 to 2,031.3 ppm in 2% CHG cloth (group 3B) group (p < 0.0001). Effective CHG levels were not detected in the 4% CHG group in selected sites in seven (35%) subjects in group 1A, three (15%) in group 2A, and five (25%) in group 3A. Effective CHG levels were achieved on most skin sites after using 4% CHG; gaps in antiseptic coverage were noted at selective sites even after repeated application. Use of the 2% CHG polyester cloth resulted in considerably higher skin concentrations with no gaps in antiseptic coverage. Effective decolonization of the skin before hospital admission can play an important role in reducing risk of surgical site infections.

In Vivo Evaluation of ProPex Electronic Apex Locator

The aim of this in vivo study was to evaluate the performance of ProPex apex locator after extirpation and in presence of different irrigation solutions: 2.5% NaOCl, 0.9% NaCl, and 0.2% chlorhexidine gluconate solutions. Twenty-seven single-rooted human teeth scheduled for extraction with mature apices were selected for this study. Measurements were performed by using ProPex after extirpation and in presence of the irrigation solutions. After extraction of the teeth, a stereomicroscope was used to confirm visually the relationship of the tip of the endodontic file to the apical foramen, and actual lengths (ALs) were determined by reducing 0.5 mm from these lengths. The data were statistically analyzed with cluster analysis. The results of this study showed that measurements after extirpation had the smallest distance to the ALs. Among the irrigation solution groups, chlorhexidine gluconate group had the smallest distance to the ALs, whereas saline group had the greatest. Most accurate measurements were obtained after extirpation.

Prevention of Nosocomial Infection in Cardiac Surgery by Decontamination of the Nasopharynx and Oropharynx With Chlorhexidine Gluconate

Nosocomial infections are an important cause of morbidity and mortality after cardiac surgery. Decolonization of endogenous potential pathogenic microorganisms is important in the prevention of nosocomial infections. To determine the efficacy of perioperative decontamination of the nasopharynx and oropharynx with 0.12% chlorhexidine gluconate for reduction of nosocomial infection after cardiac surgery. A prospective, randomized, double-blind, placebo-controlled clinical trial conducted at the Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands, between August 1, 2003, and September 1, 2005. Of 991 patients older than 18 years undergoing elective cardiothoracic surgery during the study interval, 954 were eligible for analysis. Oropharyngeal rinse and nasal ointment containing either chlorhexidine gluconate or placebo. Incidence of nosocomial infection, in addition to the rate of Staphylococcus aureus nasal carriage and duration of hospital stay. The incidence of nosocomial infection in the chlorhexidine gluconate group and placebo group was 19.8% and 26.2%, respectively (absolute risk reduction [ARR], 6.4%; 95% confidence interval [CI], 1.1%-11.7%; P = .002). In particular, lower respiratory tract infections and deep surgical site infections were less common in the chlorhexidine gluconate group than in the placebo group (ARR, 6.5%; 95% CI, 2.3%-10.7%; P = .002; and 3.2%; 95% CI, 0.9%-5.5%; P = .002, respectively). For the prevention of 1 nosocomial infection, 16 patients needed to be treated with chlorhexidine gluconate. A significant reduction of 57.5% in S aureus nasal carriage was found in the chlorhexidine gluconate group compared with a reduction of 18.1% in the placebo group (P<.001). Total hospital stay for patients treated with chlorhexidine gluconate was 9.5 days compared with 10.3 days in the placebo group (ARR, 0.8 days; 95% CI, 0.24-1.88; P = .04). Decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery. clinicaltrials.gov Identifier: NCT00272675.