Local Disinfection Research Articles

Colonization with Multidrug-Resistant Bacteria - On the Efficiency of Local Decolonization Procedures.

The effectiveness of a disinfectant-based decolonization strategy for multidrug-resistant bacteria like extended spectrum β-lactamase (ESBL)-positive Gram-negative bacteria with or without additional fluoroquinolon and carbapenem resistance as well as vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus was assessed.Between 2011 and 2015, 25 patients from Libya, Syria, and the Ukraine with war traumata were treated at the Bundeswehr hospital Hamburg. The patients were heavily colonized and infected with multidrug-resistant bacteria, altogether comprising 371 distinct combinations of pathogens and isolation sites. Local disinfection was assessed for effectiveness regarding successful decolonization of multidrug-resistant bacteria.Altogether, 170 cases of successful decolonization were observed, comprising 95 (55.8%) such events at sampling sites that were accessible to disinfecting procedures. The remaining 75 (44.2%) decolonization events had to be considered as spontaneous. In contrast, 95 out of 172 (55.2%) colonized isolation sites that were accessible to disinfection procedures were successfully decolonized. Patient compliance with the enforced hygiene procedures was associated with decolonization success. Systemic antibiotic therapy did not relevantly affect isolation time.Disinfecting washing moderately supports local decolonization of multidrug-resistant pathogens in comparison with spontaneous decolonization rates if the patients’ compliance with the applied hygiene procedures is ensured.

Spinal anaesthesia in outpatient and conventional surgery: A point of view from experienced French anaesthetists

IntroductionThe objective of this investigation was to evaluate the practice of spinal anaesthesia among French anaesthetists in inpatient and outpatient settings. Methods and materialsA questionnaire was sent to members of the French Association of Anaesthetists involved in regional anaesthesia during the first 4months of 2015. The questionnaire included items on the practice of spinal anaesthesia (type of needle, local anaesthetic available, puncture and disinfection techniques, etc.) and on the anaesthetic techniques usually used in 5 surgical situations eligible for outpatient surgery (knee arthroscopy, inguinal hernia, transobturator tape, haemorrhoids, varicose veins in the lower limbs). ResultsResponses from 703 anaesthesiologists were analysed. Spinal anaesthesia was usually performed in a sitting position (76%) using a Whitacre needle (60%) with a 25 G (57%) diameter. Ultrasound before puncture was reported in 26% of cases due to obesity or spinal abnormalities. Among the 5 surgical situations eligible for outpatient spinal anaesthesia, the technique was typically proposed in 29–49% of cases. Bupivacaine was the most used local anaesthetic. Concerns over delays in attaining readiness for hospital discharge, urine retention, operation length, and surgeon's preference were the main reasons for choosing another anaesthetic technique in these situations. DiscussionNew local anaesthetics are beginning to be used for outpatient spinal anaesthesia due to their interesting pharmacodynamic profile in this context. This study will provide a basis for evaluating future changes in practice.

Local disinfection with sodium hypochlorite as adjunct to basic periodontal therapy: a randomized controlled trial.

To investigate the clinical and microbiological effects of local disinfection with 0.5% sodium hypochlorite (NaOCl) with or without systemic antimicrobials (amoxicillin and metronidazole, AM) during basic periodontal therapy (BPT). In a randomized clinical trial (four groups), 110 chronic periodontitis patients received BPT plus local irrigation with saline (BPT+S), local disinfection with NaOCl (BPT+DIS), BPT+DIS+AM or BPT+S+AM. The outcome was analysed at baseline, 3, 6 and 12months. There was no difference in clinical attachment level gain at 12months between the four groups. BPT+DIS showed no additional improvement compared to BPT+S; BPT+DIS+AM showed fewer sites with probing pocket depth (PPD) ≥7mm versus BPT+S only up to 6months (p=0.037). In factorial analyses, additional clinical reduction for PPD (p=0.023) and number of sites with PPD ≥5 (p=0.007), ≥6 (p=0.002) and ≥7mm (p<0.001) were found when AM was added to BPT, but not when DIS was applied. In all groups, a comparable decrease in targeted bacteria was found. AM caused adverse events in 22% of the patients. Local disinfection with NaOCl, also in combination with AM, showed, after 1-year follow-up, no additional clinical and microbiological effects compared to BPT alone.

Phenothiazinium photosensitisers XI. Improved toluidine blue photoantimicrobials

The phenothiazinium derivative toluidine blue O (TBO) is widely employed as a photoantimicrobial agent in clinical trialling, particularly in dentistry. However, its activity against a range of pathogenic microbial species is not significantly different to that of the standard photoantimicrobial methylene blue. In the current study, derivatives of TBO with varying hydrocarbon substitution in chromophore position 2 were synthesised via the established anilinethiosulphonic route, using the mild oxidant silver(II) carbonate to allow substituent preservation.The resulting series of analogues demonstrated the expected increases in visible absorption wavelength and lipophilicity with increasing hydrocarbon content, as well as decreased aggregation for derivatives with bulkier substituents, and all produced singlet oxygen on illumination in vitro. Screening against a range of bacterial and fungal pathogens relevant to infection control showed remarkable increases in activity relative to the parent compound, particularly against the clinically important Gram-negative bacterium Pseudomonas aeruginosa. In addition, in order to demonstrate clinical relevance, the photoactivities of the new derivatives against microbial targets were compared to conventional antibacterial and antifungal drugs, as well as biocides commonly used for local disinfection. Activity here was also generally greater than that of the conventional agents used for comparison, considerably so relative to the local disinfectant agents.

A New Drainage Tube Device

Objective Drainage tubes (e.g., intracranial, abdominal cavity and thoracic) are commonly used to drain blood and fluid collections after surgery. It usually fails due to the lack of fixation perpendicular to the skin and the variety of tube materials. The objective of the article is to describe a new drainage tube device. Methods This new device consists of a drainage tube fixator and diverter with a rotating handle. The fixator and diverter are fixed to the skin with a pair of wings, and the base comprises acircular arc with chamfering of the edge. The removable stopper and plastic diverter have a memory function. There are 2 holes on either side of the wings, by which they can be sewn to the skin or stapled for strength and stability. Results The removable limiting stopper and plastic diverter with memory function work together to ensure that the drainage tube is firmly fixed. Therefore, the tube will not move either vertically or horizontally on the skin. Moreover, the device is fit for drainage tubes with different specifications and materials. Conclusions The limiting stopper can be moved easily, which is conducive to local skin disinfection around the drainage tube. The device deserves clinical promotion.

Monitoring of renal ischemia reperfusion injury in rabbits by ultrasonic contrast and its relationship with expression of VEGF in renal tissue

To evaluate the renal ischemia reperfusion injury (IRI) in rabbits using the ultrasonic contrast technique and discuss the clinical value of ultrasonic contrast technique in the diagnosis of renal IRI by comparing the time-intensity curve of renal cortex and the expression of vascular endothelial growth factor (VEGF) of renal tissue. Twenty 3-month-old New Zealand rabbits were randomly divided into 4 groups, namely Ctrl group, IRI-12h, IRI-24h and IRI-48h groups. The two dimensional gray-scale ultrasonography was employed to determine and mark the position of rabbit kidney. Rabbits were given the intraperitoneal anesthesia with 20% urethane with the dosage of 5mL/kg. The aseptic operation was performed after the local skin disinfection in the area of both kidneys. The right kidney of animals in the control group was excised without any treatment for the left kidney. After excising the right kidney of animals in groups of IRI-12h, IRI-24h and IRI-48h, the aneurysm clip was used to clip the renal pedicle vessel of left kidney, in order to simulate the ischemia. Because of the tissue ischemia, it could be seen that the color of kidney was changed from bright red to dark red, which indicated the successful modeling of ischemia. The aneurysm clip was released after one hour of maintaining the ischemia. Then the kidney turned out to be bright red from dark red, which indicated that the reperfusion was completed. Taking this moment as the time of ischemia reperfusion, the wound was stitched up. A total of 12, 24 and 36h after the operation, the two-dimensional and color Doppler flow imaging and ultrasonic contrast were employed for the examination. The dynamic changes of ultrasonic contrast were recorded. The quantitative analysis software (QontraXt) was adopted to analyze the time-intensity curve of echo at different positions of renal cortex. After the ultrasonic contrast testing, rabbits were put to death. The renal cortex tissue was isolated and the tissue RNA and total protein were extracted respectively. Real-time PCR and western blotting were used to detect the VEGF and the Pearson product moment correlation coefficient was used to measure the linear relationship between these two variables. The ultrasonic contrast could clearly reflect the process of IRI. The results of testing at mRNA and protein level indicated that the expression of VEGF in IRI groups was significantly increased (P<0.05) and the expression of VEGF was also increased by the time of reperfusion. There is the certain correlation between the expression of VEGF and process of IRI. The correlation coefficient between the ultrasonic contrast parameters of AT and TTP and the relative expression of VEGF is over 0.9, which indicates the relatively high correlation. But there is no significant difference in the change of perfusion peak intensity between groups, which has no correlation with the expression of VEGF.

血液透析患者静脉导管相关感染研究进展

本文通过查阅国内外文献研究，综述了血液透析患者静脉导管相关感染定义、临床表现、原因及影响因素，提出相关防治措施。当发生静脉导管相关感染时，积极进行抗感染处理，采取局部消毒、抗生素封管、全身用药等措施。同时，医护人员做好患者的健康宣教，避免易感隐患，密切观察感染征象，积极处理，预防感染发生。 In this paper, the definition, clinical manifestations, causes and influencing factors of venous ca-theter related infection in hemodialysis patients were reviewed through the literature research at home and abroad, and relevant prevention measures were put forward. When the venous catheter related infection occurs, we should actively carry out anti-infection treatment, take the local disinfection, use antibiotic sealing tube, and apply systemic medication and other measures. At the same time, health care personnel should do a good job in patients with health education, to avoid the hidden dangers, close observation of infection signs and actively deal with, and prevent infection.

A new drainage tube device

Objective: Drainage tubes (e.g., intracranial, abdominal cavity and thoracic) are commonly used to drain blood and fluid collections after surgery. It usually fails due to the lack of fixation perpendicular to the skin and the variety of tube materials. The objective of the article is to describe a new drainage tube device. Methods: This new device consists of a drainage tube fixator and diverter with a rotating handle. The fixator and diverter are fixed to the skin with a pair of wings, and the base comprises acircular arc with chamfering of the edge. The removable stopper and plastic diverter have a memory function. There are 2 holes on either side of the wings, by which they can be sewn to the skin or stapled for strength and stability. Results: The removable limiting stopper and plastic diverter with memory function work together to ensure that the drainage tube is firmly fixed. Therefore, the tube will not move either vertically or horizontally on the skin. Moreover, the device is fit for drainage tubes with different specifications and materials. Conclusions: The limiting stopper can be moved easily, which is conducive to local skin disinfection around the drainage tube. The device deserves clinical promotion.

Effect of chlorhexidine on oral airway biofilm formation of Staphylococcus epidermidis

Objective: Biofilm formation of microorganisms on the surface of airways may lead to supraglottic colonization that may cause lower respiratuar tract infections. Studies searching the efficiency of local disinfectants on biofilm formation are limited. The aim of this study was to investigate the effects of chlorhexidine coated airways on biofilm formation of Staphylococcus epidermidis. Methods: Culture and electron microscopy methods were used for biofilm assessment. Airways were divided into two groups to investigate the effects of chlorhexidine on number of bacteria attached to the airway and biofilm formation. Group 1(control): naive material, S. epidermidis, Group 2: chlorhexidine coated material, S. epidermidis. No process was applied in Group 1. Chlorhexidine gluconate (0.2%) was sprayed on the surface of naive material for four seconds and then left to dry in air, in Group to. Number of bacteria attached to the airway were counted by microbiological methods and biofilm formation was shown by Scanning Electron Microscope (SEM). Mann-Whitney u test was performed for statistical analyses. Results: In Group 2, bacteria numbers were 1x102-8x102 cfu/ml, whereas they were 3x103-1x104 cfu/ml in Group 1. Chlorhexidine decreased number of microorganisms attached to the airways with statistical significance (p=0.04). The results of the electron microscopic evaluation were in accordance with the bacteriological findings. Conclusion: This study has shown that chlorhexidine coating can successfully reduce the number of adhered bacteria and biofilm formation on airways. J Microbiol Infect Dis 2015;5(4): 162-166 Key words: Chlorhexidine; oral airway; biofilm; Staphylococcus epidermidis

Disinfection in the laboratory: theory and practice in disinfection policy in late C19th and early C20th England

This article examines the relationship between theory and practice in nineteenth century English public health disinfection practice. Disinfection undertaken by local authorities and practised on objects, spaces and people became an increasingly common public health practice in the last quarter of the nineteenth century, and was part of a newly developed public health system of 'stamping out' disease as described by Hardy. Despite disinfection's key role in public health policy, it has thus far not received significant investigation or historiographical attending. This article explores the development of disinfection policy at local level, highlighting that despite commentators assumptions that increasingly exacting standards of disinfection required professional oversight rather than that of the 'amateur' public, there was a significant gap between laboratory based knowledge and evidence derived from practical experience. Laboratory conditions could not replicate those found in day-to-day disinfection, and there were myriad debates about how to create a mutually understandable scientific standard for testing. Despite increasing efforts to bring local disinfection in line with new ideas promulgated by central government and disinfection researchers, the mismatches between the two meant that there was greater divergence. This tension lay at the heart of the changes in disinfection theory and practice in the second half of the nineteenth century, and illustrate the complexities of the impact of germ theory on public health policy.

Medicated Chewing Gum: An Innovative approach for Oral Drug Delivery System

Oral route is most convenient for the patient therefore it is very popular in the society. Chewing gum delivery system is convenient, easy to administer anywhere, anytime and is pleasantly tasting, making it patient acceptable. It is a novel drug delivery system containing masticatory gum base with pharmacologically active ingredient and intended to use for local treatment of mouth diseases or systemic absorption through oral mucosa. Chewing gums are solid and reliable drug delivery systems. It is a potentially useful means of administering drugs either locally or systemically via, the oral cavity. MCGs are solid, single dose preparations with a base consisting mainly of gums that are intended to be chewed but not swallowed. They contain one or more active substances which are released by chewing and are intended to be used for local treatment of mouth diseases. Now days the medicated chewing gum has increasing acceptance as a drug delivery system. Several active medicaments are incorporated in medicated chewing gum, e.g. Fluoride for prophylaxis of dental caries, chlorhexidine as local disinfectant, nicotine for smoking cessation, aspirin as an analgesic, and caffeine as a stay alert preparation.

Medicated Chewing Gum

Chewing gums are mobile drug delivery systems. It is a potentially useful means of administering drugs either locally or systemically via, the oral cavity. The medicated chewing gum has through the years gained increasing acceptance as a drug delivery system. Several ingredients are now incorporated in medicated chewing gum, e.g. Fluoride for prophylaxis of dental caries, chlorhexidine as local disinfectant, nicotine for smoking cessation, aspirin as an analgesic and caffeine as a stay alert preparation. MCG'S are solid, single dose preparations with a base consisting mainly of gums that are intended to be chewed but not swallowed. They contain one or more active substances which are released by chewing and are intended to be used for local treatment of mouth diseases or systemic delivery after absorption through the buccal mucosa.

Influence of ISDN, l-NAME and selenium on microcirculation, leukocyte endothelium interaction and angiogenesis after frostbite

BackgroundThe body of knowledge regarding the different facets of frostbite injury continues to expand. However, beside the administration of physiological saline, local rewarming, local disinfection and symptomatic medications, today no causal therapy is known which would accelerate angiogenesis and wound healing.The aim of this study was to investigate the influences of dilative acting drugs on microcirculation, angiogenesis and leukocyte behavior. Materials and MethodsEars of male hairless mice (n=40) were inflicted with full thickness frostbites using a cold air jet. Then the affects of four intraperitoneal injections of isosorbitdinitrate (ISDN, n=10), l-nitroarginine-methyl-ester (l-NAME, n=10), selenium (n=10) or sodium chloride (n=10; each administered to one of four corresponding study groups), on microcirculation, leukocyte-endothelial interaction and angiogenesis were investigated over a 12-day period using intravital fluorescent microscopy. ResultsAngiogenesis was most improved by ISDN (36.8 vs. 54.5% non-perfused area on day 3, 3.9 vs. 17.0% on day 7 compared to selenium, p<0.006). Venular diameter was most significantly dilated in the ISDN-group, l-NAME showed significantly decreased diameter over the complete time of 12 days. ISDN had positive influences on edema formation, which was significantly reduced compared to control (27% lower values compared to control; p=0.007 on day 3). The l-NAME-group showed the significant highest leukocyte-adhesion compared to control on days 7 and 12 (53% resp. 58% higher, p<0.006). ConclusionOverall, out of all the drugs tested, ISDN improved angiogenesis, dilated venules and decreased edema formation and therefore seems to have the greatest positive impact on these crucial parameters after frostbite injury.

A randomized trial comparing two intraosseous access devices in intrahospital healthcare providers with a focus on retention of knowledge, skill, and self-efficacy.

Intraosseous access is recommended in vitally compromised patients if an intravenous access cannot be easily obtained. Intraosseous infusion can be initiated by various healthcare providers. Currently, there are two mechanical intraosseous devices approved by the U.S. Food and Drug Administration (FDA) for use in adults and children. A comparison is made in this study of the theoretical and practical performance by anesthesiologists and registered nurses of anesthesia (RNAs) in the use of the battery-powered device (device A) versus the spring-loaded needle device (device B). This study entailed a 12-month follow-up of knowledge, skill retention, and self-efficacy measured by standardized testing. A prospective randomized trial was performed, initially comparing 15 anesthesiologists and 15 RNAs, both on using the two types of intraosseous devices. A structured lecture and skill station was given with the educational aids provided by the respective manufacturers. Individual knowledge and practical skills were tested at 0, 3, and 12months after the initial course. There was no statistical significant difference in the retention of theoretical knowledge between RNAs and anesthesiologists on all testing occasions. However, the self-efficacy of the anesthesiologists is significantly higher (p<0.01) than the self-efficacy of the RNAs for both devices, on any testing occasion. Insufficient skills were local disinfection (both groups, both devices) and attachment of the needle to the intravenous line (RNAs with both devices). In 33% of all device B handlings, unsafe practice occurred. The use of device A is safer in handling in comparison to device B at 12 months follow-up. The hypothesis that doctors are more qualified in obtaining intraosseous access has been disproven, as anesthesiologists were as successful as RNAs. However, the low self-efficacy of RNAs in the use of intraosseous devices could diminish the chance of them actually using one.

Su1291 How Should Be Applied the Premedication in Percutanous Liver Biopsy? : The Roles of Analghesics and Sedatives

AIM:Percutaneous needle liver biopsy (PLB) is important for diagnosis of liver disease and is frequently associated with pain and anxiety. This may discourage patients for further biopsies, if needed. Procedure is performed under local anesthesia(LA). No concencus are available on premedication. Some reports suggested benefits of sedation and analghesia, while others, possibility of interferance with patient's cooperation. We use LA and sometimes add Meperidine (Me) or Midazolam (Mi) for PLB premedication. We planned a study to investagate the efficacy of analghesia and sedation for PLB. MATERIALS-METHODS: This was a prospective, randomized, double-blinded, double dummy study. Approval received from local ethic committe. PLB planned, 18-65 years old patients included in study. Written informed consent was obtained. Patients randomized into three premedication groups as placebo (P), Me and Mi and requested to complete the Hospital Anxiety and Depression Scale (HADS) before biopsy. Biopsy site was located with ultrasonography. Then, 15 minutes before biopsy, 1ml %0,9 NaCl sc, 1 mg/kg (max100mg)Me sc, and 0.1 mg/kg (max5mg) Mi iv administered to P, Me and Mi patients, respectively. PLBs were performed by the same skilled operator (SY) for all, placed supine position. After local disinfection, LA with Prilocaine HCL 10 ml apllied to skin and periton beneath. Then PLB applied with 16 G Menghini needle.The patient, then lied on right side or supine, monitored in order to detect complications for 4 hours, then discharged. The day after, the patient asked about biopsy.Visual analog scale (VAS) was used to grade the intensity of the subjects' pain. RESULTS: Each of 3 groups as 30, total 90 patients included in study (62 male, 28 female, mean age 41,6 years). Groups were similar by gender, age, PLB indications, HADS scores prior to PLB (5, 4 and 4,respectively, p:0.735), and VAS score during PLB (4.5, 3, 4,respectively p:0.567). In 3 groups 7,12 and 7 patients (respectively) explained no pain (p:0.412). Other patients explained pain as mild or moderate 63%, 40%, and 66% (respectively, p:0.412). Mean length of liver specimen achieved with PLB was 23±9 mm, and pain level didn't related with (p:0.835). 80/90 patients (88.8%) defined PLB as easy, with all groups similar. PLB defined as uneasy by 20%, 6.7%, and 6.6% patients respectively; there was numeric but not stastical difference (p:0.256). There was difference between P group and other two about the attitude for re-biopsy. Patients agreeing rebiopsy without doubt were 33%,53% and 50% (p,0.035) while anxious about 50%, 30% and 33% (p,0.035) respectively. Patients refusing re-biopsy were 13.3% in P, 6.7% in Me and none in Mi groups. CONCLUSION: Premedication with Me or Mi in PLB would improve tolerance, comfort and attitude against a new PLB, and there is no increased risk related to these agents.

ORAL DOSAGES FORM: MEDICINE CONTAINING CHEWIMG GUM: A REVIEW

Chewing gums are mobile drug delivery systems. It is a potentially useful means of administering drugs either locally or systemically via, the oral cavity. Several ingredients are now incorporated in medicated chewing gum, e.g. Fluoride for prophylaxis of dental caries, chlorhexidine as local disinfectant, nicotine for smoking cessation, aspirin as an analgesic, and caffeine as a stay alert preparation. It was concluded that chewing gum is an excellent drug delivery system for self-medication as it is convenient and can be administered directly without water and they contain one or more active substances which are released by chewing and are intended to be used for local treatment of mouth diseases or systemic delivery after absorption through the buccal mucosa. Key-words : Medicated Chewing Gum, Mouth Diseases, Oral Drug Delivery System.

Local disinfection of microorganism through torch‐type atmospheric pressure plasma

Torch‐type atmospheric pressure plasma with two ring‐type copper electrodes has been analyzed to investigate the characteristics of plasma plume and local sterilizing effect on microorganisms. The concentration of ozone as an active oxygen species in plasma plume was varied with the level of applied voltage and the proportion of gasses in a mixture composed of helium and oxygen. The temperature of the plasma flume could be increased to 38 °C as a maximum temperature under an exposure time of 10 min, which suggests that the plasma plume can be directed manually by a user to come in contact with delicate objects and materials without causing any heating or painful feeling. An advantage of the plasma is that it is controllable at low temperatures with high stability. Sterilization for E. coli was strongly affected by the applied voltage, the oxygen ratio in the gas mixture of He/O2, and the treatment time. Reactive oxygen species, including atomic oxygen and ozone, which are generated by the plasma plume, play an important role in the bacteria inactivation processes. Our plasma can be used successfully to sterilize E. coli for biomedical applications. Copyright © 2012 John Wiley &amp; Sons, Ltd.

Bloc percutané du nerf mandibulaire à travers l’échancrure sigmoïdienne, guidé par neurostimulation, en chirurgie de la face

Mandibular nerve block is a simple and effective but rarely used technique. It decreases peri-operative pain in mandibular osteotomy. It improves surgical field visibility by decreasing bleeding. Mandibular nerve block allows cutaneous surgery without general anesthesia and is one of the alternative treatments for chronic facial pain.The mandibular nerve is located using a needle connected to a neurostimulator. After local disinfection, a neurostimulation needle is inserted below the zygomatic arch, between the coronoid apophysis in front, and the condyle process in back, with a 45 to 60° angle. The needle is pushed to a 40 mm depth. Masticator muscle contraction confirms mandibular nerve stimulation. After a careful negative aspiration, 5 mL of ropivacaine 0.5% are injected slowly, and in increments.The complications with this technique, such as failure or arterial puncture, are rare and limited if a nerve stimulator is used. Patient's comfort is improved by intravenous remifentanil sedation in target control infusion mode, associated to prior use of prilocaine and lidocaine cutaneous cream.

Discharge Properties of Torch-Type Atmospheric Pressure Plasma and its Local Disinfection of Microorganism

not Available.

Aerobic vaginitis in pregnancy

Aerobic vaginitis (AV) is an alteration in vaginal bacterial flora that differs from bacterial vaginosis (BV). AV is characterised by an abnormal vaginal microflora accompanied by an increased localised inflammatory reaction and immune response, as opposed to the suppressed immune response that is characteristic of BV. Given the increased local production of interleukin (IL)-1, IL-6 and IL-8 associated with AV during pregnancy, not surprisingly AV is associated with an increased risk of preterm delivery, chorioamnionitis and funisitis of the fetus. There is no consensus on the optimal treatment for AV in pregnant or non-pregnant women, but a broader spectrum drug such as clindamycin is preferred above metronidazole to prevent infection-related preterm birth. The exact role of AV in pregnancy, the potential benefit of screening, and the use of newer local antibiotics, disinfectants, probiotics and immune modulators need further study.