Dermatology

doi: 10.1159/000246023pmid: N/A

MacLellan, D.G.

doi: 10.1159/000246021pmid: 9490124

Fleischer, W.; Reimer, K.

doi: 10.1159/000246022pmid: 9403248

The natural element iodine has been used for more than 150 years to prevent infection and treat wounds. Yet only due to the development of iodophors has it become possible to use this highly efficient microbicide in a wide range of medical applications. The antimicrobial spectrum is universal. Its efficiency against clinically and epidemiologically significant new pathogens, such as mefhicillin-resistant Staphylococcus aureus and Enterυcoccus sp. has also been validated. No development of resistance has been determined. New data are also available on the excellent local tolerability of Betaisodona® (povidone-iodine) preparations. On these grounds, a number of clinical fields exist in prophylaxis and therapy, for either once only or repeated applications: the disinfection of hands and skin, mucosa antisepsis, intra- and postoperative wound treatment, therapy of skin infections, burns and chronic wounds.

Lanker Klossner, B.; Widmer, H.-R.; Frey, F.

doi: 10.1159/000246024pmid: 9403249

Since the bacterial ability to develop resistance against various factors of their surroundings is a well-known phenomenon, resistance against iodine and specifically against povidone-iodine (PVP-I) has been widely investigated. Yet there is little known about bacterial resistance in long-term daily use of disinfectants in continuous ambulatory peritoneal dialysis (CAPD) patients. The aim of our study was to investigate whether on daily use of PVP-I over a period of at least 6 months coagulase-negative staphylococci (CNS) – the predominant infective organisms of peritonitis – developed resistance against PVP-I. At the catheter exit site of 40 CAPD patients we isolated 36 CNS. 23 CNS (CNS + PVP) orginate from patients using PVP-I, 13 CNS (CNS + Cl) from patients using sodium hypochlorite (NaOC1) as disinfectant. The strains were biotyped, antibiotic resistance patterns were determined and resistance against PVP-I or NaOC1 was calculated as reduction factor using the quantitative suspension test combined with a turbidimetric standardization. Resistance against PVP-I 0.01% and against NaOC1 0.005% was determined at two contact times (30 and 300 s) for each patient group. In addition, we investigated the effects of plasmid loss on sensitivity to PVP-I. Out of 5 multiple-antibiotic-resistant CNS, 3 strains showed no difference in reduction factor against PVP-I before and after curing. There was no significant difference in reduction factor against NaOC1. CNS + PVP were even significantly more sensitive to PVP-I than CNS + C1. Taken together, our results demonstrate that long-term use of PVP-I does not cause any bacterial resistance in CNS of CAPD patients.

Kunisada, T.; Yamada, K.; Oda, S.; Hara, O.

doi: 10.1159/000246025pmid: 9403250

The bactericidal activity of commonly used antiseptics against clinical isolates was determined. It is noteworthy that povidone-iodine (PVP-I) solution showed high bactericidal activity against all of the test strains after 30 s of exposure. However, in the case of chlorhexidine gluconate (CHG), residual bacteria were observed in most species. Next, acquisition of resistance to antiseptics was examined, and it was found that remarkable increases in MICs were seen for CHG and alkyldiaminoethylglycine hydrochloride. The strains which acquired resistance against one antiseptic showed cross-resistance to all antiseptics except for PVP-I. As for bactericidal activity against biofilm, no viable cells were seen after a 10-min exposure to PVP-I solution. No decrease in viable cell count was seen even after a 60-min exposure to any of the other antiseptics. PVP-I showed high activities in all the tests conducted in this study. Thus, PVP-I was confirmed to be a clinically useful antiseptic.

Yasuda, T.; Yoshimura, Y.; Takada, H.; Kawaguchi, S.; Ito, M.; Yamazaki, F.; Iriyama, J.; Ishigo, S.; Asano, Y.

doi: 10.1159/000246026pmid: 9403251

Opportunistic infections caused by gram-negative rods (GNR), conventionally regarded as organisms with low or no pathogenicity, and intractable infections caused by various resistant organisms pose a great problem now. In view of this, we determined the bactericidal effects of 5 commonly used disinfectants using as the test strains Xanthomonas maltophilia and Serratia marcescens, chosen among other GNR since they often cause nosocomial infections. Regarding the bactericidal activities against X. maltophilia and S. marcescens, both sensitive strains and resistant strains were killed within 20 s of exposure to povidone-iodine and sodium hypochlorite. With chlorhexidine, 1 strain each of both species was not killed within 10 min of exposure at a concentration of 0.2%. Both sensitive strains and resistant strains of X. maltophilia were killed within 20 s of exposure to benzalkonium at 0.02%, while a concentration of 0.1% was required for benzalkonium to kill S. marcescens within 20 s. With Tego-51, both sensitive strains and resistant strains of X. maltophilia were killed within 20 s at 0.02%, while 1 strain of S. marcescens was not killed within 20 s at a concentration of 0.1%. In the use of disinfectants, comparative bactericidal effects of various disinfectants against clinical isolates should be taken into consideration.

Kawana, R.; Kitamura, T.; Nakagomi, O.; Matsumoto, I.; Arita, M.; Yoshihara, N.; Yanagi, K.; Yamada, A.; Morita, O.; Yoshida, Y.; Furuya, Y.; Chiba, S.

doi: 10.1159/000246027pmid: 9403252

Inactivation of a range of viruses, such as adeno-, mumps, rota-, polio- (types 1 and 3), coxsackie-, rhino-, herpes simplex, rubella, measles, influenza and human immunodeficiency viruses, by povidone-iodine (PVP-I) and other commercially available antiseptics in Japan was studied in accordance with the standardized protocol in vitro. In these experiments, antiseptics such as PVP-I solution, PVP-I gargle, PVP-I cream, chlorhexidine gluconate, alkyldiamino-ethyl-glycine hydrochloride, benzalkonium chloride (BAC) and benzethonium chloride (BEC) were used. PVP-I was effective against all the virus species tested. PVP-I drug products, which were examined in these experiments, inactivated all the viruses within a short period of time. Rubella, measles, mumps viruses and HIV were sensitive to all of the antiseptics, and rotavirus was inactivated by BAC and BEC, while adeno-, polio- and rhinoviruses did not respond to the other antiseptics. PVP-I had a wider virucidal spectrum, covering both enveloped and nonenveloped viruses, than the other commercially available antiseptics.

Michel, D.; Zäch, G.A.

doi: 10.1159/000246028pmid: 9403253

In pressure sore wounds after spinal cord injury, methicillin-resistant Staphylococcus aureus can be detected in 2% of the cases. The elimination of the germ is the aim of the treatment. Pressure sore wounds are an often found complication after spinal cord injury. For local treatment five commercially available antiseptics for the skin and mucous membrane were tested in vitro. The method used is a modified qualitative and quantitative suspension test. The antiseptics were tested without and with addition of 5% albumin in order to simulate the conditions of the wound in vivo. The results show a superior efficacy of the povidone-iodine preparations. Betadine®, probably due to the higher concentration, is more efficacious than Braunol®; chlorhexidine is sufficiently efficacious without the addition of albumin. These results still have to be confirmed by in vivo studies.

König, B.; Reimer, K.; Fleischer, W.; König, W.

doi: 10.1159/000246029pmid: 9403254

The numbers of patients in intensive care units, with immunosuppression, and of elderly people increase in parallel with antibiotic-resistant microorganisms. Therefore the demand for an effective antisepsis increases. Moreover, it became evident that the pathophysiology and the outcome of infection are dependent on the properties of the microorganisms, e.g. synthesis of endo- and exotoxins, and on the host defense, the immune system. In addition to the microbicidal action, we studied the effects of povidone-iodine (PVP-I, Betaisodona®) on the generation, release and activity of exotoxins (α-hemolysin, phospholipase C, lipase), as well as on granulocyte-derived tissue-destructive enzymes (elastase, β-glucuronidase) and microbial-induced cytokine generation from human neutrophils. Our results clearly show that PVP-I does not only kill a wide range of bacteria but also inhibits the generation and release of bacterial exotoxins; furthermore, it also inactivates bacterial exotoxins as well as granulocyte-derived tissue-destructive enzymes and cytokines. These data support the usefulness and efficacy of PVP-I as an effective therapeutic agent to combat infection.

van der Merwe, A.E.

doi: 10.1159/000246030pmid: 9403255

The management of burns has shown substantial progress over the years. The application of an effective topical agent improves the healing rate of burns. Betadine cream and ointment have been used in all the burn admissions since 1986. The data collected over 10 years are analysed in this report. All the burn patients admitted were evaluated and the factors investigated included patient age, sex, cause of injury, extent of burn wound, length of hospital stay, bacteriology, multi-organ failure and mortality. A total of 6,056 patients were admitted to a 40-bed unit during the 10-year period. Sixty-two percent were adults and 37% children. There were 67.5% males and 32.5% females. Eighty-one percent were admitted directly to the unit. Intensive/high care admissions accounted for 19.2% patients. The major cause of injury was accidental scalding in 34.2% patients, and the majority (65.4%) stayed between 1 and 4 weeks in hospital. There were 452 deaths. This audit reviewing 6,056 sequential burn cases represents a 10-year experience of burn management, using Betadine cream and ointment as topical agent.