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A reappraisal of the use of antiseptics in surgical practice
Abstract:
The use of antiseptics was reappraised because of the increasing problem of antibiotic-resistant bacteria. A formaldehyde (noxythiolin) and a halogen (povidone-iodine) were investigated, these being the most appropriate antiseptic groups. Povidone-iodine solution significantly reduced the mortality of mice (P less than 0.01) and rats (P less than 0.01) with peritonitis. Noxythiolin (1% and 0.5%) did not. Antiseptic irrigation of the rat colon before and after anastomosis resulted in significantly fewer 'poor' anastomoses (P less than 0.05) without inhibiting healing. Noxythiolin 2.5% and 1% significantly reduced peritoneal adhesion formation in rats, but a newly formulated povidone-iodine solution with increased polyvinylpyrrolidone content was superior to noxythiolin 1% and 0.5%. Povidone-iodine neither inhibited rat abdominal wound healing nor induced bacterial resistance. In 3 subsequent controlled clinical trials a dry-powder povidone-iodine formulation halved wound infection after grid-iron appendicectomy (P less than 0.025), reduced infection in elective 'clean' surgery, and significantly reduced infection after a wide variety of 'potentially contaminated' abdominal procedures (P less than 0.01). A return to the principles of Lister is advocated.
Insights
Povidone-iodine effectively combats infections and reduces surgical complications, offering a viable alternative to antibiotics. This study highlights its benefits in peritonitis, wound healing, and clinical trials, advocating for its broader use.
Area of Science:
- Microbiology
- Surgical Innovation
- Infectious Disease Management
Background:
- Rising antibiotic resistance necessitates exploring alternative antimicrobial strategies.
- Antiseptics are being reappraised for their potential in combating resistant bacteria.
- Formaldehyde (noxythiolin) and halogen (povidone-iodine) represent key antiseptic classes for investigation.
Purpose of the Study:
- To evaluate the efficacy of noxythiolin and povidone-iodine in managing infections and surgical complications.
- To assess the impact of these antiseptics on peritonitis, anastomotic healing, and peritoneal adhesion formation.
- To determine the clinical effectiveness of povidone-iodine in preventing surgical site infections.
Main Methods:
- In vivo studies using mice and rats to assess mortality, anastomotic integrity, and adhesion formation.
- Evaluation of antiseptic irrigation protocols for colon anastomosis.
- Controlled clinical trials investigating a dry-powder povidone-iodine formulation in various surgical procedures.
Main Results:
- Povidone-iodine significantly reduced mortality in peritonitis models (P<0.01).
- Antiseptic irrigation improved anastomotic quality (P<0.05); povidone-iodine outperformed noxythiolin in reducing peritoneal adhesions.
- Clinical trials showed povidone-iodine halved wound infections post-appendicectomy (P<0.025) and reduced infections in clean and potentially contaminated surgeries (P<0.01).
Conclusions:
- Povidone-iodine demonstrates significant efficacy in reducing mortality, improving surgical outcomes, and preventing infections.
- Noxythiolin showed limited benefits in peritonitis but reduced adhesions at higher concentrations.
- The study advocates for a return to antiseptic principles, particularly povidone-iodine, in light of antibiotic resistance.