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Ionic and non-ionic intravenous X-ray contrast media: antibacterial agents?
Frank Mosler1, Johannes K Richter1, Marc Schindewolf2
1Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Abstract:
X-ray contrast media have been reported to have inhibitory effects on bacterial growth. Despite its potentially beneficial effect on patients, these features of contrast media have received relatively little attention in the medical literature in the past decades. The aim of this review is to evaluate the literature concerning the bactericidal and bacteriostatic effects of X-ray contrast media, specifically if there is a known difference concerning these effects between ionic and non-ionic contrast media. Systematic literature review was performed for the years of publication between 1911 and 2019. Since the publication of Grossich in 1911, the effect of iodine on the treatment of superficial infections in surgical procedures has been established clinical knowledge. Bacteriostatic and bactericidal effects of ionic X-ray contrast media are well established. However, non-ionic contrast agents have been the subject of little research in this respect. In past decades, the hypothesis emerged in the literature that mainly the concentration of free iodine might be responsible for any bacteriostatic or bactericidal effect of ionic X-ray contrast media. Nowadays, however, only non-ionic contrast media are used. The question regarding the mechanism and magnitude of bacteriostatic or bactericidal effects of these, non-ionic contrast media, could not be answered conclusively from this review. Non-ionic contrast media could be used intentionally when a local antibacterial effect is intended (e.g. in percutaneous abscess drainage), as well as to reduce the overall dose of antibiotics administered to a patient. Thus, this question remains relevant and might constitute the area of future research.
Insights
X-ray contrast media exhibit antibacterial properties, with ionic agents showing established effects. Research on non-ionic agents, now predominantly used, is limited, leaving their antibacterial mechanisms and efficacy for future study.
Area of Science:
- Radiology and Microbiology
- Pharmacology of Diagnostic Agents
Background:
- X-ray contrast media have demonstrated inhibitory effects on bacterial growth, a feature historically overlooked.
- Ionic contrast media possess well-documented bacteriostatic and bactericidal properties, often attributed to free iodine content.
- Current clinical practice predominantly utilizes non-ionic contrast media, with less research on their antimicrobial effects.
Purpose of the Study:
- To review existing literature on the antibacterial (bactericidal and bacteriostatic) effects of X-ray contrast media.
- To investigate potential differences in these effects between ionic and non-ionic contrast media.
- To assess the current understanding of non-ionic contrast media's antimicrobial potential.
Main Methods:
- Systematic literature review of studies published between 1911 and 2019.
- Analysis of historical and contemporary research on contrast media and bacterial inhibition.
- Evaluation of evidence regarding the role of iodine concentration in antimicrobial effects.
Main Results:
- Bacteriostatic and bactericidal effects are established for ionic X-ray contrast media.
- Limited research exists on the antibacterial properties of non-ionic contrast media.
- The precise mechanism and magnitude of antibacterial effects for non-ionic agents remain inconclusive.
Conclusions:
- Non-ionic contrast media, despite limited research, may have potential applications for local antibacterial effects, e.g., in abscess drainage.
- Their use could potentially reduce the need for systemic antibiotics.
- Further research is warranted to elucidate the antibacterial mechanisms and clinical utility of non-ionic contrast media.
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