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[Pleural washing with povidone-iodine for treatment of empyema]
K Takayama1, M Hirata, S Nabeshima
1Research Institute for Diseases of the Chest, Faculty of Medicine, Kyushu University.
Abstract:
In this paper, we report two successful cases of empyema treated by pleural washing with povidone-iodine solution. In these two cases, empyema was caused by secondary infection of multi-drug resistant Pseudomonas aeruginosa. First, we replaced intrathoracic drainage tube and washed intrathoracic space with 500-1000 ml saline containing antibiotics (tobramycin, aztreonam) every 8 hours for 10-14 days. But, cultural studies of pleural effusion were positive even after this treatment. So, we tried pleural washing with warm povidone-iodine solution 1:20 diluted with saline every 8 hours. Surprisingly, after 3 days treatment, cultural studies of the pleural effusion became negative. This pleural washing method with povidone-iodine was very effective for treatment of empyema patients.
Insights
This study presents a novel treatment for empyema using povidone-iodine pleural washing. This method effectively cleared multi-drug resistant Pseudomonas aeruginosa infections when antibiotics failed.
Area of Science:
- Medicine
- Infectious Diseases
- Pulmonology
Background:
- Empyema, a serious infection of the pleural space, often involves challenging pathogens.
- Multi-drug resistant Pseudomonas aeruginosa poses a significant treatment hurdle in empyema cases.
Observation:
- Standard antibiotic treatment via intrathoracic lavage proved insufficient for empyema caused by Pseudomonas aeruginosa.
- Persistent positive cultures indicated the need for an alternative therapeutic approach.
Findings:
- Pleural washing with a warm povidone-iodine solution (1:20 dilution) demonstrated remarkable efficacy.
- Infected pleural effusions became culture-negative within three days of povidone-iodine treatment.
Implications:
- Povidone-iodine pleural lavage offers a promising, effective strategy for treating refractory empyema.
- This approach may be particularly valuable for infections caused by multi-drug resistant bacteria.