Search Results (118)

Background/Objectives: Infectious endophthalmitis is a vision-threatening complication of intraocular surgery and intravitreal injections. Standard treatment involves intravitreal antibiotics; however, concerns regarding multidrug resistance and vancomycin-associated hemorrhagic occlusive retinal vasculitis (HORV) highlight the need for alternative antimicrobial strategies. This study aimed to evaluate the clinical efficacy and safety of a protocol combining intravitreal injection of 1.25% povidone-iodine (PI) with intraoperative irrigation using low concentrations of vancomycin and ceftazidime. Methods: We retrospectively analyzed 11 eyes from patients diagnosed with postoperative or injection-related endophthalmitis. Six of the eleven cases received an initial intravitreal injection of 1.25% PI, followed by pars plana vitrectomy with irrigation using balanced salt solution PLUS containing vancomycin (20 μg/mL) and ceftazidime (40 μg/mL). A second intravitreal PI injection was administered at the end of surgery in all cases. Additional PI injections were administered postoperatively based on clinical response. Clinical outcomes included best-corrected visual acuity (BCVA), microbial culture results, corneal endothelial cell density, and visual field testing. Results: All eyes achieved complete infection resolution without recurrence. The mean BCVA improved significantly from 2.18 logMAR at baseline to 0.296 logMAR at final follow-up (p < 0.001). No adverse events were observed on specular microscopy or visual field assessment. The protocol was well tolerated, and repeated PI injections showed no signs of ocular toxicity. Conclusions: This combination protocol provides a safe and effective treatment strategy for infectious endophthalmitis. It enables rapid and complete infection resolution while minimizing the risks associated with intravitreal antibiotics. These findings support further investigation of this protocol as a practical and globally accessible alternative to standard intravitreal antimicrobial therapy. Full article

Povidone-iodine (PVP-I), a widely used aquaculture disinfectant, remains poorly understood in terms of sublethal toxicity and damage reversibility. This study employed Macrobrachium rosenbergii as the model organism to evaluate the acute toxicity and sublethal effects of PVP-I through a 4-day exposure experiment followed by a 7-day depuration period. Acute toxicity tests enabled the determination of 24–96 h median lethal concentrations (LC₅₀), with the 96 h LC₅₀ being 5.67 mg/L and the safe concentration (SC) being 1.37 mg/L. Based on this, three sublethal concentrations (1.14, 1.89, and 2.84 mg/L) were tested over a 4-day exposure followed by a 7-day depuration period. Investigated endpoints included gill ultrastructure, apoptosis, and antioxidant and immune-related gene expression. Subacute exposure at 1.89 and 2.84 mg/L induced mitochondrial vacuolization, upregulated apoptosis-related genes (Cyt-c, Caspase-3, Bok), and downregulated antioxidant gene expression (SOD, CAT, GSH-Px). The high-concentration group also showed sustained Toll-like receptor (Toll) gene overexpression and acid phosphatase (ACP) gene suppression. After depuration, antioxidant gene expression normalized; however, apoptotic markers in gill tissue remained impaired. Overall, high PVP-I concentrations cause irreversible gill damage via mitochondrial-mediated apoptosis, whereas lower concentrations (≤1.14 mg/L) allow for greater recovery. These results offer crucial toxicodynamic insights for safer PVP-I use and risk assessment in M. rosenbergii aquaculture. Full article

Viral conjunctivitis is a highly contagious ocular condition that significantly impacts patient quality of life and healthcare resources. Despite its self-limiting nature, the condition remains a significant public health concern due to its high transmissibility, prolonged symptoms, and potential complications such as subepithelial infiltrates (SEIs). This review aimed to synthesize and evaluate current management strategies for adenoviral conjunctivitis and provide an evidence-based treatment framework. A systematic literature search of PubMed and the Cochrane Library was conducted, identifying 25 eligible studies published between 2009 and 2024 that focused on clinical interventions including supportive care, antiseptics, corticosteroids, antivirals, and immune modulators. The findings indicate that while supportive therapy and hygiene measures remain central to care, antiseptic agents, specifically povidone–iodine, and topical steroids offer additional benefit in reducing symptom duration and complications. Combination therapies integrating antiseptics, corticosteroids, and immunomodulators show promise for more severe cases, especially those complicated by SEIs. This review proposes an evidence-based comprehensive, multimodal approach management algorithm while highlighting the need for future research in antiviral development and diagnostic innovation to avoid mistreatment and unnecessary antibiotic use. Full article

Surgical site infections (SSIs) and prosthetic joint infections (PJIs) remain significant challenges in orthopedic surgery, particularly in joint arthroplasty. Intraoperative irrigation is a widely used strategy for infection prevention, yet traditional solutions such as saline, povidone-iodine, hydrogen peroxide, and sodium hypochlorite are limited by cytotoxicity, short antimicrobial duration, and poor biofilm penetration. This review evaluates commonly used irrigation agents and highlights the growing evidence supporting a novel citrate-based solution as a potentially superior alternative. These agents combine broad-spectrum antimicrobial activity, effective biofilm disruption through ionic chelation, and prolonged postoperative protection with minimal harm to host tissues. Early clinical studies and ongoing randomized trials have demonstrated promising results, including reductions in postoperative swelling, opioid use, and infection rates. As more data become available, citrate-based solutions may emerge as the preferred standard for intraoperative irrigation in orthopedic procedures. Full article

Staphylococcus aureus is a mastitis pathogen that compromises cow health and causes significant economic losses in the dairy industry. High antimicrobial resistance and biofilm formation by S. aureus limit the efficacy of conventional treatments. This study evaluated the potential of polyhexamethylene biguanide nanoparticles (PHMB NPs) against mastitis-causing S. aureus. PHMB NPs showed low toxicity to bovine mammary epithelial cells (MAC-T cells) at concentrations up to four times higher than the minimum inhibitory concentration (1 µg/mL) against S. aureus. In Experiment 1, PHMB NPs significantly reduced biofilm formation by S. aureus by 50% at concentrations ≥1 µg/mL, though they showed limited efficacy against preformed biofilms. In Experiment 2, using an excised teat model, PHMB NPs reduced S. aureus concentrations by 37.57% compared to conventional disinfectants (chlorhexidine gluconate, povidone–iodine, and sodium dichloroisocyanurate), though limited by short contact time. These findings highlight the potential of PHMB NPs for the control of S. aureus growth and biofilm formation. Full article

The only biocidal iodine species in topical iodine disinfectants is molecular iodine (I2). I2, a biomolecule, has broad-spectrum antimicrobial activity and does not generate resistance. Physicians, regulatory agencies, and scientists have assumed that I2 is responsible for the skin staining and irritation associated with the clinical use of iodine disinfectants; this assumption is deeply embedded in the medical community but is not supported with empirical data. This study provides the first experimental data that measure the biocompatibility of I2 with human skin. Human skin explants in tissue culture were evaluated at 3, 7, and 24 h after being exposed to I2 (500 to 15,000 ppm). Cell viability was measured relative to phosphate-buffered saline using 3-[4,5-dimethylthiazol-2yl]-2,5-diphenyl-tetrazolium bromide (MTT). The biocidal activity of I2 vapor emitted from silicone was demonstrated against bacteria growing on agar to confirm I2 off-gassing from skin was an active biocide. Additionally, statistically significant bacterial reductions with both gas and solution phase I2 were observed in a static and dynamic five-species wound biofilm. The data suggest that high, e.g., 50–5000 ppm, levels of I2 should be incorporated into topical iodine disinfectants instead of the very low (0.2–10 ppm) levels found in 10% povidone iodine products currently in use. Full article

Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA), poses significant challenges in healthcare settings due to its ability to form biofilms on various surfaces. These biofilms enhance bacterial survival and increase resistance to conventional treatments, complicating infection control efforts. This study evaluated the efficacy of combined povidone-iodine (PVP-I) and hydrogen peroxide (H₂O₂) to disrupt pre-formed S. aureus biofilms. A series of assays—including crystal violet staining, colony-forming unit (CFU) enumeration, gene expression analysis, and confocal laser scanning microscopy—were performed to assess the effects of each treatment individually and in combination. The combined treatment resulted in significantly greater reductions in biofilm biomass and viable bacteria compared with either agent alone. Gene expression analysis revealed downregulation of key biofilm-associated genes (icaA, icaB, icaD, icaR, and clfA), suggesting interference with biofilm stability and maintenance. While formal synergy quantification was not conducted, the observed effects suggest a potentially synergistic or additive interaction between the two agents. These findings support the use of dual antiseptic strategies as a promising approach to biofilm eradication and highlight the potential clinical utility of dual antiseptic strategies. However, we underscore the need for further optimization and safety evaluation. Full article

Spontaneous cell detachment describes an effect in which eukaryotic cells first sediment onto a heated chip and then detach from it spontaneously and collectively after a sharply defined dwell time t_d. This behavior is triggered by the temperature gradient between the chip and the colder supernatant liquid. Notably, t_d allows distinguishing between different yeast strains and cancer-cell lines. At the same time, it also varies in the presence of nutrients and cytotoxins, suggesting an added value of this method for pharmacological studies. In the present work, we study the role of fluid convection on the detachment of yeast cells experimentally and by simulations using a sample compartment with a variable aspect ratio. Hereby, we found that the absolute chip temperature, the strength of the temperature gradient and the number of cells inside the sample compartment all affect the dwell time t_d. To demonstrate the concept, we show that the spontaneous-detachment method can measure the impact of an antibiotic and an antiseptic drug on yeast cultures and corroborate this with reference assays. Full article

Episiotomy is a common obstetric intervention aimed at facilitating childbirth and reducing severe perineal trauma. Lactic acid, a naturally occurring alpha-hydroxy acid (AHA), has emerged as a promising alternative to conventional wound-care methods due to its antimicrobial, anti-inflammatory, and regenerative properties. Objective: This systematic review evaluates the effectiveness of lactic acid in episiotomy wound healing compared to conventional wound-care methods, focusing on healing time, infection rates, and patient-reported outcomes. Methods: A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus using the keywords “lactic acid”, “episiotomy wound healing”, “perineal wound care”, and “infection prevention”. Inclusion criteria covered randomized controlled trials (RCTs), observational studies, and systematic reviews. The Cochrane Risk of Bias 2 (RoB 2) tool and the Newcastle–Ottawa Scale were used for quality assessment. Results: Eight studies met the inclusion criteria. Lactic acid-treated wounds demonstrated 30% faster healing rates, 50% lower infection rates, and reduced pain scores compared with standard wound-care methods (e.g., povidone-iodine or saline). A meta-analysis of five RCTs found a significant reduction in post-episiotomy infections (RR = 0.68, 95% CI: 0.52–0.85). Conclusions: Lactic acid shows promise in episiotomy wound care by improving healing outcomes and reducing infection and discomfort. However, further large-scale RCTs are needed to confirm its safety and long-term efficacy. Full article

Background: Interventional physiatry is a branch of medicine that uses minimally invasive ultrasound-guided techniques for diagnosis and treatment in the musculoskeletal system. The aim of this scoping review is to investigate the sterilisation techniques used and the rate of infection with ultrasound-guided injections. Methods: PubMed was searched up to 30 September 2024 using the following search terms (“Ultrasound, Interventional”[mesh]) AND “Injections, Intra-Articular”[mesh]; “Ultrasound-guided intra-articular injection”. The inclusion criteria were randomised clinical trials, written in English, involving US-guided mini-invaexercissive procedures. Results: The search identified a total of 256 potentially relevant publications. After screening for duplication, inclusion, and exclusion criteria, 105 articles were eligible for data extraction. In 51 studies, the method of skin disinfection was not specified, 18 RCT reported a ’sterile condition’, 9 studies used povidone–iodine solution, 5 used alcohol, and 2 used chlorhexidine 0.5%. In 64 trials, the method of probe preparation was not specified, 11 trials described the use of sterile gel, 10 trials reported the use of a probe cover, sterile pad, or barrier, and 2 trials reported the use of chlorhexidine 0.5%; 41 studies reported mild adverse events and 4 serious adverse events. Conclusions: Taken together, the findings of this scoping review did not show a clear relationship between current sterilisation protocols and the prevention of the microbial contamination of the probes or the patient’s skin. The variation in protocols highlights the need for standardised guidelines and more rigorous studies to accurately determine the most effective disinfection practices. Full article

Background: Chemical debridement with an irrigating solution associated with surgical debridement has proven to be useful in the treatment of periprosthetic joint infection (PJI). The aim of the study was to perform a systematic review and meta-analysis of the current literature regarding the efficacy of different irrigation solutions on bacterial biofilm. Methods: This study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Network Meta-Analysis (PRISMA-NM) checklist. A Network Meta-Analysis was performed to analyze which irrigation solution achieved a greater reduction in colony-forming units (CFU) after specific exposure times in vitro. Effect size was measured using the log ratio of means (logRoM) and 95% confidence intervals (95% CI). The rank probability for each treatment was calculated using P-values. Results: After discarding duplicates, screening, and reviewing the full texts, four studies with 10 irrigation solutions for different exposure durations were included. The solutions were studied on mature biofilms of the most frequent bacteria. The greatest effect was achieved with 10% povidone–iodine for 5 min (est.: −12.02; 95% CI: −14.04, −9.99). The best-ranked solutions were 10% povidone–iodine for 5, 3, and 1 min (respective p-values: 0.977, 0.932, 0.887), and its combination with hydrogen peroxide for 3 min (p-score: 0.836). Povidone–iodine 0.3% for 5 min completed the top five ranked solutions in this study (p-score: 0.761). Conclusions: Our results show that 10% povidone–iodine is the best antiseptic solution when studied in vitro in the context of prosthetic joint infection. Further research in these areas is necessary to determine whether these results are reproducible with in vivo situations. Full article

Background: Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. A skin antiseptic solution is used to reduce the bacterial count and prevent PJI. There is no consensus in the literature on the application of antiseptic solutions. This study aims to compare the rate of infection between patients who received alcohol wash with Chloraprep to those who received povidone iodine wash with Chloraprep. Methods: A total of 607 patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a single institution between January 2009 and July 2023 were reviewed. Perioperative variables were collected. The infection rate was used as a primary outcome. An odds ratio was calculated to compare infection and complication rates between the groups. Results: For patients who underwent THA, no difference in the rate of complications (alcohol wash: n = 6, 4.5%; povidone wash: n = 5, 3.6%; OR: 0.796; 95% CI: 0.237–2.673) or infection (alcohol wash: n = 1, 0.7%; povidone wash: n = 2, 1.4%; OR: 1.942; 95% CI: 0.174–21.667) was found. No difference in the rate of complications (alcohol wash: n = 3, 1.9%; povidone wash: n = 2, 1.2%; OR: 0.635; 95% CI: 0.105–3.849) or infection (alcohol wash: n = 0; povidone wash: n = 1, 0.6%; OR: 0.994; 95% CI: 0.983–1.006) was found in patients who underwent TKA. Conclusions: Surgical site preparation using alcohol wash with chlorhexidine offers similar short-term benefits in preventing postoperative infection to a povidone iodine wash with chlorhexidine in primary total joint arthroplasty. The use of alcohol wash and chlorhexidine is effective, while reducing the preparation time. Full article

This review provides an overview of recent research and advancements in infection prevention and the treatment of drug-resistant bacterial diseases. Cefiderocol, a novel siderophore cephalosporin, has demonstrated effectiveness against carbapenem-resistant bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. Clinical trials, including APEKS-NP and CREDIBLE-CR, affirm its efficacy for hospital-acquired pneumonia (HAP) but highlight concerns over increased mortality due to severe renal complications. Cefiderocol has shown superior outcomes in complicated urinary tract infections (cUTI) compared to imipenem–cilastatin. A comparison of colistin monotherapy versus combination therapy with meropenem for carbapenem-resistant infections revealed no significant improvement in clinical outcomes with combination therapy but noted delays in resistance development. Colistin–rifampicin combination therapy showed potential benefits for colistin-resistant Acinetobacter baumannii, although results were not statistically significant. SPR206, a polymyxin derivative, and durlobactam, a β-lactamase inhibitor, show promise in addressing these resistant strains, with durlobactam demonstrating efficacy in combination with sulbactam and imipenem–cilastatin. Additional studies investigated antibiotic strategies for resistant infections, including cefoperazone–sulbactam versus combination therapy with tigecycline, and examined infection-prevention strategies in surgical settings, comparing chlorhexidine–alcohol and povidone–iodine. This research highlights the importance of optimizing treatment regimens and infection-control measures across various healthcare settings, including neonatology and surgical care. Full article

Classical preoperative skin antisepsis is insufficient in completely eliminating bacterial skin colonization for arthroplasty. In contrast, photodynamic therapy (PDT) with red light and methyl-aminolevulinate (MAL), combined with skin antisepsis, led to the absence of bacterial growth in healthy participants, though with local skin erythema, posing an obstacle for orthopedic surgery. Therefore, we explored whether artificial daylight PDT (PDT-DL) was superior to red light. Twenty healthy participants were allocated to either 5-aminolevulinic acid-(5-ALA) PDT-DL (n = 10) or MAL-PDT-DL (n = 10) before antisepsis with povidone-iodine/alcohol. Skin swabs from the groin were taken to cultivate bacteria at baseline, after PDT-DL, and after the subsequent antisepsis. Additional swabs were taken on day 4 before and after antisepsis without PDT. The contralateral groin of each participant and of ten additional healthy volunteers served as the control (n = 30). In selected participants, 16S rRNA-based amplicon deep sequencing was performed. All participants showed a baseline bacterial colonization. After a PDT-DL with skin antisepsis, bacterial growth occurred in three (30%) and in one (10%) participants with 5-ALA and MAL, respectively, compared to the sixteen (55%) participants in the control group. On day 4, three (30%) participants per group showed positive cultures post antisepsis. Adverse effects were reported in six (60%) and zero (0%) participants for 5-ALA- and MAL-PDT-DL, respectively. The skin bacteriome changes correlated with the bacterial culture results. The MAL-PDT-DL with skin antisepsis significantly increased bacterial reduction on the skin without adverse effects. This offers an opportunity to prevent infections in arthroplasty patients and reduce antibiotic use, thus contributing to antibiotic stewardship goals emphasized in the One Health approach. Full article

Background/Objectives: Pseudomonas aeruginosa rapidly acquires antibiotic resistance and demonstrates increasing tolerance to antiseptics. This study evaluated the activity of eight antiseptics against P. aeruginosa, assessed its ability to develop adaptation to these antiseptics, and, for the first time, determined the Karpinski Adaptation Index (KAI) for this bacterium. Methods: The minimal inhibitory concentration (MIC), susceptibility to antibiotics, bactericidal time according to EN 1040:2005, adaptation potential, and KAI of P. aeruginosa strains were evaluated. Results: The most effective antiseptics against P. aeruginosa, based on MIC activity, were octenidine dihydrochloride (OCT; mean MIC 11.3 ± 4.5 µg/mL), polyhexamethylene biguanide (PHMB; MIC 22.6 ± 8.0 µg/mL), and chlorhexidine digluconate (CHX; MIC 26.6 ± 14.4 µg/mL). Sodium hypochlorite (NaOCl) and ethacridine lactate (ET) showed moderate activity, while boric acid (BA), povidone-iodine (PVI), and potassium permanganate (KMnO₄) exhibited the weakest MIC activity. MIC values for NaOCl (95 ± 15.4 µg/mL) and KMnO₄ (>10 mg/mL) were close to or exceeded the clinical concentrations used in commercial products. OCT, CHX, and PVI exhibited the fastest bactericidal effect within 1 min. Bactericidal times were up to 15 min for PHMB, up to 60 min for ET, and more than 60 min for BA, NaOCl, and KMnO₄. The lowest KAI values, indicating a low resistance risk, were observed for OCT (0.12), PHMB (0.19), and BA (0.19). Moderate resistance risk was noted for PVI (0.21), CHX (0.29), and ET (0.47). The highest KAI values, signifying a very high resistance risk, were found for NaOCl (1.0) and KMnO₄ (≥1.0). Conclusions: Antiseptics like OCT, CHX, and partially PVI can be critical in quick antibacterial action on infected wounds, while agents such as PHMB might be reserved for cases where prolonged contact times are possible. Given the rapid adaptation of P. aeruginosa to the clinical concentrations of NaOCl and KMnO₄ currently in use, reconsideration of their effectiveness in treating skin and mucous membrane infections is recommended. Full article