A study at the Reading District Hospitals on 451 consecutive patients undergoing appendicectomy through grid‐iron incisions sought to determine factors influencing wound infection and the effects of a prophylactic wound‐spraying procedure. Wound infection increased with the severity of appendicular inflammation and was well correlated with the degree and nature of bacterial contamination at the time of wound closure1. The infection rate was reduced by about one‐half when either an aerosol dry‐powder formulation of povidone iodine (Disadine D. P.1) or an aerosol antibiotic powder spray containing neomycin, bacitracin and polymixin (Dispray) was sprayed on the wound before and after closure. The reduction of infection achieved by spraying with pouidine iodine was statistically significant (P<0.025). The results of the polyantibiotic spraying did not quite reach significance (P<0.06)1. The povidone iodine dry powder was better overall since it reduced infection in all degrees of appendicular inflammation, in all age groups and in enlarged, drained, contaminated and non‐contaminated wounds without the attendant disadvantages of antibiotics.
THE widely used antiseptic, chlorhexidine, is generally believed to possess high activity against most of the human pathogens with which it is required to contend ; and although its activity against Gram-negative organisms is less than that against Gram-positive ones, it is still in excess of what is required in actual practice (Davies et al., 1954; Lawrence, 1960).It has been claimed, however (Lubsen, Boissevain and Fass, 1961), that the resistance to chlorhexidine of some proteus strains is sufficiently high to be of clinical significance. These workers found, moreover, that one species, Proteus rettgeri, was particularly resistant, and suggested that an increase of Pr. rettgeri infections in their urological ward was connected with the use of this antiseptic. These claims were criticised by Beeuwkes (1961), who repeated the in-vitro testing of some of the proteus strains of Lubsen et al. and failed to confirm the degree of chlorhexidine-resistance.In view of the widespread use of chlorhexidine and the prevalence of proteus infections of the urinary tract, particularly in hospitals, this question is of obvious interest. A number of strains of different species of the Proteus group, isolated during the course of routine hospital bacteriology, have therefore been tested against various concentrations of the antiseptic.The sensitivity of the same strains to a number of chemotherapeutic drugs was also tested, primarily to determine whether chlorhexidine-resistance was associated with " hospital strains " of Proteus, i.e., those showing multiple drug-resistance. MATERIALS AND METHODS Source of strainsThe 205 strains of Proteus studied were isolated during the routine examination of specimens from hospital in-patients and out-patients, and from the patients of general practitioners: 162 strains were isolated from urines and 43 from other sources, mainly wound swabs. No strains from faeces were included.Gram-negative bacilli that swarmed on blood agar and had a urinous smell, or produced urease in the course of routine laboratory screening tests, were purified by plating on MacConkey's agar. A single colony was then placed on a nutrient agar slope. After incubation the slopes were stored at room temperature.
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