Antiseptics Commonly Used in Total Joint Arthroplasty Interact and May Form Toxic Products

Campbell, Sean T.; Goodnough, L. Henry; Bennett, Chase; Giori, Nicholas J.

doi:10.1016/j.arth.2017.10.028

Cited by 22 publications

(22 citation statements)

References 17 publications

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“…Sodium hypochlorite (NaOCl) commercially sold as Dakin's solution (Century Pharmaceuticals, Inc, Indianapolis, Indiana), is household bleach that has antimicrobial activity against aerobic and anaerobic bacteria, viruses, and fungi at lower concentrations (0.005 %-0.025 %), while sparing host fibroblasts and chondrocytes. Sodium hypochlorite produces chloride ions, a potent oxidizer that inhibits protein synthesis and essential lipids in the bacterial and fungal cell membrane resulting in its bactericidal and fungicidal effect (Campbell et al, 2018). Its antimicrobial activity and host cytotoxicity are time-dependent with an ability to dissolve necrotic tissue debris (Campbell et al, 2018).…”

Section: Sodium Hypochloritementioning

confidence: 99%

“…Sodium hypochlorite produces chloride ions, a potent oxidizer that inhibits protein synthesis and essential lipids in the bacterial and fungal cell membrane resulting in its bactericidal and fungicidal effect (Campbell et al, 2018). Its antimicrobial activity and host cytotoxicity are time-dependent with an ability to dissolve necrotic tissue debris (Campbell et al, 2018).…”

Section: Sodium Hypochloritementioning

confidence: 99%

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Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections

Abdo

Springer

Chen

2021

J. Bone Joint Infect.

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Abstract. Irrigation and debridement in the treatment of periprosthetic joint infection (PJI) serve an integral role in the eradication of bacterial burden and subsequent re-infection rates. Identifying the optimal irrigation agent, however, remains challenging, as there is limited data on superiority. Direct comparison of different irrigation solutions remains difficult because of variability in treatment protocols. While basic science studies assist in the selection of irrigation fluids, in vitro results do not directly translate into clinical significance once implemented in vivo. Dilute povidone iodine, hydrogen peroxide, chlorhexidine gluconate, acetic acid, sodium hypochlorite, hypochlorous acid, and preformed combination solutions all have potential against a broad spectrum of PJI pathogens with their own unique advantages and disadvantages. Future clinical studies are needed to identify ideal irrigation solutions with optimal bactericidal properties and low cytotoxicity for PJI treatment.

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Section: Sodium Hypochloritementioning

confidence: 99%

Section: Sodium Hypochloritementioning

confidence: 99%

Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections

Abdo

Springer

Chen

2021

J. Bone Joint Infect.

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“…The current evidence implies safety and efficacy in PJI reduction with the use of dilute betadine lavage [18]; however, there remains a need for randomized controlled studies to continue expanding the body of evidence of its efficacy. Taking an approach of combining antiseptics has also been explored and cautioned against due to the risk of causing harmful by-products [19]. Further randomized controlled studies are warranted for the use of CHG, as many of the proposed benefits in arthroplasty surgery remain theoretical and unproven.…”

Section: Antiseptic Solutionsmentioning

confidence: 99%

Intraoperative Considerations for Treatment/Prevention of Prosthetic Joint Infection

Suleiman

Mesko

Nam

2018

Curr Rev Musculoskelet Med

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The most recent literature demonstrates promising results in regard to hydrofiber dressings as an independent risk factor for primary prosthetic joint infection reduction, which in turn is also linked with cost savings. As our understanding of safe yet effective concentrations of antiseptic solutions develops, dilute betadine in particular has demonstrated encouraging efficacy which warrants continued investigation through controlled trials. In summary, we found that the application of a hydrofiber dressing may prove beneficial in decreasing the risk of prosthetic joint infection following primary total hip and knee arthroplasty. The gold standard for an infection prevention protocol continues to be explored and optimized.

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“…Bacteria can become antibiotic-resistant as a result of mutations and horizontal transfer of genes localized in mobile genetic elements, genomic islands, phages, plasmids (Kramer et al, 2016;Von Wintersdorff et al, 2016). Furthermore, microorganisms may have not only interstrain and intraspecies, but also inter-genus transfer of antibioticresistance genes, which would contribute to emergence of cultures with obtained resistance to antibiotics and development of multidrug-resistant variants (Campbell et al, 2018;Cheng et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Apart from antibiotics, medical practice also applies antiseptics (Campbell et al, 2018;Palchykov et al, 2019;Zazharskyi et al, 2019). They are used in low concentrations for desinfection of skin and mucous membranes, surfaces of wounds.…”

Section: Introductionmentioning

confidence: 99%

Efficiency of combined action of antimicrobial preparations against poly-resistant strains of conditionally-pathogenic bacteria isolated from wounds of surgery patients

Sklyar

Lavrentievа

Rudas

et al. 2020

Regul. Mech. Biosyst.

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The strategy of use of combination therapy of antibacterial preparations is being broadly introduced to clinical practice to fight bacterial infections caused by poly-resistant strains of microorganisms. From the wounds of surgery patients, we isolated 67 clinical strains of conditionally-pathogenic bacteria identified as Staphylococcus aureus, S. epidermidis, Escherichia coli, Klebsiella pneumoniaе, Proteus vulgaris, Proteus mirabilis, Pseudomonas aeruginosa. Using disk diffusion method, the isolated bacterial strains were found to be most resistant to penicillin preparations: ampicillin, oxacillin, amoxicillin/clavulanat; tetracycline and cephalosporin of the II generation – cefoxitin. The percentage of strains insusceptible to these antibacterial preparations accounted for 65.0%. The division of antibiotic-resistant cultures regarding phenotype groups according to the level of their antibiotic resistance allowed determination of 4 PDR-, 8 XDR- and 14 MDR-strains. During the studies on experimental determining of MIC of antibiotic and antiseptics in the condition of applying them as monopreparations against isolated bacterial cultures, we saw significant exceess in the threshold values of MIC, and, first of all, regarding pandrug-resistant and extensive drug-resistant clinical microbial isolates. Use of combinations of antibacterial preparations was found to show the synergic effect of antibiotics (ceftriaxone, ofloxacin, gentamicin) and antiseptics (chlorhexidine, decasan), which is expressed in simultaneous decrease in MIC of each of the tested preparations by 2–8 times compared with their isolative application. Such combinatory approach regarding simultaneous application of antibacterial preparations may be considered as one of the most promising ways to combat poly-resistant clinical isolates of conditionally-pathogenic microorganisms and to offer a new strategic approach to prevention of spread of antibiotic resistance as a phenomenon in medical practice.

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Antiseptics Commonly Used in Total Joint Arthroplasty Interact and May Form Toxic Products

Cited by 22 publications

References 17 publications

Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections

Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections

Intraoperative Considerations for Treatment/Prevention of Prosthetic Joint Infection

Efficiency of combined action of antimicrobial preparations against poly-resistant strains of conditionally-pathogenic bacteria isolated from wounds of surgery patients

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