Biocompatibility index of antiseptic agents by parallel assessment of antimicrobial activity and cellular cytotoxicity

Müller, Gerald; Krämer, Axel

doi:10.1093/jac/dkn125

Cited by 376 publications

(307 citation statements)

References 44 publications

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“…Antimicrobials must exert selective toxicity against microorganisms without harming human tissues or cells. Müller and Kramer proposed using a biocompatibility index to assess the biocompatibility of antiseptics, defining it as the ratio of the concentration at which a compound kills 50% of mouse fibroblasts to the concentration at which it kills 99.9% of bacteria (Müller and Kramer, 2008). The PHMG-P biocompatibility index has yet to be calculated; however, the PHMB biocompatibility index is around 1.36-1.51, indicating superior biocompatibility compared with other general-purpose disinfectants such as chlorhexidine, povidone-iodine, and triclosan.…”

Section: Biocidal Properties Of Phmg-pmentioning

confidence: 99%

Adverse health effects of humidifier disinfectants in Korea: lung toxicity of polyhexamethylene guanidine phosphate

et al. 2016

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-Exposure to humidifier disinfectants was identified in 2011 as the potential cause of an outbreak of lung disease in Korea. It is estimated that over 8 million people have been exposed to humidifier disinfectants-chemicals added to the water used in humidifiers to prevent the growth of microorganisms-since their commercial introduction. The primary component of humidifier disinfectant products involved was polyhexamethylene guanidine phosphate (PHMG-P), a guanidine-based antimicrobial agent. Lesions observed in the lungs of patients were similar to those observed in laboratory animals exposed to PHMG-P. In this review, we outline the physicochemical and toxicological properties of PHMG-P, and introduce a putative mechanism for its lung toxicity based in large part on research findings to date.

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Section: Biocidal Properties Of Phmg-pmentioning

confidence: 99%

Adverse health effects of humidifier disinfectants in Korea: lung toxicity of polyhexamethylene guanidine phosphate

et al. 2016

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“…For example, for iodine solutions, due to their in vitro cytotoxicity, a relatively low BI of 0.68 is reported, while in contrast a cytotoxic effect of cadexomer iodine according to recent studies could not be confirmed in vivo [49]. For povidone iodine, histologically detectable tissue toxicity could not be demonstrated in a controlled study [50].…”

Section: Infection Controlmentioning

confidence: 95%

“…In the use of antiseptic solutions, the characteristics of the individual substances, the type of wound (wound cavities, protein error) as well as the individual risk profile (allergies) of the patient should be taken into consideration [49,51,52].…”

Section: Antisepsis and Breakthrough Of Chronic Inflammationmentioning

confidence: 99%

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Klein

Schreml

Dolderer

et al. 2013

J Deutsche Derma Gesell

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SummaryThe number of patients suffering from chronic wound healing disorders in Germany alone is estimated to be 2.5-4 million. Therapy related expenses reach 5-8 billion Euros annually. This number is partially caused by costly dressing changes due to non-standardized approaches and the application of non-evidence-based topical wound therapies. The purpose of this paper is to elucidate a straightforward principle for the management of chronic wounds, and to review the available evidence for the particular therapy options. The T.I.M.E.-principle (Tissue management, Inflammation and infection control, Moisture balance, Epithelial [edge] advancement) was chosen as a systematic strategy for wound bed preparation. Literature was retrieved from the PubMed and Cochrane Library databases and subjected to selective analysis.Topical wound management should be carried out according to a standardized principle and should further be synchronized to the phases of wound healing. Despite the broad implementation of these products in clinical practice, often no benefit exists in the rate of healing, when evaluated in meta-analyses or systematic reviews. This insufficient evidence is additionally limited by varying study designs. In case of non-superiority, the results suggest to prefer relatively inexpensive wound dressings over expensive alternatives. Arbitrary endpoints to prove the effectiveness of wound dressings, contribute to the random use of such therapies. Defining rational endpoints for future studies as well as the deployment of structured therapy strategies will be essential for the economical and evidence-based management of chronic wounds.

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“…PHMB has been shown to be equally effective as chlorhexidine in the treatment of other infections, like acanthamoeba keratitis (Lim et al, 2008). PHMB also has a slightly higher biocompatibility index (1.36 VS. 0.98), meaning that the ratio of antibacterial activity to cytotoxicity is higher with PHMB (Muller and Kramer, 2008). In vitro data suggest that PHMB is active against organisms at lower concentrations (lower minimum inhibitory concentrations and minimum bactericidal concentrations) and PHMB-impregnated gauze and foam wound dressings have also been used to prevent infection and promote wound healing in other types of wounds (e.g., surgical site infections, traumatic wounds, ulcers) (Roth et al, 2007;Andriessen and Eberlein, 2008;Valenzuela and Perucho, 2008;Penn et al, 2006;Timmons and Leak, 2010).…”

Section: Effectiveness Of Phmb-impregnated Discsmentioning

confidence: 99%

Antimicrobial-Impregnated Discs for Prevention of Intravenous Catheter-Related Infections

Daniels

Frei²

2012

American Journal of Infectious Diseases

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Problem statement: Healthcare-associated infections are the 5th leading cause of death in the United States. Catheter-Related Bloodstream Infections (CRBSIs) comprise 14% of all healthcareassociated infections and contribute to increased mortality and financial costs. Antimicrobialimpregnated sponge discs to be used surrounding the catheter insertion site are a newer addition to the options available for the prevention of catheter-related infections. Approach: This review critically appraises the literature regarding the utility of antimicrobial-impregnated discs. We performed a literature search using the MEDLINE (1948-November 2011) database. Only controlled clinical trials were included and the electronic database search was performed using the following MeSH and keyword search terms: ("Biopatch" or "chlorhexidine") and ("dressing" or "sponge") and ("catheter"). Results: Our search yielded eight trials. Chlorhexidine-impregnated discs are effective in preventing catheter colonization in hospitalized patients and outpatients; however, effectiveness in preventing CRBSIs may be limited to hospitalized, critically ill patients. Although many studies have evaluated the effectiveness of several pharmaceutical agents for the prevention of catheter-related infections, there are still significant gaps in the literature regarding these infections, including the effectiveness of Polyhexamethylene Biguanide (PHMB)-impregnated discs and the cost-effectiveness of PHMBimpregnated discs compared to chlorhexidine-impregnated discs. It is also unclear if antimicrobialimpregnated discs are effective in specific populations, like in outpatients, patients at high risk compared to low risk patients and patients with long-term catheters. Conclusion: Chlorhexidineimpregnated discs should be utilized for the duration of catheterization in high risk, critically ill patients and in hospitals where catheter-related infection rates are persistently high despite other preventative strategies. Futher investigation of the effectiveness of these discs in other populations and of other antimicrobial-impregnated discs is needed.

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Biocompatibility index of antiseptic agents by parallel assessment of antimicrobial activity and cellular cytotoxicity

Abstract: The BI presented may be a useful tool to evaluate antiseptic agents for use in clinical practice.

Cited by 376 publications

References 44 publications

Adverse health effects of humidifier disinfectants in Korea: lung toxicity of polyhexamethylene guanidine phosphate

Adverse health effects of humidifier disinfectants in Korea: lung toxicity of polyhexamethylene guanidine phosphate

Evidence‐based topical management of chronic wounds according to the T.I.M.E. principle

Antimicrobial-Impregnated Discs for Prevention of Intravenous Catheter-Related Infections

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