General
- n849 (Intention-to-treat analysis. (all specialities))
For both per protocol and per treatment | Chlorhexidine–alcohol | Povidone–iodine |
Overall surgical site infection | 9.5% | 16.1% |
Mechanism of action
- 2% Chlorhexidine Gluconate & 70% Isopropyl Alcohol:
- Chlorhexidine gluconate is a cationic bisbiguanide that destroys bacterial cell membranes, exposing the cell contents.
- The alcohol then acts to denature cell proteins.
- Povidone Iodine Solution:
- As solution dries, free iodine becomes available, which oxidises bacterial sulfhydryl groups within the amino acids found in bacterial cell membranes (e.g. histidine and tyrosine) resulting in the formation of a disulfide bond and disrupting function.
- Cheng 2005 et al
- RCT dilute betadine irrigation vs no irrigation
- Technique
- Betadine 10% povidoneiodine (100 mg of povidoneiodine per 1 mL of solution).
- Approximately 5 mL of povidoneiodine was diluted with normal saline to achieve a 0.35% povidoneiodine (3.5% betadine)
- Wound was soaked for 3 minutes after procedures
- Irrigated with 2L saline after
Groups | Infection rate |
Irrigation | 0% |
No irrigation | 3.4% |
Infection
- Biofilm
- Causes poor nutrition to bacteria therefore their prot, dna and cell wall synthesis are downregulated. Abx which act on these pathways cannot work well.
- Reduces phagocytosis
- Biopsy
- Only 36 percent are positive
- 2015 infectious disease idea guidelines for vertebral osteomyelitis wants biopsy
- PET CT vs mri
- PET CT is good for excluding infection
- PET CT is useful for spondylodiscitis
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