Comparative efficacy of two different topical povidone-iodine 5% regimens in reducing conjunctival bacterial flora: A randomized parallel double-masked clinical trial

Letícia Fernandes Barroso, Sarah Pereira Cazella, Antonio Brunno Nepomuceno, Luiza Toscano, Liliane Ângela de Souza Castilho, Eloísa Marcela Rueda Furlan, André Messias, Ingrid U. Scott, Rodrigo Jorge

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Abstract

Introduction The increasing prevalence of multi-resistant bacteria is a major public health concern. Infections acquired during ophthalmic surgery are devastating. The purpose of the current study is to compare the proportion of eyes with negative bacterial cultures on all tested media after 1 versus 3 sequential drops of povidone-iodine (PI) 5% into the inferior conjunctival fornix. Methods Patients were randomly assigned to receive 1 (PI group) drop (at time 28 minutes) or 3 (PI plus group) sequential drops (at time 0, 20 minutes and 28 minutes) of PI 5% into the inferior conjunctival sac of one randomly selected eye. A swab culture was obtained from the inferior conjunctival fornix 5 minutes before and 30 minutes after time 0. Central corneal thickness (CCT) was measured shortly before time 0 and shortly after time 30. Conjunctival swabs were incubated aerobically in enriched Thioglycolate liquid medium (meat broth) and in three solid culture media (chocolate agar, trypticase soy agar with 5% sheep blood, and Sabouraud agar). Results There was no significant difference in the proportion of negative cultures after intervention between groups (p = 0.1638). Also in the PI group (n = 59), the proportion of eyes with negative cultures after PI (79.7%) did not differ significantly from baseline (76.3%; p = 0.7539). However in the PI plus group (n = 61), the proportion of eyes with all negative cultures after PI (85.3%) was significantly higher than before PI (70.5%) (p = 0.0177). There was no significant difference in mean CCT before and after the intervention in both groups. Conclusion Instillation of 3 sequential drops of PI was associated with a significant increase in the proportion of eyes with all negative cultures, while instillation of a single drop of PI was not associated with a significant increase in the proportion of negative cultures. Further study is warranted to determine whether the difference between the PI administration regimens is also associated with differences in the rates of postoperative ocular infections.

Original languageEnglish (US)
Article numbere0189206
JournalPloS one
Volume12
Issue number12
DOIs
StatePublished - Dec 2017

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Povidone-Iodine
iodine
clinical trials
flora
Clinical Trials
eyes
Agar
agar
lacrimal apparatus
Thioglycolates
Eye Infections
Lacrimal Apparatus
Meats
chocolate
Public health
infection
Meat
Surgery
Culture Media
Sheep

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Barroso, L. F., Cazella, S. P., Nepomuceno, A. B., Toscano, L., Castilho, L. Â. D. S., Furlan, E. M. R., ... Jorge, R. (2017). Comparative efficacy of two different topical povidone-iodine 5% regimens in reducing conjunctival bacterial flora: A randomized parallel double-masked clinical trial. PloS one, 12(12), [e0189206]. https://doi.org/10.1371/journal.pone.0189206
Barroso, Letícia Fernandes ; Cazella, Sarah Pereira ; Nepomuceno, Antonio Brunno ; Toscano, Luiza ; Castilho, Liliane Ângela de Souza ; Furlan, Eloísa Marcela Rueda ; Messias, André ; Scott, Ingrid U. ; Jorge, Rodrigo. / Comparative efficacy of two different topical povidone-iodine 5% regimens in reducing conjunctival bacterial flora : A randomized parallel double-masked clinical trial. In: PloS one. 2017 ; Vol. 12, No. 12.
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abstract = "Introduction The increasing prevalence of multi-resistant bacteria is a major public health concern. Infections acquired during ophthalmic surgery are devastating. The purpose of the current study is to compare the proportion of eyes with negative bacterial cultures on all tested media after 1 versus 3 sequential drops of povidone-iodine (PI) 5{\%} into the inferior conjunctival fornix. Methods Patients were randomly assigned to receive 1 (PI group) drop (at time 28 minutes) or 3 (PI plus group) sequential drops (at time 0, 20 minutes and 28 minutes) of PI 5{\%} into the inferior conjunctival sac of one randomly selected eye. A swab culture was obtained from the inferior conjunctival fornix 5 minutes before and 30 minutes after time 0. Central corneal thickness (CCT) was measured shortly before time 0 and shortly after time 30. Conjunctival swabs were incubated aerobically in enriched Thioglycolate liquid medium (meat broth) and in three solid culture media (chocolate agar, trypticase soy agar with 5{\%} sheep blood, and Sabouraud agar). Results There was no significant difference in the proportion of negative cultures after intervention between groups (p = 0.1638). Also in the PI group (n = 59), the proportion of eyes with negative cultures after PI (79.7{\%}) did not differ significantly from baseline (76.3{\%}; p = 0.7539). However in the PI plus group (n = 61), the proportion of eyes with all negative cultures after PI (85.3{\%}) was significantly higher than before PI (70.5{\%}) (p = 0.0177). There was no significant difference in mean CCT before and after the intervention in both groups. Conclusion Instillation of 3 sequential drops of PI was associated with a significant increase in the proportion of eyes with all negative cultures, while instillation of a single drop of PI was not associated with a significant increase in the proportion of negative cultures. Further study is warranted to determine whether the difference between the PI administration regimens is also associated with differences in the rates of postoperative ocular infections.",
author = "Barroso, {Let{\'i}cia Fernandes} and Cazella, {Sarah Pereira} and Nepomuceno, {Antonio Brunno} and Luiza Toscano and Castilho, {Liliane {\^A}ngela de Souza} and Furlan, {Elo{\'i}sa Marcela Rueda} and Andr{\'e} Messias and Scott, {Ingrid U.} and Rodrigo Jorge",
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Comparative efficacy of two different topical povidone-iodine 5% regimens in reducing conjunctival bacterial flora : A randomized parallel double-masked clinical trial. / Barroso, Letícia Fernandes; Cazella, Sarah Pereira; Nepomuceno, Antonio Brunno; Toscano, Luiza; Castilho, Liliane Ângela de Souza; Furlan, Eloísa Marcela Rueda; Messias, André; Scott, Ingrid U.; Jorge, Rodrigo.

In: PloS one, Vol. 12, No. 12, e0189206, 12.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparative efficacy of two different topical povidone-iodine 5% regimens in reducing conjunctival bacterial flora

T2 - A randomized parallel double-masked clinical trial

AU - Barroso, Letícia Fernandes

AU - Cazella, Sarah Pereira

AU - Nepomuceno, Antonio Brunno

AU - Toscano, Luiza

AU - Castilho, Liliane Ângela de Souza

AU - Furlan, Eloísa Marcela Rueda

AU - Messias, André

AU - Scott, Ingrid U.

AU - Jorge, Rodrigo

PY - 2017/12

Y1 - 2017/12

N2 - Introduction The increasing prevalence of multi-resistant bacteria is a major public health concern. Infections acquired during ophthalmic surgery are devastating. The purpose of the current study is to compare the proportion of eyes with negative bacterial cultures on all tested media after 1 versus 3 sequential drops of povidone-iodine (PI) 5% into the inferior conjunctival fornix. Methods Patients were randomly assigned to receive 1 (PI group) drop (at time 28 minutes) or 3 (PI plus group) sequential drops (at time 0, 20 minutes and 28 minutes) of PI 5% into the inferior conjunctival sac of one randomly selected eye. A swab culture was obtained from the inferior conjunctival fornix 5 minutes before and 30 minutes after time 0. Central corneal thickness (CCT) was measured shortly before time 0 and shortly after time 30. Conjunctival swabs were incubated aerobically in enriched Thioglycolate liquid medium (meat broth) and in three solid culture media (chocolate agar, trypticase soy agar with 5% sheep blood, and Sabouraud agar). Results There was no significant difference in the proportion of negative cultures after intervention between groups (p = 0.1638). Also in the PI group (n = 59), the proportion of eyes with negative cultures after PI (79.7%) did not differ significantly from baseline (76.3%; p = 0.7539). However in the PI plus group (n = 61), the proportion of eyes with all negative cultures after PI (85.3%) was significantly higher than before PI (70.5%) (p = 0.0177). There was no significant difference in mean CCT before and after the intervention in both groups. Conclusion Instillation of 3 sequential drops of PI was associated with a significant increase in the proportion of eyes with all negative cultures, while instillation of a single drop of PI was not associated with a significant increase in the proportion of negative cultures. Further study is warranted to determine whether the difference between the PI administration regimens is also associated with differences in the rates of postoperative ocular infections.

AB - Introduction The increasing prevalence of multi-resistant bacteria is a major public health concern. Infections acquired during ophthalmic surgery are devastating. The purpose of the current study is to compare the proportion of eyes with negative bacterial cultures on all tested media after 1 versus 3 sequential drops of povidone-iodine (PI) 5% into the inferior conjunctival fornix. Methods Patients were randomly assigned to receive 1 (PI group) drop (at time 28 minutes) or 3 (PI plus group) sequential drops (at time 0, 20 minutes and 28 minutes) of PI 5% into the inferior conjunctival sac of one randomly selected eye. A swab culture was obtained from the inferior conjunctival fornix 5 minutes before and 30 minutes after time 0. Central corneal thickness (CCT) was measured shortly before time 0 and shortly after time 30. Conjunctival swabs were incubated aerobically in enriched Thioglycolate liquid medium (meat broth) and in three solid culture media (chocolate agar, trypticase soy agar with 5% sheep blood, and Sabouraud agar). Results There was no significant difference in the proportion of negative cultures after intervention between groups (p = 0.1638). Also in the PI group (n = 59), the proportion of eyes with negative cultures after PI (79.7%) did not differ significantly from baseline (76.3%; p = 0.7539). However in the PI plus group (n = 61), the proportion of eyes with all negative cultures after PI (85.3%) was significantly higher than before PI (70.5%) (p = 0.0177). There was no significant difference in mean CCT before and after the intervention in both groups. Conclusion Instillation of 3 sequential drops of PI was associated with a significant increase in the proportion of eyes with all negative cultures, while instillation of a single drop of PI was not associated with a significant increase in the proportion of negative cultures. Further study is warranted to determine whether the difference between the PI administration regimens is also associated with differences in the rates of postoperative ocular infections.

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