Search Results (129)

Antimicrobial resistance (AMR) has become a major global public health challenge, and widely residual disinfectants in the environment are one of the key drivers of bacterial AMR development. This study aimed to investigate the inductive effects of three commonly used disinfectants—benzalkonium bromide (BAB), glutaraldehyde (GTA), and povidone-iodine (PVP-I)—on the resistance of Escherichia coli (E. coli), as well as the resultant bacterial phenotypic and genetic alterations. Three disinfectants frequently detected in clinical and environmental settings were selected as the research objects: first, their bactericidal efficacy against environmental bacteria was determined; subsequently, a concentration-increasing gradient approach was adopted to systematically explore the evolutionary patterns of E. coli resistance under the stress of sub-inhibitory concentrations (SICs). After induction, the bacterial resistance levels to disinfectants and various antibiotics, growth characteristics, and biofilm-forming ability were detected, and combined with whole-genome analysis to investigate genetic-level changes. The results showed that all three disinfectants could enhance E. coli resistance to themselves (12–48-fold) and antibiotics, and the induced antibiotic resistance exhibited favorable genetic stability. Among them, BAB induced the strongest resistance, with the most significant increase in resistance levels to multiple antibiotics (16–64-fold); GTA had the weakest inductive effect, only slightly enhancing bacterial resistance to a small number of antibiotics. Notably, all induced strains exhibited reduced growth rates yet markedly enhanced biofilm-forming capacity, alongside acquired genomic structural variations. Their gene functions displayed shared adaptive signatures in coping with environmental stress, while core pathogenicity-associated genes remained conserved. This study demonstrates that inducing E. coli using environmentally relevant low concentrations of disinfectant residues as initial induction doses drives the evolution of bacterial antimicrobial resistance (AMR), with distinct resistance induction risks among the three disinfectant types. These findings offer critical insights for standardizing disinfectant application, mitigating the transmission of bacterial AMR, and underscore the imperative of interdisciplinary collaboration to tackle the environmental risks posed by disinfectant residues. Full article

Background/Objectives: Reverse total shoulder arthroplasty (RTSA), a commonly performed procedure in elderly patients with osteoarthritis, is frequently complicated by postoperative infections—primarily caused by Cutibacterium acnes and coagulase-negative staphylococci (CoNS)—which remain a major clinical challenge. While standard antiseptic skin protocols can reduce the bacterial load at the surgical site, they often fail to achieve complete eradication, particularly with C. acnes, a resident species of the shoulder microbiome. Recent evidence indicates that intraoperative povidone–iodine irrigation is effective in significantly decreasing microbial burden; however, a thorough characterization of the virulence factors of the isolated strains remains essential. Methods: A total of 187 clinical strains isolated immediately after RTSA were characterized with respect to their antibiotic resistance profiles and biofilm-forming capacity, and the impact of intraoperative povidone–iodine irrigation on the reduction in bacteria that express these virulence traits was evaluated. Results: Of the 120 C. acnes isolates, 97.67% were susceptible to the tested antimicrobial agents, while only 3.33% exhibited resistance, specifically to clindamycin. In contrast, 53% of CoNS isolates were classified as susceptible, whereas the remaining 47% demonstrated multidrug resistance. Biofilm production was detected in 24% (29/120) of C. acnes and 39% (25/64) of CoNS isolates, with a statistically significant reduction observed after irrigation only for C. acnes. No association was found between biofilm formation and clindamycin resistance in C. acnes, likely due to the low number of resistant isolates. Conversely, among CoNS, a correlation was observed, with the 17.2% of biofilm-producing strains also exhibiting resistance to antimicrobial agents. Conclusions: Notwithstanding the presence of these virulence factors, povidone–iodine irrigation proved effective in substantially reducing the number of bacterial isolates recovered at the surgical site without selecting for strains with enhanced pathogenicity. Notably, the majority of resistant bacteria were detected prior to intraoperative irrigation. This intraoperative procedure may be a key approach to reducing prosthetic joint infections frequently caused by more virulent pathogens, which are unlikely to be selected following this disinfection strategy. Full article

The objective of this study was to investigate the effect of surface disinfectant solutions against COVID-19 on the surface roughness, gloss, and color of removable denture materials. Fifty rectangular metallic specimens made of Co-Cr alloy and fifty disk-shaped specimens made of PMMA were prepared according to the manufacturers’ instructions. Fifty maxillary right central incisors were also included in the study. The above-mentioned specimens were equally divided into five groups (n = 10). Four disinfectant solutions were tested (0.1 wt% NaOCl, 0.5 wt% H₂O₂, 78 wt% ethanol, and 1 wt% Povidone Iodine), and freshly distilled water was used as the control. To simulate clinical practice, each specimen was immersed in the disinfectant solution 15 times. All specimens were marked, and surface roughness, gloss, and color were measured before and after immersion. All roughness parameters (Sa, Sq, Sz, Sc, and Sv) and gloss values before and after immersion were statistically compared. ΔE*ab values were statistically compared with perception and acceptability thresholds according to ISO/TR 28642. No significant differences were identified for surface roughness parameters for all groups tested. All materials demonstrated a significant increase in gloss after aging regime, while only the metallic specimens illustrated ΔE*ab values higher than the acceptability threshold after disinfection with H₂O₂. None of the surface properties deteriorated after exposure to tested disinfectants, and thus, all of them can be effectively implemented in everyday practice. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major global health threat. In patients undergoing cataract surgery, AMR complicates infection control, particularly efforts to reduce the risk of endophthalmitis—a rare but severe postoperative complication. This article reviews country-specific strategies for endophthalmitis prevention, focusing on antimicrobial use. Methods: Ophthalmology experts from 10 countries contributed national perspectives on infection prevention. Official guidelines served as the primary basis for analysis; when unavailable, expert opinion and routine clinical practice were considered. Results: Routine preoperative antibiotic use is uncommon in 6 out of 10 countries. Instead, artificial tears and bacteriostatic or bactericidal treatments are frequently employed. One country allows optional antibiotic use, while 3 include it in routine preoperative care. For intraoperative management, antisepsis with 5–10% povidone-iodine is standard practice in 9 countries. Intracameral cefuroxime (typically 1 mg/0.1 mL) is widely used in 7 countries and considered essential in most countries. Postoperatively, broad-spectrum topical antibiotics, primarily fluoroquinolones, are typically prescribed, often as fixed-dose combinations with corticosteroids (8 countries), although duration and regimens vary. Conclusions: Despite national differences, povidone-iodine, intracameral cefuroxime, and topical fluoroquinolones are widely used. Preoperative antibiotic use varies, while postoperative regimens are more consistent. These practices reflect local AMR patterns, regulations, and available healthcare resources. Although broad-spectrum agents are generally preferred, they raise concerns about resistance. Tailoring prophylactic strategies to local microbiological profiles and limiting the duration of antibiotic therapy are key to balancing efficacy and stewardship. An individualized, evidence-based approach is essential to reduce endophthalmitis risk and address AMR challenges. Full article

Background: Ventilator-associated pneumonia (VAP) is a prevalent and serious complication of invasive mechanical ventilation (MV), contributing to significant mortality and increased healthcare resource utilization. While numerous oropharyngeal interventions exist, their comparative efficacy across critical outcomes remains uncertain due to a lack of direct comparisons in clinical trials. Methods: We conducted a systematic review and network meta-analysis (NMA) with a comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL up to September 2025 for randomized and non-randomized studies comparing topical oral interventions in intubated patients. The primary outcome was VAP incidence; secondary outcomes were intensive care unit (ICU) mortality, duration of MV, and ICU length of stay (LOS). Pairwise and network meta-analyses were performed, and the certainty of evidence was assessed. The effect estimates were odds ratios (OR) for categorical outcomes and mean difference (MD) for numerical outcomes represented with 95% confidence intervals (95% CI). Results: Ninety-six studies (20,650 patients) were included, evaluating 44 interventions. For VAP prevention, several interventions were superior to reference/control, including Antimicrobial combinations (OR: 0.21, 95% CI: 0.05–0.39), Povidone-iodine (OR: 0.47, 95% CI: 0.21–0.98), and Chlorhexidine (OR 0.61, 95% CI 0.39–0.95). However, only Chlorhexidine plus toothbrushing significantly reduced mortality (OR: 0.74, 95% CI: 0.58–0.93). For resource utilization, only antimicrobial combinations significantly reduced the duration of MV (MD: −5.55 days, 95% CI: −10.75–−1.7) and ICU LOS (MD: −7.74 days, 95% CI: −13–−4). Evidence certainty (GRADE) was moderate for chlorhexidine and very low for other comparisons. Conclusions: This NMA demonstrates that while multiple oropharyngeal interventions are effective for VAP prevention, their benefits are outcome specific. The choice of intervention should be guided by clinical priorities, as the most effective strategy for preventing VAP may not concurrently reduce mortality or resource use. These findings can inform guideline development and underscore the need for standardized, multi-faceted oral care protocols in the ICU. Full article

Background: The oral cavity is an entry site and a reservoir for viruses. Viral particles accumulate in saliva, which serves as a diagnostic fluid and vehicle for transmission (droplets and aerosols). Antiseptic mouthwashes were proposed as adjunctive measures to temporarily reduce oral viral load. Objectives: This scoping review aims to investigate the role of the oral cavity in viral infections, focusing on saliva and the use of antiseptic mouthwashes to reduce salivary viral load. Methods: Following the PRISMA-ScR guidelines, PubMed, EMBASE, and Web of Science were searched for human studies (2015–2025) investigating oral viral infections, saliva, or mouthwashes. Eligible studies were classified and analyzed for population, intervention, and outcomes. Results: Twenty-three studies met inclusion criteria (sixteen randomized controlled trials and seven systematic reviews). All included studies focused exclusively on SARS-CoV-2, as no clinical evidence on other oral viruses met the eligibility criteria. Saliva was consistently identified as a reliable, non-invasive specimen reflecting disease dynamics and transmission potential. Mouthwashes containing povidone-iodine, cetylpyridinium chloride, chlorhexidine, hydrogen peroxide or β-cyclodextrin–citrox produced measurable but short-lived reductions in salivary viral load. Heterogeneity and lack of standardized outcomes limited comparability. Conclusions: Antiseptic mouthwashes can provide a transient and complementary reduction in salivary viral load, particularly before aerosol-generating procedures; however, they should be regarded only as adjunctive measures and not as substitutes for standard infection-control protocols. Full article

Objective: To evaluate the effect of different mouthwashes on the microhardness and color stability of two CAD/CAM restorative materials. Methods: A total of 60 rectangular samples (2 mm × 7 mm × 12 mm) were prepared by sectioning two CAD/CAM materials (NICE and Lava Ultimate) and divided into six groups according to material type and immersion solution: distilled water (DW, control), hydrogen peroxide (HP), and povidone-iodine (PVP-I). Microhardness and color parameters (L*, a*, b*) were measured at baseline and after 30 days of immersion, and the ΔE₀₀ color difference was calculated. Data were analyzed using t-tests, two-way and one-way ANOVA, and Tukey’s post hoc test. Results: After 30 days of immersion, both materials showed a significant decrease in microhardness following treatment with HP and PVP-I (NICE from ~823 to ~720 HV and ~709 HV; LAVA from ~197 to ~142 HV and ~113 HV, respectively). Regarding color, ΔE₀₀ values exceeded the clinically acceptable threshold (ΔE₀₀ > 1.8), with no significant differences between the two materials (p > 0.05). Within each material, ΔE₀₀ was significantly higher in both mouthwash groups compared to the control (p < 0.001), but no significant difference was observed between the two antimicrobial solutions (p > 0.05). Conclusion: Within the limitations of this study, the microhardness and color stability of both CAD/CAM restorations may be susceptible to degradation after prolonged exposure to HP and PVP-I mouthwashes. Full article

Background: Irrigation is a key strategy in reducing bioburden, disrupting biofilms, and supporting wound healing. While saline is the standard for its safety and availability, antiseptic and antibiotic solutions are often used in clinical scenarios that require infection control. However, the rise in antibiotic stewardship and concerns regarding cytotoxicity are reshaping current practices. This review identifies recent trends, current controversies, and persistent gaps in knowledge that warrant further investigation and regulatory attention. Methods: A literature review identified irrigation solutions commonly used in plastic surgery; labeling and concentrations were obtained from Devices@FDA, Drugs@FDA, and DailyMed, and PubMed, Cochrane Central, and Embase were searched (January 2022–July 2025) for human studies on acute wounds, chronic wounds, and implant-based breast surgery. Results: In acute wounds, saline and potable tap water effectively prevent infection. In chronic wounds, such as diabetic foot ulcers and pressure injuries, antiseptic agents, including hypochlorous acid, sodium hypochlorite, polyhexanide, and citrate-based solutions, have shown promise in improving healing and reducing infection. In implant-based breast reconstruction and augmentation, data on antiseptics, such as chlorhexidine, and changes in FDA guidance for povidone–iodine and bacitracin have prompted a reevaluation of intraoperative irrigation practices. Conclusion: Despite widespread use, many antiseptics remain off-label, and high-quality clinical studies comparing efficacy and safety are lacking. Full article

The influence of minor components on leaching molecular iodine (I₂) through polypropylene (PP)-based packaging from a povidone iodine-based (PVP-I) formulation, simulating an ophthalmic application, was evaluated. I₂ is a cheap, broad-spectrum, and multi-target antiseptic. Nevertheless, it is volatile, and the prolonged storage of I₂-based formulations is demanding in plastic packaging because of transmission through the material. Therefore, we explored the possibility of moderating the loss of I₂ from an iodophor formulation by introducing small amounts of molecular iodine into the polymer material commonly used in eyedropper caps, i.e., PP. Thus, PP was blended via an extrusion process with a polymeric complex containing iodine (such as PVP-I) or with a second polymeric component able to complex the I₂ released from an iodophor solution. The aim of this work was to introduce I₂ into PP-based polymer matrices without using organic solvents and indirectly, i.e., through the addition of components that could generate molecular iodine or complex it in the solid phase, as I₂ is heat-sensitive. To increase the miscibility between PP and PVP-I, poly(N-vinylpyrrolidone) (PVP) or a vinyl pyrrolidone vinyl acetate copolymer 55/45 (Sokalan) were added as compatibilizers. The PP-based binary and ternary blends, in granular or sheet form, were characterized thermally (Differential Scanning Calorimetry, DSC, and Thermogravimetric analysis, TGA), mechanically (tensile tests), morphologically (scanning electron microscopy (SEM)), and chemically (attenuated total reflectance Fourier transform infrared (ATR-FTIR)). Additionally, the variation in wettability induced by the introduction of the hydrophilic minority components was determined by static contact angle measurements (static contact angle (SCA)), and tests were carried out to determine the barrier properties against oxygen (oxygen transmission rate (OTR)) and molecular iodine. The I₂ leaching of the different blends was compared with that of PP by monitoring the I₂ retention in a buffered PVP-I solution via UV-vis spectroscopy. Overall, the experimental data showed the capability of the minority components in the blends to increase thermal stability as well as act as a barrier to oxygen. Additionally, the PP blend with PVP-I induced a reduction in molecular iodine leaching in comparison with PP. Full article

Background/Objectives: Tissue expander (TE)-based breast reconstruction is a common procedure, but postoperative infection rates can reach up to 30%. The optimal skin antiseptic solution for minimizing these infections remains uncertain. This retrospective cohort study aimed to compare the impact of chlorhexidine and povidone-iodine for skin antisepsis in preventing surgical site infections in patients who underwent TE-based breast reconstruction. Methods: The TriNetX database was queried to identify patients who underwent TE-based breast reconstruction. Patients were classified into two cohorts: the chlorhexidine group and the povidone-iodine group. A propensity score matching analysis was performed to control infection risk factors. The primary outcome was the occurrence of surgical site infections, while secondary outcomes included wound dehiscence, emergency department visits, debridement, and TE removal. All outcomes were assessed at 30, 60, and 90 days following surgery. Results: After matching of both the chlorhexidine cohort and povidone-iodine cohort, each consisted of 1446 patients. Within 30 days post-surgery, no significant differences were observed between the chlorhexidine and povidone-iodine groups in terms of the risk of surgical site infections (RR 0.62, p = 0.168), wound dehiscence (RR 1.00, p = 1.000), emergency department visits (RR 0.95, p = 0.700), debridement (RR 0.71, p = 0.271), or TE removal (RR 0.84, p = 0.335). Similar results were seen at 60 and 90 days post-surgery. Conclusions: This study suggests that chlorhexidine and povidone-iodine may be equally effective for skin antisepsis in preventing surgical site infections and associated complications in patients undergoing TE-based breast reconstruction. Full article

Background/Objectives: Infectious endophthalmitis is a vision-threatening complication of intraocular surgery and intravitreal injections. Standard treatment involves intravitreal antibiotics; however, concerns regarding multidrug resistance and vancomycin-associated hemorrhagic occlusive retinal vasculitis (HORV) highlight the need for alternative antimicrobial strategies. This study aimed to evaluate the clinical efficacy and safety of a protocol combining intravitreal injection of 1.25% povidone-iodine (PI) with intraoperative irrigation using low concentrations of vancomycin and ceftazidime. Methods: We retrospectively analyzed 11 eyes from patients diagnosed with postoperative or injection-related endophthalmitis. Six of the eleven cases received an initial intravitreal injection of 1.25% PI, followed by pars plana vitrectomy with irrigation using balanced salt solution PLUS containing vancomycin (20 μg/mL) and ceftazidime (40 μg/mL). A second intravitreal PI injection was administered at the end of surgery in all cases. Additional PI injections were administered postoperatively based on clinical response. Clinical outcomes included best-corrected visual acuity (BCVA), microbial culture results, corneal endothelial cell density, and visual field testing. Results: All eyes achieved complete infection resolution without recurrence. The mean BCVA improved significantly from 2.18 logMAR at baseline to 0.296 logMAR at final follow-up (p < 0.001). No adverse events were observed on specular microscopy or visual field assessment. The protocol was well tolerated, and repeated PI injections showed no signs of ocular toxicity. Conclusions: This combination protocol provides a safe and effective treatment strategy for infectious endophthalmitis. It enables rapid and complete infection resolution while minimizing the risks associated with intravitreal antibiotics. These findings support further investigation of this protocol as a practical and globally accessible alternative to standard intravitreal antimicrobial therapy. Full article

Povidone-iodine (PVP-I), a widely used aquaculture disinfectant, remains poorly understood in terms of sublethal toxicity and damage reversibility. This study employed Macrobrachium rosenbergii as the model organism to evaluate the acute toxicity and sublethal effects of PVP-I through a 4-day exposure experiment followed by a 7-day depuration period. Acute toxicity tests enabled the determination of 24–96 h median lethal concentrations (LC₅₀), with the 96 h LC₅₀ being 5.67 mg/L and the safe concentration (SC) being 1.37 mg/L. Based on this, three sublethal concentrations (1.14, 1.89, and 2.84 mg/L) were tested over a 4-day exposure followed by a 7-day depuration period. Investigated endpoints included gill ultrastructure, apoptosis, and antioxidant and immune-related gene expression. Subacute exposure at 1.89 and 2.84 mg/L induced mitochondrial vacuolization, upregulated apoptosis-related genes (Cyt-c, Caspase-3, Bok), and downregulated antioxidant gene expression (SOD, CAT, GSH-Px). The high-concentration group also showed sustained Toll-like receptor (Toll) gene overexpression and acid phosphatase (ACP) gene suppression. After depuration, antioxidant gene expression normalized; however, apoptotic markers in gill tissue remained impaired. Overall, high PVP-I concentrations cause irreversible gill damage via mitochondrial-mediated apoptosis, whereas lower concentrations (≤1.14 mg/L) allow for greater recovery. These results offer crucial toxicodynamic insights for safer PVP-I use and risk assessment in M. rosenbergii aquaculture. Full article

Viral conjunctivitis is a highly contagious ocular condition that significantly impacts patient quality of life and healthcare resources. Despite its self-limiting nature, the condition remains a significant public health concern due to its high transmissibility, prolonged symptoms, and potential complications such as subepithelial infiltrates (SEIs). This review aimed to synthesize and evaluate current management strategies for adenoviral conjunctivitis and provide an evidence-based treatment framework. A systematic literature search of PubMed and the Cochrane Library was conducted, identifying 25 eligible studies published between 2009 and 2024 that focused on clinical interventions including supportive care, antiseptics, corticosteroids, antivirals, and immune modulators. The findings indicate that while supportive therapy and hygiene measures remain central to care, antiseptic agents, specifically povidone–iodine, and topical steroids offer additional benefit in reducing symptom duration and complications. Combination therapies integrating antiseptics, corticosteroids, and immunomodulators show promise for more severe cases, especially those complicated by SEIs. This review proposes an evidence-based comprehensive, multimodal approach management algorithm while highlighting the need for future research in antiviral development and diagnostic innovation to avoid mistreatment and unnecessary antibiotic use. Full article

Surgical site infections (SSIs) and prosthetic joint infections (PJIs) remain significant challenges in orthopedic surgery, particularly in joint arthroplasty. Intraoperative irrigation is a widely used strategy for infection prevention, yet traditional solutions such as saline, povidone-iodine, hydrogen peroxide, and sodium hypochlorite are limited by cytotoxicity, short antimicrobial duration, and poor biofilm penetration. This review evaluates commonly used irrigation agents and highlights the growing evidence supporting a novel citrate-based solution as a potentially superior alternative. These agents combine broad-spectrum antimicrobial activity, effective biofilm disruption through ionic chelation, and prolonged postoperative protection with minimal harm to host tissues. Early clinical studies and ongoing randomized trials have demonstrated promising results, including reductions in postoperative swelling, opioid use, and infection rates. As more data become available, citrate-based solutions may emerge as the preferred standard for intraoperative irrigation in orthopedic procedures. Full article

Staphylococcus aureus is a mastitis pathogen that compromises cow health and causes significant economic losses in the dairy industry. High antimicrobial resistance and biofilm formation by S. aureus limit the efficacy of conventional treatments. This study evaluated the potential of polyhexamethylene biguanide nanoparticles (PHMB NPs) against mastitis-causing S. aureus. PHMB NPs showed low toxicity to bovine mammary epithelial cells (MAC-T cells) at concentrations up to four times higher than the minimum inhibitory concentration (1 µg/mL) against S. aureus. In Experiment 1, PHMB NPs significantly reduced biofilm formation by S. aureus by 50% at concentrations ≥1 µg/mL, though they showed limited efficacy against preformed biofilms. In Experiment 2, using an excised teat model, PHMB NPs reduced S. aureus concentrations by 37.57% compared to conventional disinfectants (chlorhexidine gluconate, povidone–iodine, and sodium dichloroisocyanurate), though limited by short contact time. These findings highlight the potential of PHMB NPs for the control of S. aureus growth and biofilm formation. Full article