Clinical application of skin antisepsis using aqueous olanexidine: a scoping review

Abstract

Surgical site infections (SSIs) and catheter‐related bloodstream infections (CRBSIs) caused by bacteria from surfaces poorly disinfected with chlorhexidine gluconate (CHG) and povidone‐iodine (PVP‐I) are increasing. Olanexidine gluconate (OLG) was developed in 2015 in Japan to prevent SSI and CRBSI caused by bacteria resistant to CHG and PVP‐I. This scoping review aimed to identify the knowledge gap between what is known and what is not known about the disinfection efficacy of OLG. We searched MEDLINE through PubMed, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the International Clinical Trials Registry Platform search database, ClinicalTrials.gov , and the Web‐based database of Japanese medical articles for works published to July 18, 2021. Manual reference searches were also carried out. A total of 131 studies were screened. Forty‐seven studies were included in this review and classified into two major categories: studies on pharmacological effects and spectrum ( n = 29) and studies on clinical and adverse effects ( n = 18). Olanexidine gluconate showed bactericidal activity against methicillin‐resistant Staphylococcus aureus and vancomycin‐resistant enterococci, in addition to common Gram‐positive and Gram‐negative bacteria. In clinical settings, although there is limited evidence on SSI prevention, 1.5% OLG might be more effective than 10% PVP‐I and 1% CHG in preventing SSI. However, the clinical usefulness of OLG is unclear due to the limited number of clinical studies. Also, clinical research is limited to studies targeting SSI prevention, and there are no clinical studies on CRBSI. Further clinical studies are needed on SSI and CRBSI prevention.

Comparison of olanexidine versus povidone‐iodine as a preoperative antiseptic for reducing surgical site infection in both scheduled and emergency gastrointestinal surgeries: A single‐center randomized clinical trial

“…in patients undergoing open surgery in 10% povidone-iodine group. 19 Laparoscopic approach for perforated appendicitis significantly decreased the incisional SSI, however, organ/space SSI incidences were similar in both approaches. 27 Conversely, we demonstrated a significant decrease of the organ/space SSI incidence in 1.5% olanexidine group.…”

“…On the other hand, SSI incidence of open approach in the 1.5% olanexidine group was significantly lower compared to that in the 10% povidone‐iodine group. This may be explained by the long‐acting bactericidal effect of 1.5% olanexidine, however, there might be complicated biases increasing SSI incidence in patients undergoing open surgery in 10% povidone‐iodine group 19 . Laparoscopic approach for perforated appendicitis significantly decreased the incisional SSI, however, organ/space SSI incidences were similar in both approaches 27 .…”

“…18 Furthermore, olanexidine has an immediate disinfectant effect on a wide range of bacteria within 30 s and substantivity until 6 h relative to chlorhexidine and 10% povidone-iodine. 19 Olanexidine is a newly invented antiseptic agent approved in Japan in 2015. Since then, it has been used as a routine preoperative antiseptic in clinical practice based on prior basic studies.…”

“…Nii et al reported that 0.1% olanexidine significantly inhibits the production of inflammatory chemokines, such as interleukin 8, C‐C motif ligand 20, and growth‐related oncogene protein‐α, which are stimulated by Porphyromonas gingivalis lipopolysaccharide in oral epithelial cells in in vitro experiments 18 . Furthermore, olanexidine has an immediate disinfectant effect on a wide range of bacteria within 30 s and substantivity until 6 h relative to chlorhexidine and 10% povidone‐iodine 19 . Olanexidine is a newly invented antiseptic agent approved in Japan in 2015.…”

SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update

“…A review of studies of the pharmacological and clinical effects suggests that the clinical usefulness of OLG in prevention of surgical site infections and device-related infections requires additional study. 235 Octenidine dihydrochloride is a cationic biguanide with a broad antibacterial spectrum toward gram-positive bacteria including MRSA. Octenidine is not percutaneously absorbed and partly remains on the location of the application, providing persistence at that site.…”