Efficacy of a povidone iodine preparation in reducing nasal methicillin-resistant Staphylococcus aureus in colonized patients

Abstract

In a randomized, nonblinded, placebo-controlled trial, a single application of a 10% povidone iodine preparation significantly reduced nasal methicillin-resistant Staphylococcus aureus at 1 and 6 hours after application, but suppression was not sustained at 12 or 24 hours. Twice-daily treatment for 5 days did not reduce nasal methicillin-resistant S aureus measured 12 hours postdosing in comparison to controls. These results suggest that single preoperative applications of povidone iodine will be effective for short-term suppression of S aureus during the perioperative period.

Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and Staphylococcus aureus Decolonization

“…Its successful use in trauma patients undergoing emergency surgery within 24 h of admission is also notable, since the use of a 5-day regimen of mupirocin is not feasible in this setting (75). Recent data indicate that a single preoperative application of intranasal PVP-I may be enough for the short-term suppression of MRSA during the perioperative period (70). Therefore, repeated dosing with intranasal PVP-I after surgery in order to enhance or prolong its antimicrobial activity may not be necessary, although studies are required to investigate this further.…”

“…Overall, there is a general absence of data relating to the possible synergistic actions of PVP-I in combination with other antiseptics or antibiotics, and this is an area of research that warrants further investigation. Some studies suggest that PVP-I may have a shorter time to bacterial regrowth than other antiseptic agents (36,68,70,106,107). Although this is unlikely to be an issue for surgical patients, clinical studies are needed to understand the long-term dynamics of PVP-I.…”

“…Intranasal and topical PVP-I has been investigated in several studies for the preoperative decolonization of patients undergoing surgery. Four of these studies were prospective with a randomized controlled design ( 22 , 68 – 70 ), and the remaining studies were retrospective database studies with historical controls ( 71 – 75 ). The main outcome measures were either S. aureus colonization status ( 68 – 70 ) or the prevention of SSI ( 22 , 71 – 75 ).…”

“…Four of these studies were prospective with a randomized controlled design (22,(68)(69)(70), and the remaining studies were retrospective database studies with historical controls (71)(72)(73)(74)(75). The main outcome measures were either S. aureus colonization status (68)(69)(70) or the prevention of SSI (22,(71)(72)(73)(74)(75). Current World Health Organization (WHO) guidelines for decolonization recommend intranasal mupirocin with or without chlorhexidine body wash in patients with known S. aureus carriage that are undergoing cardiothoracic or orthopedic surgery 1; patients undergoing other types of surgery with known S. aureus carriage should also be considered for decolonization with the same regimen (1).…”

“…Current World Health Organization (WHO) guidelines for decolonization recommend intranasal mupirocin with or without chlorhexidine body wash in patients with known S. aureus carriage that are undergoing cardiothoracic or orthopedic surgery 1; patients undergoing other types of surgery with known S. aureus carriage should also be considered for decolonization with the same regimen (1). A summary of clinical studies investigating intranasal and topical PVP-I is presented in Table 2 (22,(68)(69)(70)(71)(72)(73)(74)(75).…”