Effectiveness of 0.35% Diluted Povidone- Iodine Irrigation on Bacterial Cultures: An In Vitro Study
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Published:
Feb 24, 2025
Keywords:
Periprosthetic infection, McFarland scale, povidone-iodine, gram-negative microorganism
Main Article Content
Abstract
Introduction: Hip and knee arthroplasties are increasingly performed due to their excellent outcomes in pain relief and quality of life improvement. However, they are not free from complications, with periprosthetic infection being one of the most challenging. This study aimed to evaluate the effectiveness of 0.35% diluted povidone-iodine irrigation against various microorganisms as a prophylactic measure against periprosthetic infections.
Materials and Methods: A prospective study was conducted using in vitro irrigation of 0.35% diluted povidone-iodine on bacterial cultures. Gram-positive cocci (Staphylococcus aureus, coagulase-negative Staphylococcus, and Enterococcus faecalis) and gram-negative bacilli (Pseudomonas aeruginosa, Acinetobacter sp., and Klebsiella pneumoniae) were studied to simulate intraoperative contamination. The bacterial inoculum was quantified using the Mc-Farland scale, reflecting concentrations similar to those expected in in vivo periprosthetic infections.
Results: Growth inhibition of Staphylococcus sp. (S. aureus and coagulase-negative Staphylococcus) was observed in the presence of diluted povidone-iodine. However, there was no significant reduction in the colony-forming units of gram-negative bacilli treated with povidone-iodine.
Conclusions: Povidone-iodine diluted to 0.35% significantly inhibits the growth of Staphylococcus sp. However, gram-negative bacilli and Enterococcus sp. (E. faecalis) exhibited substantial colony growth, highlighting the limited efficacy of this dilution against these pathogens in vitro.
Materials and Methods: A prospective study was conducted using in vitro irrigation of 0.35% diluted povidone-iodine on bacterial cultures. Gram-positive cocci (Staphylococcus aureus, coagulase-negative Staphylococcus, and Enterococcus faecalis) and gram-negative bacilli (Pseudomonas aeruginosa, Acinetobacter sp., and Klebsiella pneumoniae) were studied to simulate intraoperative contamination. The bacterial inoculum was quantified using the Mc-Farland scale, reflecting concentrations similar to those expected in in vivo periprosthetic infections.
Results: Growth inhibition of Staphylococcus sp. (S. aureus and coagulase-negative Staphylococcus) was observed in the presence of diluted povidone-iodine. However, there was no significant reduction in the colony-forming units of gram-negative bacilli treated with povidone-iodine.
Conclusions: Povidone-iodine diluted to 0.35% significantly inhibits the growth of Staphylococcus sp. However, gram-negative bacilli and Enterococcus sp. (E. faecalis) exhibited substantial colony growth, highlighting the limited efficacy of this dilution against these pathogens in vitro.
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How to Cite
Vega, C. A., Moruno, F., Sued, M., Vergara, F., Cabrera, S., Gaudenzi, F., Grilli, M. L., Bertolini, P. M., Núñez , E., & Omonte, M. (2025). Effectiveness of 0.35% Diluted Povidone- Iodine Irrigation on Bacterial Cultures: An In Vitro Study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(1), 63-72. https://doi.org/10.15417/issn.1852-7434.2025.90.1.2012
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Basic Research
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10. Ferreira AS, Gomes AM, Ferreira E, Sousa JC. The use of McFarland standards for the adjustment of the
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11. Calkins TE, Culvern C, Nam D, Gerlinger TL, Levine BR, Sporer SM, et al. Dilute betadine lavage reduces the risk of acute postoperative periprosthetic joint infection in aseptic revision total knee and hip arthroplasty: A randomized controlled trial. J Arthroplasty 2020;35(2):538-43. https://doi.org/10.1016/j.arth.2019.09.011
12. Cichos KH, Andrews RM, Wolschendorf F, Narmore W, Mabry, SE, Ghanem ES. Efficacy of intraoperative antiseptic techniques in the prevention of periprosthetic joint infection: superiority of Betadine. J Arthroplasty
2019;34(7 Suppl)):S312- S318. https://doi.org/10.1016/j.arth.2019.02.002
13. Brown NM, Cipriano CA, Moric M, Sporer SM, Della Valle CJ. Dilute betadine lavage before closure for the
prevention of acute postoperative deep periprosthetic joint infection. J Arthroplasty 2012;27(1):27-30. https://doi.org/10.1016/j.arth.2011.03.034
14. Driesman A, Shen M, Feng JE, Waren D, Slover J, Bosco J, et al. Perioperative chlorhexidine gluconate wash during joint arthroplasty has equivalent periprosthetic joint infection rates in comparison to betadine wash. J Arthroplasty 2020;35(3):845-8. https://doi.org/10.1016/j.arth.2019.10.009
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Arthroplasty 2013;28(6):918-21. https://doi.org/10.1016/j.arth.2013.02.018
16. Jiranek WA, Waligora AC, Hess SR, Golladay GL. Surgical treatment of prosthetic joint infections of the hip and
knee: Changing paradigms? J Arthroplasty 2015;30(6):912-8. https://doi.org/10.1016/j.arth.2015.03.014
2. Haddad FS, Sukeik M, Alazzawi S. Is single-stage revision according to a strict protocol effective in treatment of
chronic knee arthroplasty infections? Clin Orthop Relat Res 2015;473(1):8-14. https://doi.org/10.1007/s11999-014-3721-8
3. Siddiqi A, Abdo ZE, Rossman SR, Kelly MA, Piuzzi NS, Higuera CA, et al. What is the optimal irrigation solution
in the management of periprosthetic hip and knee joint infections? J Arthroplasty 2021;36:3570e3583.
https://doi.org/10.1016/j.arth.2021.05.032
4. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Healthcare Infection Control
Practices Advisory Committee. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152(8):784-91. https://doi.org/10.30445/rear.v10i4.224
5. Directrices globales para la prevención de la infección del sitio quirúrgico. Ginebra: Organización Mundial de la
Salud; 2017.
6. Blom A, Cho J, Fleischman A, Goswami K, Ketonis C, Kunutsor SK, et al. General Assembly, Prevention, Antiseptic Irrigation Solution: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty
2019;34(2S):S131-S138. https://doi.org/10.1016/j.arth.2019.02.064
7. Bashyal RK, Mathew M, Bowen E, James GA, Stulberg SD. A novel irrigant to eliminate planktonic bacteria
and eradicate biofilm superstructure with persistent effect during total hip arthroplasty. J Arthroplasty 2022;37:S647eS652. https://doi.org/10.1016/j.arth.2022.01.045
8. Oduwole KO, Glynn AA, Molony DC, Murray D, Rowe S, Holland LM, et al. Anti-biofilm activity of subinhibitory
povidone-iodine concentrations against Staphylococcus epidermidis and Staphylococcus aureus. J Orthop Res 2010;28(9):1252-6. https://doi.org/10.1002/jor.21110
9. Tillet F, Bochatey E, Pérez Alamino L, Lopreite FA. Lavado con povidona yodada diluida en el reemplazo articular de cadera y rodilla para prevenir infecciones: estudio retrospectivo comparativo. Rev Asoc Argent Ortop Traumatol 2022;87(5):619-25. https://doi.org/10.15417/issn.1852-7434.2022.87.5.1530
10. Ferreira AS, Gomes AM, Ferreira E, Sousa JC. The use of McFarland standards for the adjustment of the
antimicrobial susceptibility tests in clinical microbiology laboratories: Ensuring uniformity. J Microbiol Methods
2018;144:48-52.
11. Calkins TE, Culvern C, Nam D, Gerlinger TL, Levine BR, Sporer SM, et al. Dilute betadine lavage reduces the risk of acute postoperative periprosthetic joint infection in aseptic revision total knee and hip arthroplasty: A randomized controlled trial. J Arthroplasty 2020;35(2):538-43. https://doi.org/10.1016/j.arth.2019.09.011
12. Cichos KH, Andrews RM, Wolschendorf F, Narmore W, Mabry, SE, Ghanem ES. Efficacy of intraoperative antiseptic techniques in the prevention of periprosthetic joint infection: superiority of Betadine. J Arthroplasty
2019;34(7 Suppl)):S312- S318. https://doi.org/10.1016/j.arth.2019.02.002
13. Brown NM, Cipriano CA, Moric M, Sporer SM, Della Valle CJ. Dilute betadine lavage before closure for the
prevention of acute postoperative deep periprosthetic joint infection. J Arthroplasty 2012;27(1):27-30. https://doi.org/10.1016/j.arth.2011.03.034
14. Driesman A, Shen M, Feng JE, Waren D, Slover J, Bosco J, et al. Perioperative chlorhexidine gluconate wash during joint arthroplasty has equivalent periprosthetic joint infection rates in comparison to betadine wash. J Arthroplasty 2020;35(3):845-8. https://doi.org/10.1016/j.arth.2019.10.009
15. Von Keudell A, Canseco JA, Gomoll AH. Deleterious effects of diluted povidone-iodine on articular cartilage. J
Arthroplasty 2013;28(6):918-21. https://doi.org/10.1016/j.arth.2013.02.018
16. Jiranek WA, Waligora AC, Hess SR, Golladay GL. Surgical treatment of prosthetic joint infections of the hip and
knee: Changing paradigms? J Arthroplasty 2015;30(6):912-8. https://doi.org/10.1016/j.arth.2015.03.014