Addressing the challenges in antisepsis: focus on povidone iodine

• Published in: International journal of antimicrobial agents 2020-09, Vol.56 (3), p.106064-106064, Article 106064
• Main Authors: Barreto, Ruben, Barrois, Brigitte, Lambert, Julien, Malhotra-Kumar, Surbhi, Santos-Fernandes, Victor, Monstrey, Stan
• Format: Article
• Language: English
• Subjects: Anti-Infective Agents, Local - therapeutic use; Bacteria - drug effects; Bacterial Infections - drug therapy; Bacterial Infections - prevention & control; Biguanides - therapeutic use; Biofilms - drug effects; Chlorhexidine - analogs & derivatives; Chlorhexidine - therapeutic use; Chlorhexidine gluconate; Efficacy; Humans; Octenidine; Polyhexanide; Povidone-iodine; Povidone-Iodine - therapeutic use; Pyridines - therapeutic use; Resistance; Wound Healing - drug effects
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2020.106064

•Key challenges in antisepsis include wound healing and skin tolerability•Antimicrobial resistance is also an increasing challenge in antisepsis•Povidone-iodine has the broadest spectrum of activity versus other antiseptics•Povidone-iodine has acceptable tolerability and no reports of resistance•Povidone-iodine promotes wound healing and is effective against bacterial biofilms Objectives: Using antiseptics in wound care can promote healing by preventing and treating infection. However, using antiseptics can present many challenges, including issues with tolerability, inactivation by organic matter and the emergence of antimicrobial resistance/cross-resistance. This review discussed the key challenges in antisepsis, focusing on povidone-iodine (PVP-I) antiseptic. Methods: Literature searches were conducted in PubMed, in January 2019, with a filter for the previous 5 years. Searches were based on the antimicrobial efficacy, antiseptic resistance, wound healing properties, and skin tolerability for the commonly used antiseptics PVP-I, chlorhexidine gluconate (CHG), polyhexanide (PHMB), and octenidine (OCT). Additional papers were identified based on author expertise. Results: When compared with CHG, PHMB and OCT, PVP-I had a broader spectrum of antimicrobial activity against Gram-negative bacteria, actinobacteria, bacterial spores, fungi and viruses, and a similar and broad spectrum of activity against Gram-positive bacteria. PVP-I was also highly effective at eradicating bacterial biofilms, which is a vitally important consideration for wound care and infection control. Despite a long history of extensive use, no resistance or cross-resistance to PVP-I has been recorded, which is in contrast with other antiseptics. Despite previous misconceptions, it has been shown that PVP-I has low allergenic properties, low cytotoxicity and can promote wound healing through increased expression of transforming growth factor beta. Conclusion: With increased understanding of the importance of tackling antimicrobial resistance and bacterial biofilms in acute and chronic wound care, alongside improved understanding of the challenges of antiseptic use, PVP-I remains a promising agent for the management of antisepsis.