Povidone-Iodine Solution Cuts Surgery Site Infections

A new study suggests that a cheap nasal povidone-iodine solution is at least as equally effective in preventing Staphylococcus aureus surgical site infections as more expensive nasal mupirocin ointment.

The study, by researchers at New York University Langone Medical Center (NY, USA), arose following a survey among surgical patients regarding compliance with the prescribed home prophylaxis treatment following joint or back surgery, aimed at preventing S. aureus infection. The survey revealed that 96% of the patients had been compliant with use of chlorhexidine soap, but only 86% were compliant with the use of mupirocin nasal ointment. A major reason for noncompliance was the cost of the drug, which prompted the researchers to investigate the possibility of using the less expensive povidone-iodine solution.

The researchers therefore conducted an open-label, randomized trial over a 12-month period, involving 742 patients in the mupirocin group and 776 in the povidone-iodine group in an intent-to-treat analysis. The patients in the first arm of the study were given 2% mupirocin nasal ointment and were told to apply it twice daily for 5 days before surgery. In the second arm, research personnel applied a 5% povidone-iodine solution to both nostrils within two hours of surgical incision. In addition, all patients were given antibiotic prophylaxis with cefazolin or clindamycin; but if the nasal culture was positive for methicillin-resistant S. aureus (MRSA), they were treated with vancomycin.

The results of the study showed 13 infections in the mupirocin patients and 5 infections among the povidone-iodine patients. In a per protocol analysis there were five infections among the patients on mupirocin and none in the povidone-iodine group. Significantly more adverse events were observed in the mupirocin patients (76 adverse events compared to 15 in the povidone-iodine group), with more patients reporting headache, rhinorrhea, congestion, pharyngeal pain. The study was presented at Infectious Disease Week (IDW), held during October 2012 in San Diego (CA, USA).

“We observed fewer S. aureus surgical site infections after arthroplasty and spinal fusion surgery in the povidone-iodine arm of this study. There were also fewer adverse events and fewer patients felt the application was 'unpleasant' in the povidone-iodine group,” said lead author and study presenter clinical assistant professor of medicine Michael Phillips, MD. “We think that physicians should consider nasal povidone-iodine as a component of a multifaceted approach to prevent S. aureus surgical site infections after high-risk surgery.”

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New York University Langone Medical Center