乳房植入物灌洗液的疗效：使用体外模型的比较分析。
The Efficacy of Breast Implant Irrigant Solutions: A Comparative Analysis Using an In Vitro Model.
机构信息
From the Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine; the Department of Plastic Surgery, The Johns Hopkins Hospital/University of Maryland School of Medicine; the Department of Microbial Pathogenesis, University of Maryland School of Dentistry; the Division of Plastic Surgery, Department of Surgery, Yale University School of Medicine; and the Department of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center.
出版信息
Plast Reconstr Surg. 2020 Aug;146(2):301-308. doi: 10.1097/PRS.0000000000007028.
BACKGROUND
Infections are challenging complications of implant-based breast reconstruction and augmentation. They pose a clinical challenge, with significant economic implications. One proposed solution is implant irrigation at the time of placement. There is no consensus on the optimal irrigant solution.
METHODS
The authors tested the relative efficacy of 10% povidone-iodine, Clorpactin, Prontosan, triple-antibiotic solution, or normal saline (negative control) against two strains each of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. Sterile, smooth silicone implant disks were immersed in irrigant solution, then incubated in suspensions of methicillin-resistant S. aureus or S. epidermidis overnight. The disks were rinsed and sonicated to displace adherent bacteria from the implant surface, and the displaced bacteria were quantified. Normalized values were calculated to characterize the relative efficacy of each irrigant.
RESULTS
Povidone-iodine resulted in reductions of the bacterial load by a factor of 10 to 10 for all strains. Prontosan-treated smooth breast implant disks had a 10-fold reduction in bacterial counts for all but one methicillin-resistant S. aureus strain. In comparison to Prontosan, triple-antibiotic solution demonstrated a trend of greater reduction in methicillin-resistant S. aureus bacterial load and weaker activity against S. epidermidis strains. Clorpactin reduced the recovered colony-forming units for only a single strain of S. epidermidis. Povidone-iodine demonstrated the greatest efficacy against all four strains. However, Clorpactin, triple-antibiotic solution, and Prontosan demonstrated similar efficacies.
CONCLUSIONS
Povidone-iodine was the most efficacious of the irrigants at reducing methicillin-resistant S. aureus and S. epidermidis contamination. Given the recent lifting of the U.S. Food and Drug Administration moratorium, larger clinical studies of povidone-iodine as a breast implant irrigant solution are warranted.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
背景
感染是植入物乳房重建和隆胸的挑战性并发症。它们构成了临床挑战，具有重大的经济影响。一种提出的解决方案是在放置时对植入物进行冲洗。对于最佳的冲洗液解决方案尚未达成共识。
方法
作者测试了 10%聚维酮碘、氯己定、普朗托尼、三联抗生素溶液或生理盐水（阴性对照）对两种耐甲氧西林金黄色葡萄球菌和表皮葡萄球菌菌株的相对疗效。无菌、光滑的硅胶植入物圆盘浸入冲洗液中，然后在耐甲氧西林金黄色葡萄球菌或表皮葡萄球菌的悬浮液中孵育过夜。圆盘被冲洗和超声处理，以从植入物表面置换附着的细菌，并对被置换的细菌进行定量。计算归一化值以表征每种冲洗液的相对疗效。
结果
聚维酮碘使所有菌株的细菌负荷减少了 10 到 10 倍。普朗托尼处理的光滑乳房植入物圆盘对所有耐甲氧西林金黄色葡萄球菌菌株除一株外，细菌计数减少了 10 倍。与普朗托尼相比，三联抗生素溶液对耐甲氧西林金黄色葡萄球菌的细菌负荷显示出更大的减少趋势，对表皮葡萄球菌菌株的活性较弱。氯己定仅减少了单个表皮葡萄球菌菌株的回收菌落形成单位。聚维酮碘对所有四种菌株均显示出最大的疗效。然而，氯己定、三联抗生素溶液和普朗托尼表现出相似的疗效。
结论
聚维酮碘是减少耐甲氧西林金黄色葡萄球菌和表皮葡萄球菌污染最有效的冲洗液。鉴于美国食品和药物管理局最近取消了禁令，有必要对聚维酮碘作为乳房植入物冲洗液进行更大规模的临床研究。
临床问题/证据水平：治疗，V。
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