Wewalka G, Kurz C, Enzelsberger H
Federal State Institute of Bacteriology and Serology, Vienna, Austria.
Postgrad Med J. 1993;69 Suppl 3:S43-8.
Indications for antiseptic prophylaxis include use prior to urinary catheterization and other transurethral instrumentations, diagnostic or therapeutic instrumentation of the cavum uteri, and operations on the external genitalia and the vagina. Indications for antiseptic therapy include treatment of wounds and of infections of the genital tract and also include treatment of the vaginas of pregnant women to prevent infection in the newborn. For prophylactic antisepsis the aim is the optimal reduction of potentially pathogenic microorganisms. In some fields of application, e.g. before urinary catheterization, an immediate effect on the mucous membrane is required, but on other occasions, such as transvaginal operations, an additional sustained effect is desired. Testing the efficacy of mucous membrane antiseptics, especially for the genital tract, necessitates the establishment of standardized test methods. The variability in vaginal flora at various ages makes it reasonable to study women aged 20-50 years. Studies presented in this paper indicate that microorganism sampling using a cotton swab moistened with neutralizing fluid can be favoured compared to using a rinsing technique and that anaerobic culture techniques enable the measurement of the high reduction factors achieved by very efficient antiseptic procedures. Test methods validated for hand disinfectants are used for calculations and statistical evaluation. The antimicrobial efficacy of six vaginal antiseptic procedures were compared in patients prior to vaginal surgery. Three minutes after treatment, the highest mean reduction (log RF) of the normal vaginal flora as well as of potentially pathogenic microorganisms was obtained by povidone-iodine solution undiluted and povidone-iodine solution 1:10 (log RF 3.60 and 2.68, respectively). Out of three detergents with antimicrobial efficacy, octenidine 0.1% was the most effective preparation (log RF 2.32). Chlorhexidine 0.1%, hexetidine 0.1% and chlorhexidine 0.05% led to lower reduction factors (log RF 1.80, 1.62 and 1.02, respectively). After 30 minutes the log reduction factors were approximating each other in nearly all procedures (log RF 2.79-3.25) except the log RF derived from the procedure performed using chlorhexidine 0.05% (log RF 2.07). Povidone-iodine solutions seem to be the method of choice for mucous membrane antisepsis where an immediate effect is required. If a long period of action is needed all procedures examined, except chlorhexidine 0.05%, are acceptable.
抗菌预防的适应证包括在导尿和其他经尿道器械操作、子宫腔的诊断或治疗性器械操作以及外阴和阴道手术前使用。抗菌治疗的适应证包括伤口和生殖道感染的治疗，还包括治疗孕妇的阴道以预防新生儿感染。对于预防性抗菌，目的是最佳减少潜在致病微生物。在某些应用领域，例如导尿前，需要对黏膜有即时作用，但在其他情况下，如经阴道手术，还需要有额外的持续作用。测试黏膜抗菌剂的疗效，特别是生殖道的抗菌剂疗效，需要建立标准化测试方法。不同年龄段阴道菌群的变异性使得研究20至50岁的女性是合理的。本文所呈现的研究表明，与冲洗技术相比，使用用中和液湿润的棉拭子进行微生物采样可能更受青睐，并且厌氧培养技术能够测量非常有效的抗菌程序所实现的高降低因子。用于手部消毒剂验证的测试方法用于计算和统计评估。在阴道手术前对患者比较了六种阴道抗菌程序的抗菌效果。治疗三分钟后，未稀释的聚维酮碘溶液和1:10的聚维酮碘溶液对正常阴道菌群以及潜在致病微生物的平均降低值最高（对数降低因子分别为3.60和2.68）。在三种具有抗菌效果的洗涤剂中，0.1%的奥替尼啶是最有效的制剂（对数降低因子为2.32）。0.1%的氯己定、0.1%的己西定和0.05%的氯己定导致的降低因子较低（对数降低因子分别为1.80、1.62和1.02）。30分钟后，除了使用0.05%氯己定的程序所得到的对数降低因子（对数降低因子为2.07）外，几乎所有程序的对数降低因子都相互接近（对数降低因子为2.79 - 3.25）。在需要即时作用的黏膜抗菌方面，聚维酮碘溶液似乎是首选方法。如果需要长时间作用，除了0.05%氯己定外，所有检查的程序都是可以接受的。
