Use of elemental iodine for shunt infection prophylaxis

SooHo Choi, J. Gordon McComb, Michael L. Levy, Ignacio Gonzalez-Gomez, Roger Bayston, Richard G. Ellenbogen, Alan Cohen, Robin P. Humphreys, A. Leland Albright

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Elemental iodine (I2) can kill a broad spectrum of organisms, including bacteria, fungi, and viruses. Furthermore, it is inexpensive, bacterial resistance is unknown, and allergic reactions are rare. Because of these properties, we wanted to determine the concentration of I2 that would kill Staphylococcus epidermidis and Staphylococcus aureus without causing injury to the central nervous system, in an attempt to further reduce the rates of shunt infections. METHODS: Bacterial kill studies using S. epidermidis and S. aureus were performed by using Ringer's lactate solution alone or solution containing I2 at a concentration of 5, 10, 20, 50, 100, or 1000 parts per million (ppm), cefazolin at 1 mg/ml, or bacitracin at 100 units/ml. Twenty-one adult male Wistar rats, in seven groups, underwent a frontoparietal craniectomy. The surfaces of their brains were irrigated for 1 hour with Ringer's lactate solution alone or solution containing I2 (at the concentrations noted above). After 72 hours of observation, the animals were killed. Their brains were then fixed in formalin, stained with hematoxylin/eosin, and examined. RESULTS: Even with exposure of only 15 seconds to an I2 solution of 20 ppm, no growth was detected with an inoculum of either bacteria of 100 million. In contrast, the two antibiotics were not nearly as effective as I2, with kill rates ranging from 19 to 93%. Examination of the rat brains demonstrated no histological changes after subarachnoid exposure to solutions containing 5, 10, 20, or 50 ppm; however, necrosis was observed with concentrations of 100 and 1000 ppm. CONCLUSION: I2 can be added to irrigation solutions in sufficient concentrations to be bactericidal without causing any central nervous system injury.

Original languageEnglish (US)
Pages (from-to)908-913
Number of pages6
JournalNeurosurgery
Volume52
Issue number4
StatePublished - Apr 1 2003
Externally publishedYes

Fingerprint

Iodine
Infection
Staphylococcus epidermidis
Staphylococcus aureus
Brain
Central Nervous System
Bacitracin
Bacteria
Nervous System Trauma
Cefazolin
Hematoxylin
Eosine Yellowish-(YS)
Formaldehyde
Wistar Rats
Hypersensitivity
Fungi
Necrosis
Observation
Anti-Bacterial Agents
Viruses

Keywords

  • Infection prophylaxis
  • Iodine
  • Irrigation solution
  • Shunt infection

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Choi, S., McComb, J. G., Levy, M. L., Gonzalez-Gomez, I., Bayston, R., Ellenbogen, R. G., ... Albright, A. L. (2003). Use of elemental iodine for shunt infection prophylaxis. Neurosurgery, 52(4), 908-913.

Use of elemental iodine for shunt infection prophylaxis. / Choi, SooHo; McComb, J. Gordon; Levy, Michael L.; Gonzalez-Gomez, Ignacio; Bayston, Roger; Ellenbogen, Richard G.; Cohen, Alan; Humphreys, Robin P.; Albright, A. Leland.

In: Neurosurgery, Vol. 52, No. 4, 01.04.2003, p. 908-913.

Research output: Contribution to journalArticle

Choi, S, McComb, JG, Levy, ML, Gonzalez-Gomez, I, Bayston, R, Ellenbogen, RG, Cohen, A, Humphreys, RP & Albright, AL 2003, 'Use of elemental iodine for shunt infection prophylaxis', Neurosurgery, vol. 52, no. 4, pp. 908-913.
Choi S, McComb JG, Levy ML, Gonzalez-Gomez I, Bayston R, Ellenbogen RG et al. Use of elemental iodine for shunt infection prophylaxis. Neurosurgery. 2003 Apr 1;52(4):908-913.
Choi, SooHo ; McComb, J. Gordon ; Levy, Michael L. ; Gonzalez-Gomez, Ignacio ; Bayston, Roger ; Ellenbogen, Richard G. ; Cohen, Alan ; Humphreys, Robin P. ; Albright, A. Leland. / Use of elemental iodine for shunt infection prophylaxis. In: Neurosurgery. 2003 ; Vol. 52, No. 4. pp. 908-913.
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abstract = "OBJECTIVE: Elemental iodine (I2) can kill a broad spectrum of organisms, including bacteria, fungi, and viruses. Furthermore, it is inexpensive, bacterial resistance is unknown, and allergic reactions are rare. Because of these properties, we wanted to determine the concentration of I2 that would kill Staphylococcus epidermidis and Staphylococcus aureus without causing injury to the central nervous system, in an attempt to further reduce the rates of shunt infections. METHODS: Bacterial kill studies using S. epidermidis and S. aureus were performed by using Ringer's lactate solution alone or solution containing I2 at a concentration of 5, 10, 20, 50, 100, or 1000 parts per million (ppm), cefazolin at 1 mg/ml, or bacitracin at 100 units/ml. Twenty-one adult male Wistar rats, in seven groups, underwent a frontoparietal craniectomy. The surfaces of their brains were irrigated for 1 hour with Ringer's lactate solution alone or solution containing I2 (at the concentrations noted above). After 72 hours of observation, the animals were killed. Their brains were then fixed in formalin, stained with hematoxylin/eosin, and examined. RESULTS: Even with exposure of only 15 seconds to an I2 solution of 20 ppm, no growth was detected with an inoculum of either bacteria of 100 million. In contrast, the two antibiotics were not nearly as effective as I2, with kill rates ranging from 19 to 93{\%}. Examination of the rat brains demonstrated no histological changes after subarachnoid exposure to solutions containing 5, 10, 20, or 50 ppm; however, necrosis was observed with concentrations of 100 and 1000 ppm. CONCLUSION: I2 can be added to irrigation solutions in sufficient concentrations to be bactericidal without causing any central nervous system injury.",
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AU - Levy, Michael L.

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AU - Bayston, Roger

AU - Ellenbogen, Richard G.

AU - Cohen, Alan

AU - Humphreys, Robin P.

AU - Albright, A. Leland

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N2 - OBJECTIVE: Elemental iodine (I2) can kill a broad spectrum of organisms, including bacteria, fungi, and viruses. Furthermore, it is inexpensive, bacterial resistance is unknown, and allergic reactions are rare. Because of these properties, we wanted to determine the concentration of I2 that would kill Staphylococcus epidermidis and Staphylococcus aureus without causing injury to the central nervous system, in an attempt to further reduce the rates of shunt infections. METHODS: Bacterial kill studies using S. epidermidis and S. aureus were performed by using Ringer's lactate solution alone or solution containing I2 at a concentration of 5, 10, 20, 50, 100, or 1000 parts per million (ppm), cefazolin at 1 mg/ml, or bacitracin at 100 units/ml. Twenty-one adult male Wistar rats, in seven groups, underwent a frontoparietal craniectomy. The surfaces of their brains were irrigated for 1 hour with Ringer's lactate solution alone or solution containing I2 (at the concentrations noted above). After 72 hours of observation, the animals were killed. Their brains were then fixed in formalin, stained with hematoxylin/eosin, and examined. RESULTS: Even with exposure of only 15 seconds to an I2 solution of 20 ppm, no growth was detected with an inoculum of either bacteria of 100 million. In contrast, the two antibiotics were not nearly as effective as I2, with kill rates ranging from 19 to 93%. Examination of the rat brains demonstrated no histological changes after subarachnoid exposure to solutions containing 5, 10, 20, or 50 ppm; however, necrosis was observed with concentrations of 100 and 1000 ppm. CONCLUSION: I2 can be added to irrigation solutions in sufficient concentrations to be bactericidal without causing any central nervous system injury.

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