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Mitchell B, Curryer C, Holliday E, Rickard CM, Fasugba O. Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: an updated systematic review and meta-analysis. BMJ Open 2021; 11:e046817. [PMID: 34103320 PMCID: PMC8190044 DOI: 10.1136/bmjopen-2020-046817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE A systematic review on meatal cleaning prior to urinary catheterisation and post catheterisation and reduces the risk catheter-associated urinary tract infections (CAUTIs) and bacteriuria was published in 2017, with further studies undertaken since this time. The objective of this paper is to present an updated systematic review on the effectiveness of antiseptic cleaning of the meatal area for the prevention of CAUTIs and bacteriuria in patients who receive a urinary catheter. DESIGN Systematic review. DATA SOURCES Electronic databases Cochrane Library, PubMed, Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Academic Search Complete were searched from 1 January 2016 and 29 February 2020. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) and quasi-experimental studies evaluating the use of antiseptic, antibacterial or non-medicated agents for cleaning the meatal, periurethral or perineal areas before indwelling catheter insertion or intermittent catheterisation or during routine meatal care. DATA EXTRACTION AND SYNTHESIS Data were extracted using the Cochrane Collaboration's data collection form for RCTs and non-RCTs. Data were extracted by one researcher and then checked for accuracy by a second researcher. RESULTS A total of 18 studies were included. Some potential benefit of using antiseptics, compared with non-antiseptics for meatal cleaning to prevent bacteriuria and or CAUTI was identified (OR 0.84, 95% CI 0.69 to 1.02; p=0.071). Antiseptics (chlorhexidine or povidine-iodine) may be of value for meatal cleaning on the incidence of CAUTI, compared with comparator agents (saline, soap or antimicrobial cloths) (OR=0.65, 95% CI 0.42 to 0.99; p=0.047). CONCLUSION There is emerging evidence of the role of some specific antiseptics (chlorhexidine) prior to urinary catheterisation, in reducing CAUTIs, and some potential benefit to the role of antiseptics more generally in reducing bacteriuria. PROSPERO REGISTRATION NUMBER CRD42015023741.
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Affiliation(s)
- Brett Mitchell
- School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia
| | - Cassie Curryer
- School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Herston Infectious Disease Institute, Metro North Hospitals and Health Service, Brisbane, Queensland, Australia
| | - Oyebola Fasugba
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, New South Wales, Australia
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Antibiotic Prophylaxis in Pelvic Floor Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00601-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Does periurethral cleaning with water prior to indwelling urinary catheterization increase the risk of urinary tract infections? A systematic review and meta-analysis. Am J Infect Control 2018; 46:1400-1405. [PMID: 29778430 DOI: 10.1016/j.ajic.2018.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether periurethral cleaning with water before indwelling urinary catheterization increases the risk of urinary tract infections (UTIs) compared with studies using anti-infective agents. METHODS A literature search via MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials through October 2017 and a manual search of references for additional relevant studies. Trials studying clean intermittent catheterization were excluded. Data were extracted independently by 2 reviewers. Disagreements were resolved through discussion. Results of randomized controlled trials were pooled using random effects models. Both individual and pooled risk estimates were reported using risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS From 121 identified articles, 5 studies involving 824 patients were included in the review (822 patients included in meta-analysis). No statistical significance in the incidence of UTIs existed between the water group and antiseptics group (RR, 1.07; 95% CI, 0.77-1.49; P = .89; I2 = 0%). Available data comparing water with povidone-iodine or chlorhexidine gluconate demonstrated no significant difference between the incidence of UTIs (RR, 1.10; 95% CI, 0.66-1.83; P = .79; I2 = 0%; and RR, 1.05; 95% CI, 0.68-1.62; P = .72; I2 = 0%; respectively). CONCLUSIONS Based on current data, water is as safe as other topical antiseptics for periurethral cleansing before indwelling urinary catheter insertion.
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Cao Y, Gong Z, Shan J, Gao Y. Comparison of the preventive effect of urethral cleaning versus disinfection for catheter-associated urinary tract infections in adults: A network meta-analysis. Int J Infect Dis 2018; 76:102-108. [PMID: 30243912 DOI: 10.1016/j.ijid.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are the main cause of infectious complications in patients with indwelling urinary catheters (IDCs). However, the best cleaning methods for the prevention of CAUTIs have not been evaluated clearly in previous studies. METHODS An electronic database search was performed, from inception to December 2017. Randomized controlled trials and quasi-experimental trials using different methods of urethral cleaning versus disinfection to prevent CAUTIs were considered. The study selection and data collection were performed independently by two reviewers. The risk of bias assessment was performed using the Cochrane risk of bias scale. The primary outcome was the incidence rates of CAUTIs. A network meta-analysis was conducted to compare the effect among the different methods of urethral cleaning versus disinfection to prevent CAUTIs. RESULTS Thirty-three studies (6490 patients) with seven different methods of urethral cleaning versus disinfection were eligible for inclusion, and the data were summarized in the network meta-analysis. No evidence of heterogeneity (P>0.05) was observed among the studies. The network meta-analysis showed that there was no difference in the incidence of CAUTIs when comparing the different urethral cleaning methods versus disinfection (P>0.05 for all). However, chlorhexidine ranked first in the results of the Bayesian analysis and is recommended for preventing CAUTIs. CONCLUSIONS Current evidence suggests that there are no significant differences among different urethral cleaning versus disinfection methods with regard to CAUTI incidence rates.
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Affiliation(s)
- Yulong Cao
- Department of Hospital-AcquiredInfectionControl, Peking University People's Hospital, Beijing, China
| | - Zhizhong Gong
- Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Jiao Shan
- Department of Hospital-Acquired Infection Control, Beijing Jishuitan Hospital, Beijing, China
| | - Yan Gao
- Department of Hospital-AcquiredInfectionControl, Peking University People's Hospital, Beijing, China.
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Fasugba O, Koerner J, Mitchell B, Gardner A. Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. J Hosp Infect 2017; 95:233-242. [DOI: 10.1016/j.jhin.2016.10.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
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Mohee AR, Gascoyne-Binzi D, West R, Bhattarai S, Eardley I, Sandoe JAT. Bacteraemia during Transurethral Resection of the Prostate: What Are the Risk Factors and Is It More Common than We Think? PLoS One 2016; 11:e0157864. [PMID: 27391962 PMCID: PMC4938130 DOI: 10.1371/journal.pone.0157864] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/06/2016] [Indexed: 11/18/2022] Open
Abstract
The aim of this work was to investigate the microbial causes, incidence, duration, risk factors and clinical implications of bacteraemia occurring during transurethral resection of the prostate (TURP) surgery to better inform prophylaxis strategies. An ethically approved, prospective, cohort study of patients undergoing TURP was conducted. Clinical information and follow-up details were collected using standardized data collection sheets. Blood was obtained for culture at 6 different time points peri-procedure. Standard of care antibiotic prophylaxis was given prior to surgery. Bacteriuria was assessed in a pre-procedure urine sample. Histopathology from all prostate chips was assessed for inflammation and malignancy. 73 patients were consented and 276 blood samples obtained. No patients developed symptomatic bacteraemia during the procedure, 17 patients developed asymptomatic bacteraemia (23.2%). Enterococcus faecalis and Pseudomonas aeruginosa were the most common organisms cultured. 10 minutes after the start of the TURP, the odds ratio (OR) of developing bacteraemia was 5.38 (CI 0.97-29.87 p = 0.05), and 20 minutes after the start of the procedure, the OR was 6.46 (CI 1.12-37.24, p = 0.03), compared to before the procedure. We also found an association between the development of intra-operative bacteraemia and recent antibiotic use (OR 4.34, CI 1.14-16.62, p = 0.032), the presence of a urinary catheter (OR 4.92, CI 1.13-21.51, p = 0.034) and a malignant histology (OR 4.90, CI 1.30-18.46, p = 0.019). There was no statistical relationship between pre-operative urine culture results and blood culture results. This study shows that asymptomatic bacteraemia is commonly caused by TURP and occurs in spite of antibiotic prophylaxis. Our findings challenge the commonly held view that urine is the primary source of bacteraemia in TURP-associated sepsis and raise the possibility of occult prostatic infection as a cause of bacteraemia. More work will be needed to determine the significance of transient bacteraemia in relation to more serious complications like infective endocarditis and malignancy.
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Affiliation(s)
- Amar Raj Mohee
- Department of Urology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, United Kingdom
| | - Deborah Gascoyne-Binzi
- Department of Microbiology, The Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom
| | - Robert West
- Department of Biostatistics, The University of Leeds, Woodhouse Lane, Leeds, United Kingdom
| | - Selina Bhattarai
- Department of Pathology, The Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom
| | - Ian Eardley
- Department of Urology, The Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom
| | - Jonathan A. T. Sandoe
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom
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Cunha M, Santos E, Andrade A, Jesus R, Aguiar C, Marques F, Enes F, Santos M, Fernandes R, Soares S. [Effectiveness of cleaning or disinfecting the urinary meatus before urinary catheterization: a systematic review]. Rev Esc Enferm USP 2014; 47:1410-6. [PMID: 24626369 DOI: 10.1590/s0080-623420130000600023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/12/2013] [Indexed: 11/22/2022] Open
Abstract
The urinary tract infections associated with catheterization are very common in hospital and home care contexts. Currently there are several recommendations for its prevention, however, when approaching the kind of solute used in the urinary meatus prior to catheterization doubts continue to persist. Thus this study aimed at determining the effectiveness of cleaning the urinary meatus with water or saline comparing to its sterilization through a systematic review and meta-analysis. In order to do so, the principles proposed by the Cochrane Handbook were followed, a critical analysis was conducted by two researchers and the statistical analysis was performed with the use of STATA 11.1. We concluded that the cleaning or disinfection of the urinary canal prior to bladder catheterization is not statistically significant (OR=1.07, CI 95%=0.68-1.68, p=0.779) and that there is some evidence that the use of water/saline reduces rates of UTI (urinary tract infection).
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Affiliation(s)
- Madalena Cunha
- Unidade de Investigação e Desenvolvimento, Escola Superior de Saúde de Viseu, Portugal, Centro de Estudos em Educação, Tecnologias e Saúde, Unidade de Investigação e Desenvolvimento , Escola Superior de Saúde de Viseu , Portugal
| | - Eduardo Santos
- Fundação Aurélio Amaro Diniz, Portugal, Viseu, Enfermeiro, Serviço de Medicina, Fundação Aurélio Amaro Diniz , Viseu , Portugal
| | - Ana Andrade
- Escola Superior de Saúde de Viseu, Viseu, Portugal, Graduanda de Enfermagem, Escola Superior de Saúde de Viseu , Portugal
| | - Rita Jesus
- Escola Superior de Saúde de Viseu, Viseu, Portugal, Graduanda de Enfermagem, Escola Superior de Saúde de Viseu , Portugal
| | - Carlos Aguiar
- Escola Superior de Saúde de Viseu, Viseu, Portugal, Graduando de Enfermagem, Escola Superior de Saúde de Viseu , Portugal
| | - Filipa Marques
- Escola Superior de Saúde de Viseu, Viseu, Portugal, Graduanda de Enfermagem, Escola Superior de Saúde de Viseu , Portugal
| | - Filipa Enes
- Escola Superior de Saúde de Viseu, Viseu, Portugal, Graduanda de Enfermagem, Escola Superior de Saúde de Viseu , Portugal
| | - Mafalda Santos
- Escola Superior de Saúde de Viseu, Viseu, Portugal, Graduanda de Enfermagem, Escola Superior de Saúde de Viseu , Portugal
| | - Raquel Fernandes
- Escola Superior de Saúde de Viseu, Viseu, Portugal, Graduanda de Enfermagem, Escola Superior de Saúde de Viseu , Portugal
| | - Sara Soares
- Escola Superior de Saúde de Viseu, Viseu, Portugal, Graduanda de Enfermagem, Escola Superior de Saúde de Viseu , Portugal
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Alsaywid BS, Smith GHH. Antibiotic prophylaxis for transurethral urological surgeries: Systematic review. Urol Ann 2013; 5:61-74. [PMID: 23798859 PMCID: PMC3685747 DOI: 10.4103/0974-7796.109993] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 07/10/2012] [Indexed: 11/06/2022] Open
Abstract
The use of antibiotic prophylaxis to prevent urinary tract infection and bacteremia (sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of urinary tract infection and bacteremia. The aim of this review is to evaluate the effectiveness of antibiotic prophylaxis in reducing the risk of urinary tract infection in patients who had transurethral urological surgeries. We have selected all RCTs of adult population who underwent all different types of transurethral urological surgery, including cystoscopy, transurethral resection of prostate and transurethral resection of bladder tumor, and received prophylactic antibiotics or placebo/no treatment. At first, more than 3000 references were identified and reviewed; of which 42 studies with a total of 7496 patients were included in the final analysis. All those trials were analyzing antibiotic prophylaxis versus placebo/no treatment, and they were significantly favoring antibiotic use in reducing all outcomes, including bacteriuria (RR 0.36, 95% CI 0.29 to 0.46, P < 0.0001) with moderate heterogeneity detected (I2 48%), symptomatic UTI (RR 0.38, 95% CI 0.28 to 0.51, P < 0.0001) with no significant heterogeneity was detected (I2= 17%), bacteremia (RR 0.43, 95% CI 0.23 to 0.82, P < 0.0001) with no noted heterogeneity (I2 = 0%), and fever ≥38.5 Celsius (RR 0.41, 95% CI 0.23 to 0.73, P = 0.003); also, there was no noted heterogeneity (I2 = 0%). However, using antibiotic prophylaxis did not reduce the incidence of low grade temperature (RR 0.82, 95% CI 0.61 to 1.11, P = 0.20) or in moderate grade temperature (RR 1.03, 95% CI 0.71 to 1.48, P = 0.89). Antibiotic prophylaxis appears to be an effective intervention in preventing urinary tract infections and its sequels following transurethral urological surgeries in patients with preoperative sterile urine.
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Affiliation(s)
- Basim S Alsaywid
- Department of Urology, The Sydney Children's Hospitals Network: Westmead Campus, Sydney, Australia ; Department of Surgery, The Urology Section, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia ; Conjoint Associate Lecturer, University of New South Wales, School of Women's and Children's Health, Sydney, Australia
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El Basri A, Petrolekas A, Cariou G, Doublet JD, Hoznek A, Bruyere F. Clinical Significance of Routine Urinary Bacterial Culture After Transurethral Surgery: Results of a Prospective Multicenter Study. Urology 2012; 79:564-9. [DOI: 10.1016/j.urology.2011.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 11/12/2011] [Accepted: 11/15/2011] [Indexed: 11/15/2022]
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Huang X, Shi HB, Wang XH, Zhang XJ, Chen B, Men XW, Yu ZY. Bacteriuria After Bipolar Transurethral Resection of the Prostate: Risk Factors and Correlation With Leukocyturia. Urology 2011; 77:1183-7. [DOI: 10.1016/j.urology.2010.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 08/10/2010] [Accepted: 08/13/2010] [Indexed: 11/27/2022]
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Ozturk M, Koca O, Kaya C, Karaman MI. A prospective randomized and placebo-controlled study for the evaluation of antibiotic prophylaxis in transurethral resection of the prostate. Urol Int 2007; 79:37-40. [PMID: 17627166 DOI: 10.1159/000102911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 09/26/2006] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the risk of bacteriuria after transurethral resection of the prostate and the preventive effects of different kinds of antibiotics. PATIENTS AND METHODS Urine was collected for culturing 1 week before the operation and on postoperative days 2 and 10. The patients were divided into four groups: group 1 patients were given a first-generation cephalosporin (cefazolin 1 g), group 2 patients received a second-generation cephalosporin (cefuroxime 750 mg), group 3 patients were given a third-generation cephalosporin (ceftazidime 1 g), and group 4 patients received a placebo. RESULTS The 2nd-day postoperative bacteriuria rates were similar in all groups. On the 10th day, the incidence rates of bacteriuria in group 4 and group 1 patients were 40 and 31%, respectively (p = 0.661). In group 2, the bacteriuria incidence rate was 6.6%, and when compared with the placebo group, the difference was considered significant (p = 0.002). The difference between group 3 and group 4 was also significant (p = 0.003). There were statistically significant differences between group 1 and group 2 (p = 0.008) and between group 1 and group 3 (p = 0.01). CONCLUSIONS Our study demonstrated that postoperative bacteriuria incidence rates are high, even in patients who underwent transurethral resection of the prostate with sterile urine, but it can be reduced by using antibiotic prophylaxis with cefuroxime or ceftazidime.
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Affiliation(s)
- Metin Ozturk
- 2nd Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
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de Arruda Almeida K, de Queiroz AAA, Higa OZ, Abraham GA, San Román J. Macroporous poly(ϵ-caprolactone) with antimicrobial activity obtained by iodine polymerization. J Biomed Mater Res A 2003; 68:473-8. [PMID: 14762926 DOI: 10.1002/jbm.a.20085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The most serious problem usually encountered in the field of implanted biomedical devices is infectious morbidity as a primary source of mortality. In this work, the synthesis and characterization of a macroporous iodine-based sanitizer (iodophor), poly(caprolactone)-iodine (PCL-I(2)), are presented. Characterization methods include nuclear magnetic resonance spectroscopy, gel permeation chromatography, nitrogen adsorption-desorption, and scanning electron microscopy. The in vitro cytotoxicity to CHO cells based on cell viability with Chinese hamster ovary cells (CHO) and antimicrobial activities against Escherichia coli and Staphylococcus aureus were examined. The obtained macropore PCL-I(2) structures had a rather narrow size distribution. The PCL-I(2) iodophor was noncytotoxic to Chinese hamster ovary cells. The antimicrobial activities of the PCL-I(2) were assessed against E. coli and S. aureus. The tested PCL-I(2) showed better antimicrobial activity against E. coli than against S. aureus.
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Affiliation(s)
- Kleber de Arruda Almeida
- Departamento de Física e Química/Instituto de Ciências, Universidade Federal de Itajubá (UNIFEI), Av. BPS. 1303, 37500-903, Itajubá, Minas Gerais, Brasil
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