title: Selection of an optimal antiseptic solution for intraoperative irrigation: an in vitro study.
abstract: BACKGROUND
  With increasing bacterial antibiotic resistance and an increased infection risk due to more complicated surgical procedures and patient populations, prevention of surgical infection is of paramount importance. Intraoperative irrigation with an antiseptic solution could provide an effective way to reduce postoperative infection rates. Although numerous studies have been conducted on the bactericidal or cytotoxic characteristics of antiseptics, the combination of these characteristics for intraoperative application has not been addressed.
  
  
  METHODS
  Bacteria (Staphylococcus aureus and S. epidermidis) and human cells were exposed to polyhexanide, hydrogen peroxide, octenidine dihydrochloride, povidone-iodine, and chlorhexidine digluconate at various dilutions for two minutes. Bactericidal properties were calculated by means of the quantitative suspension method. The cytotoxic effect on human fibroblasts and mesenchymal stromal cells was determined by a WST-1 metabolic activity assay.
  
  
  RESULTS
  All of the antiseptics except for polyhexanide were bactericidal and cytotoxic at the commercially available concentrations. When diluted, only povidone-iodine was bactericidal at a concentration at which some cell viability remained. The other antiseptics tested showed no cellular survival at the minimal bactericidal concentration.
  
  
  CONCLUSIONS
  Povidone-iodine diluted to a concentration of 1.3 g/L could be the optimal antiseptic for intraoperative irrigation. This should be established by future clinical studies.
authors.affiliation: Departments of Orthopaedics (S.J.v.M., D.G., H.C.V., and M.C.K.) and Medical Microbiology (K.A.H.), University Medical Center Utrecht, PO Box 85500, NL 3508 GA Utrecht, The Netherlands. E-mail address for M.C. Kruyt: mkruyt@umcutrecht.nl.
authors.forename: S J
authors.initials: SJ
authors.lastname: van Meurs
authors.affiliation: Departments of Orthopaedics (S.J.v.M., D.G., H.C.V., and M.C.K.) and Medical Microbiology (K.A.H.), University Medical Center Utrecht, PO Box 85500, NL 3508 GA Utrecht, The Netherlands. E-mail address for M.C. Kruyt: mkruyt@umcutrecht.nl.
authors.forename: D
authors.initials: D
authors.lastname: Gawlitta
authors.affiliation: Departments of Orthopaedics (S.J.v.M., D.G., H.C.V., and M.C.K.) and Medical Microbiology (K.A.H.), University Medical Center Utrecht, PO Box 85500, NL 3508 GA Utrecht, The Netherlands. E-mail address for M.C. Kruyt: mkruyt@umcutrecht.nl.
authors.forename: K A
authors.initials: KA
authors.lastname: Heemstra
authors.affiliation: Department of Orthopaedics, OLVG Hospital, PO Box 95500, 1090 HM Amsterdam, The Netherlands.
authors.forename: R W
authors.initials: RW
authors.lastname: Poolman
authors.affiliation: Departments of Orthopaedics (S.J.v.M., D.G., H.C.V., and M.C.K.) and Medical Microbiology (K.A.H.), University Medical Center Utrecht, PO Box 85500, NL 3508 GA Utrecht, The Netherlands. E-mail address for M.C. Kruyt: mkruyt@umcutrecht.nl.
authors.forename: H C
authors.initials: HC
authors.lastname: Vogely
authors.affiliation: Departments of Orthopaedics (S.J.v.M., D.G., H.C.V., and M.C.K.) and Medical Microbiology (K.A.H.), University Medical Center Utrecht, PO Box 85500, NL 3508 GA Utrecht, The Netherlands. E-mail address for M.C. Kruyt: mkruyt@umcutrecht.nl.
authors.forename: M C
authors.initials: MC
authors.lastname: Kruyt
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology* / Q000627:therapeutic use; D001645:Biguanides / Q000494:pharmacology / Q000627:therapeutic use; D002470:Cell Survival / Q000187:drug effects; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D005347:Fibroblasts / Q000187:drug effects; D006801:Humans; D006861:Hydrogen Peroxide / Q000494:pharmacology / Q000627:therapeutic use; D007097:Imines; D007430:Intraoperative Care / Q000379:methods*; D059630:Mesenchymal Stem Cells / Q000187:drug effects; D011206:Povidone-Iodine / Q000494:pharmacology / Q000627:therapeutic use; D011725:Pyridines / Q000494:pharmacology / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus; D013212:Staphylococcus epidermidis; D007507:Therapeutic Irrigation / Q000379:methods*
chemical_list: D000891:Anti-Infective Agents, Local; D001645:Biguanides; D007097:Imines; D011725:Pyridines; C031233:polihexanide; D011206:Povidone-Iodine; D006861:Hydrogen Peroxide; C010882:chlorhexidine gluconate; C034213:octenidine; D002710:Chlorhexidine